Common Conditions
Achilles Tendonitis
Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation is typically short-lived. Over time, if not resolved, the condition may progress to a degeneration of the tendon (Achilles tendinosis), in which the tendon loses its organized structure and is likely to develop microscopic tears. Sometimes the degeneration involves the site where the Achilles tendon attaches to the heel bone. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.
Symptoms
- Pain—aching, stiffness, soreness, or tenderness—within the tendon. This may occur anywhere along the tendon’s path, beginning with the tendon’s attachment directly above the heel upward to the region just below the calf muscle. Pain often appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity.
- Tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on the back of the tendon.
- When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.
Causes
As “overuse” disorders, Achilles tendonitis and tendinosis are usually caused by a sudden increase in repetitive activity involving the Achilles tendon. Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain.
Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis and tendinosis are also common in individuals whose work puts stress on their ankles and feet, such as laborers, as well as in “weekend warriors”—those who are less conditioned and participate in athletics only on weekends or infrequently.
In addition, people with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendinosis due to the greater demands placed on the tendon when walking. If these individuals wear shoes without adequate stability, their overpronation could further aggravate the Achilles tendon.
Treatment
Treatment approaches for Achilles tendonitis or tendinosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon. In the early stage, when there is sudden (acute) inflammation, one or more of the following options may be recommended:
- Immobilization. Immobilization may involve the use of a cast or removable walking boot to reduce forces through the Achilles tendon and promote healing.
- Ice. To reduce swelling due to inflammation, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation in the early stage of the condition.
- Orthotics. For those with overpronation or gait abnormalities, custom orthotic devices may be prescribed.
- Night splints. Night splints help to maintain a stretch in the Achilles tendon during sleep.
- Physical therapy. Physical therapy may include strengthening exercises, soft-tissue massage/mobilization, gait and running re-education, stretching, and ultrasound therapy.
Ankle Pain
Any type of pain or discomfort that affects the ankle’s various parts is referred to as ankle pain. With at-home remedies like rest, ice, and over-the-counter painkillers, ankle pain typically gets better. You can strengthen your muscles and avoid more injuries with the use of a physical therapy program. More severe discomfort is treated by medical professionals using injections, surgery, splits, and braces.
Ankle Sprain
An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue, similar to rubber bands, that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.
Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.
Symptoms
- Pain or soreness
- Swelling
- Bruising
- Difficulty walking
- Stiffness in the joint
Ankle fractures are common injuries most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.
Causes
Sometimes ankle sprains occur because a person is born with weak ankles. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.
Treatment
There are four key reasons why an ankle sprain should be promptly evaluated and treated by a foot and ankle surgeon:
- An untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a giving way of the ankle. Weakness in the leg may also develop.
- A more severe ankle injury may have occurred along with the sprain. This might include a serious bone fracture that, if left untreated, could lead to troubling complications.
- An ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far.
- Rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.
When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins. Your foot and ankle surgeon may recommend one or more of the following treatment options:
- Rest. Stay off the injured ankle. Walking may cause further injury.
- Ice. Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Compression. An elastic wrap may be recommended to control swelling.
- Elevation. The ankle should be raised slightly above the level of your heart to reduce swelling.
- Early physical therapy. Your doctor will start you on a rehabilitation program as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.
In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. The foot and ankle surgeon will select the surgical procedure best suited for your case based on the type and severity of your injury as well as your activity level.
After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see your foot and ankle surgeon during this period to ensure that your ankle heals properly and your function is restored.
Arthritis
Stiffness of the big toe joint is termed Hallux Limitus. