• Joint pain
• Little to no movement of the joint
• Red bump on top of foot due to shoe pressure

Many people suffer from arthritis in the toe joints. The condition is called Osteoarthritis or Degenerative Joint Disease. It is a condition where the cartilage wears away. Once the cartilage wears away there is bone on bone contact with decreased movement in the joint. The bone on bone contact is what causes the pain and swelling. Simple activities such as walking, running or golf can be painful. The most common joint affected is the first toe joint.

The most common causes for damaged cartilage are trauma, gout, rheumatoid arthritis, or bunions. Although one of the main treatment options is to fuse the joint.  Most often the patient is weight bearing in a surgical boot for 6 weeks, and there is a risk of a nonunion to the joint.

Another treatment is implantation of an artificial partial joint.  The titanium hemi-implant replaces part of the cartilage so there is no more bone on bone contact. The patient is weightbearing and most often can get back into a regular shoe in 2 weeks.

• Bony bump near the joint at the base of big toe
• Joint redness
• Joint pain
• Skin irritation over the bump

A bunion is an enlargement of the joint in the first toe, which causes the bones in the joint to become misaligned. Genetics and improper footwear are both factors in the development of bunions. Once this condition starts, it tends to worsen over time. If left untreated, the big toe will begin to point inward and a bulge will develop on the side of the foot, resulting in pain and disfiguration.

Bunions can also lead to calluses, ingrown toenails, hammertoes and improper walking biomechanics. You do not have to suffer the pain and embarrassment of unsightly bunions. Even simple treatments, such as special shoes, custom orthotics (arch supports) and padding may help relieve the discomfort of bunions.

If surgery is necessary, an x-ray and exam can determine if you are a candidate for a state-of-the-art procedure. If you are a candidate, Dr. Beth Klawitter can reduce the bunion with small incisions. There is no unsightly, long scar that may occur from traditional foot surgery. We are among the few doctors that perform this innovative procedure which minimizes discomfort and recovery time. Many patients are back at work in only a few days and most insurance plans cover the procedure. Minimally invasive foot surgeries can be done on a multitude of conditions such as hammertoes, bunions, bone spurs, tailored bunions just to name a few.

Fungus is a common mold that thrives in warm, dark, damp environments. It is most commonly found on the bottom of the feet and between the toes. The appearance can present as dry, red, cracked feet with fluid filled blisters. Between the toes can be white in appearance due to excess moisture. It is contageous and is often found near pools and public showers. It is important to treat the fungas as it can develop into a serious secondary infection.

Fungal nails are often the result of athlete’s foot, nail polish, decrease in your immune system or trauma to the area. The nails are thick and discolored in appearance. As the nails thicken, they can become ingrown and painful. Fungal nails can be the result of any nail polish.

Ingrown nails are most commonly found on the first toes. It is usually the result of the nail growing into the skin. The most common causes are: improper trimming, injuries, fungal infections or the shape due to inherited factors. It is important to seek treatment if the nail becomes painful, red, swollen, odor, and drainage. There could be an underlying infection that may need antibiotics. If the infection is not treated and gets into the bone it could lead to amputation.

If the ingrown nail becomes chronic, a simple in office procedure is done to relieve your symptoms. A local anesthetic is used and a chemical is applied to prevent the nail edge from regrowing.

• Breaks in the skin
• Bacterial or fungal infection from excessively moist skin
• Drainage
• Redness

Cracks and fissures are breaks in your skin that can occur when it is too moist or too dry. Dry skin may become rough and flaky. Bacterial or fungal infections can occur in overly moist skin causing cracks between the toes. The base of the heel is a common area for cracks and large fissures to form.

Achieving the right balance of moisture in your feet is important. Walking barefoot, or wearing sandals or open-toe shoes, can strip your feet of the natural layer of oil that protects your feet from dry skin. Deep cracks and fissures may not heal on their own, leaving your feet open to bacterial and/or fungal infection.

Treatment for excesively moist skin may include applying drying agents, antifungal lotion or oral medication. Dry skin may be treated by using lotion (not between toes) or a pumice stone to remove rough patches.

• Pain when walking
• Awkwardness when walking
• Fatigue, pain, or stiffness in the ankles, knees, hips and lower back

The supportive arch of your foot may begin to collapse from loss of strength causing your foot to flatten. Some people are born with flat feet while others develop the condition as a result of arthritis, trauma, or musculo-skeletal disorders.

Overuse or repeated pounding on hard surfaces can also weaken the foot’s arch. Discomfort caused from flat feet may not appear for years. Walking may become awkward, difficult or painful as feet and calves receive increasing strain. Excess strain from flat feet may cause other problems such as:

• Itching
• Inflamed areas between the toes
• Moist reddened scales or blisters

Fungus grows in dark, warm, moist areas such as the toenails, the bottom of the feet and between the toes. Most common fungal problems include athlete’s foot and fungal nails. Socks, shoes, heat and humidity affect fungal foot problems. Serious secondary bacterial infections may result from untreated fungal infections.

Athlete’s foot may be spread in public places where shoes are not worn, such as swimming pools and public showers. Treatments vary based on the type of fungal infection. Over-the-counter and prescription medications often help treat the problem.

Fungal nails may result from spreading fungal infections, use of artificial nails, nail polish or injury to the nail. The nail may become thick and discolored, causing inflamation and sensitivity. Fungal nails are more resistant to treatment than athlete’s foot. In some cases, trimming, filing or grinding away the diseased part of the nail may be needed.

To help prevent fungal infections, alternate shoes, dry your feet carefully, change socks daily and wear sandals in public showers, pools etc.

• Fluid-filled swelling of a joint or tendon
• Tingling
• Numbness
• May have pain in the joint area

A ganglion is a sack of jelly-like fluid, sometimes called a cyst. They most commonly occur on the wrist, but may occur on the ankle or top of the foot. Wearing improperly fitting shoes can put stress on the foot and lead to ganglions. Bone spurs, repeated injury, inadequate warm-up prior to physical activity and poor muscle conditioning are also potential causes of ganglions. They are typically pea sized, but may become as large as a golf ball.

Ganglions may be mistaken for tumors, therefore a medical diagnosis is important. In addition to a physical examination, a podiatrist may use x-ray, fluid analysis, or an MRI to diagnose and determine the proper treatment for a ganglion.

Sometimes ganglions can reoccur. Surgery is typically necessary to remove a painful ganglion.

• Intense pain in one or more joints
• Redness, swelling and warmth over the joint
• Pain in the middle of the night
• Pain upon rising in the morning

Gout –or gouty arthritis- is a painful condition caused by excessive uric acid, which crystallizes and collects in the joints. Symptoms tend to suddenly appear at night and last for about 10 days. If you are awakened by pain in the first toe and the joint is swollen, tender and red, you might have gout. Gout may also appear in other parts of the feet, ankles, knees, hands and wrists.

High blood-pressure medication, consumption of excessive alcohol and the following foods have been associated with gout:

• Foot pain
• Callus or corn formation on the sole of the foot
• Corn formation on the top of the affected toe

Hammer toes may be present from birth, but more often are acquired by wearing improperly fitting footwear. In children, the condition can occur from wearing shoes they have outgrown. The condition may occur in all but the first toe and is caused by ligaments and tendons that tighten, causing the toes joints to curl downward. The toes will appear bent or curled under. In time, pain will develop and it becomes difficult to maneuver the foot.

Your podiatrist can treat hammer toes. In mild cases, a shoe change may correct the problem or prevent the condition from worsening. Sometimes the toes are straightened for a period of time using a splint. In more severe cases; surgery may be required. In most cases, the hammer toes can be corrected using minimally invasive surgery. There are no unsightly scars on the top of the toes. Many patients are back to work in a few days.

• Pain & stiffness in heel with first step in the morning
• Pain may improve, but usually returns

Heel pain is one of the most common but painful problems seen in a podiatrist’s office. It is usually due to excessive pulling on a major supportive ligament in the heel called the plantar fascia.

The symptoms are most often described as pain and stiffness in the heel with the first step in the morning. The pain may improve after a few minutes but usually returns as the day progresses or after sitting for an extended period of time. The condition is known as plantar fasciitis, but is also referred to as heel spur syndrome, stone bruise or heel bruise.

As we age, the plantar fascia can loose its elasticity. It can start to pull at the heel and cause inflammation around the nerve and bursa (a fluid filled sac). The pain comes from the irritable nerve and bursa by the Plantar Fascia strain. Over time a heel spur may develop due to constant tugging of the Plantar Fascia on the heel bone.

When non-surgical therapies do not provide satisfactory relief from pain, surgery is most often recommended. The latest surgical technique to relieve chronic heel pain is the In-Step Plantar Fasciotomy and has many advantages:

• Early return to normal activities.
• Decreased postoperative pain. (Most patients have only modest discomfort for the first few days following surgery.)
• Done in outpatient surgery
• Small incision

See the video of this procedure >

• Numbness, burning and tingling
• Symptoms aggravated by walking in shoes
• Pain is not relieved by rest

A neuroma is an agitation of the nerve, most commonly between the second and third or third and forth toes. This condition is usually caused by improperly fitting shoes that squeeze the toes together, thus pinching the nerve between the bones. If a neuroma is present, it may feel like stepping on a cord or as if your sock is bunched-up. Other symptoms include burning, tingling, cramping or numbness. The pain may radiate from the tips of your toes, through your ankle, into your thigh and into your lower back (sciatic pain).

Through an examination, your podiatrist can determine if symptoms are a neuroma or some other foot problem. Treatment for neuromas may include shoe changes, custom orthotics (arch supports), ultrasound therapy, medication or surgery.

What to do?
Once symptoms are recognized, proper medical care should be obtained as soon as possible to minimize the likelihood of permanent nerve damage.

Surgery
If conservative care does not help, surgery may be necessary.

See the video of this procedure >

• Sensory nerves are damaged
• Numbness
• Burning or pins & needles sensation

Peripheral Neuropathy is a disease of the nerves in your feet. It triggers sensations such as numbness, burning or pins and needles in your feet. It may cause an inability to sense pain. This condition is most common in diabetics, but may also occur spontaineously or with back injuries. Sometimes the pain can be caused from Tarsal Tunnel Syndrome. Read more about it in the Tarsal Tunnel Syndrome below.

Signals are transmitted from your feet to your brain, which are interpreted as sensations. Lack of pain sensation may cause signal interruption or confusing information being sent to the brain. As more of the nerve is damaged and slowly moves upward from the toes, it may be difficult to determine when you have fractured a bone or otherwise injured yourself.

The doctor may check your reflexes and how well you sense pressure, vibration and temperature. It is important to check your feet daily for wounds you may not have noticed. Proper shoes and socks should always be worn outside and indoors.

• Leg cramps while walking or climbing stairs
• Pain is not relieved by rest
• Numbness, burning or weakness in the legs
• Loss of hair on legs

With Peripheral Vascular Disease, the blood vessels that carry blood to your lower body may become damaged from built up plaque along the vessel’s inner walls. Blood flow to the lower leg becomes narrowed or blocked.

A pain cycle called intermittent claudication includes cramping during walking or climbing stairs, while the pain subsides during rest periods. This is a sign of peripheral vascular disease or clogging of blood vessels.

As the disease progresses, plaque continues to build up. This will block the blood from delivering oxygen to muscle tissue, causing cramping. Tissue begins to die when blocked vessels do not allow oxygen-rich blood to flow. Nightime muscle cramps and pains are common during this stage. Serious complications ingluding gangrene may result if peripheral vascular disease is left untreated.

A doctor may use sound waves to produce images of your blood vessels. Dye is injected into your blood vessels during an arteriogram to view your blood vessels in x-rays.

Peripheral Vascular Disease may be managed by:

• Redness of the skin
• Blistering
• Open wound that drains fluids

Stress caused by excess body weight and the impact of the foot striking the ground may result in pressure ulcers. They are most common in diabetics and may occur on the ball of the foot, big toe or heel. Infection from the sore may enter the blood stream or bone putting you at risk for a more serious infection.

A callus forms from friction against the bottom of the foot. Thickening of the skin, caused by the callus, kills healthy tissue and causes pain. Peripheral neuropathy limits the feeling in the foot and may prevent you from noticing the pain from the callus. Ulcers form where healthy skin dies and may quickly change from a ‘hot’ spot into an infected wound.

Pressure or friction causes red hot spots on the skin. These spots can develop into a blister if pressure is not relieved and may result in an open wound or corn. Ulcers can be formed when corns and calluses press on the inner layers of skin and fat. Infections may enter through these ulcers. Infected ulcers may kill healthy tissue and begin to drain white, yellow or greenish discharge. They may also bleed or have an unusual odor.

Physicians may prescribe medications for infected hot spots, small cracks or sores. Removing thickened skin and applying medication may be necessary for healing the wound. Custom orthotics (arch supports) take pressure off hot spots and ulcers. In some cases, surgery may be necessary.

• Similar to Carpel Tunnel Syndrome
• Occasionally misdiagnosed as Plantar Fasciitis
• Pain at night
• Tingling, burning sensation in the ankle, heel, arch, toes and even into the calf

Tarsal Tunnel Syndrome is very similar to Carpel Tunnel Syndrome. Many people who suffer from Carpel Tunnel Syndrome may also suffer from Tarsal Tunnel Syndrome.

Tarsal Tunnel occurs on the inside of the ankle just behind the bone. The Posterior Tibial Nerve runs behind the ankle bone, through the Tarsal Tunnel and dives into the arch. It is similar to Carpel Tunnel Syndrome in the wrist and arises from compression of the nerve.

Some of the symptoms associated with Tarsal Tunnel Syndrome are burning and tingling sensations in the heel, ankle, arch, toes and even up into the calf. The pain is not usually relieved with rest and may be painful at night. It is occasionally misdiagnosed as Plantar Fasciitis. Read more about it in the Peripheral Neuropathy section above.

There are many possible causes of the nerve impingement, such as: ganglions, fat, varicose veins, trauma, bone spurs, muscle impingement, or foot deformities.

Diagnosing the syndrome is usually done with a thorough foot exam. The podiatrist will tap on the nerve as it passes through the tarsal tunnel creating an electrical shock or tingling in the area and recreating the symptoms. Nerve conduction studies may be ordered to detect how well a pulse of electricity conducts through the nerve.

There are many different treatment modalities for Tarsal Tunnel Syndrome, such as: rest, ice, oral medications, immobilization,physical therapy, injections, arch supports, shoes, braces, and possibly surgery. Your podiatrist will evaluate you and determine the best method of treatment for this syndrome. It is very important to seek early treatment as the condition may progress and result in permanent damage.

If surgery is necessary, it is performed through a small incision just under and behind the inside of the ankle. The incision measures approximately 1 inch. There is very little down time with this procedure and most often you are back into your own shoes in a few days.

See the video of this procedure >

• Pain at the instep of the foot
• Burning, tingling, shooting or stabbing pain
• Instep may appear inflamed
• Instep may have pronounced flat foot deformity

Tendonitis develops from overuse of a set of muscles. Strain causes swelling or small fibers in a tendon to pull apart. Continual exertion of your muscles may cause pain and swelling, limiting your activities.

At first, tendons in the foot may hurt only during or after rigorous activity. Continued irritation may cause pain when you walk or even when standing still. The various types of tendonitis include:

• Achilles tendonitis – may cause pain when you step down or when your heel lifts off the ground. This tendon connects the heel bone to the calf muscle.
• Posterior tibial tendonitis – may cause pain when stepping forward to push off or when your heel shifts from side to side. This tendon runs along the inside of the ankle and foot.
• Anterior tibial tendonitis – may cause pain when going down stairs or walking or running on hills. This form of tendonitis is commonly known as shin splints. This tendon starts at the front of the shin and connects to the big toe.
• Peroneal tendonitis – may cause pain when standing or pushing off the ground. The peroneal tendon wraps across the bottom of your foot from the outside to the inside.

A tight Achilles tendon (the medical condition is named Equinus)  is a very common condition we see regularly in the office.  A tight Achilles tendon isn’t usually the primary  complaint of a patient that comes into our office, but it is often the cause of other foot problems that bring patients into our office for treatment.  A tight Achilles tendon can cause various conditions such as flat feet, bunions, hammertoes, neuromas, heel spurs, and calluses.  It doesn’t often cause pain in the tendon itself (other than sometimes calf cramping) unless the condition is so severe that it causes damage to the tendon itself.

Tight Achilles tendon can be easily diagnosed with simple range of motion tests.  Sometimes x-rays and/or MRI exams can be helpful to determine the cause of the tightness or to see the extent of damage to the tendon itself.

Primary treatment is usually shoe and activity modifications, shoe inserts, a night splint, or stretching (either at home exercises or physical therapy).

In cases that do not respond to conservative therapy sometimes surgery may be indicated.  With advancements in recent medical technology the procedure can usually be performed through arthroscopy (a minimally invasive technique that uses a camera through tiny incisions).  It is done on an outpatient basis and the patient can usually walk on the surgical foot the same day in a protective walking boot (no crutches!).

• Small black dot in center of wart
• Sensation of lump under the foot
• Firm warty lesions with tiny pinpoint dark spots
• Smooth surface with gray-yellow or brown color

A wart is a viral infection which can spread through cuts or open sores in the skin. At first, warts appear as spongy with tiny red, brown or black spots and develop into a hard growth on the skins surface. Many people think that the dark spots in the warts are seeds when in fact they are small blood vessels that feed the wart.

Warts may be mistaken for corns or calluses. They can grow up to one inch or more in diameter. Left untreated, they can spread to other parts of the body.

Treatments include:

• Freezing
• Burning
• Medication
• Canthrone
• Curettage (use of a small, spoon-shaped instrument to remove the wart)
• Laser Removal
• Drying agents (decreased moisture)
• Alternating shoes

Over-the-counter medications may result in damaged skin and may be dangerous if you have diabetes or poor circulation. A podiatrist can help you determine which treatment option is best for you.

Avoid going barefoot in public showers, gyms and locker rooms. Moist settings are ideal for spreading the wart virus.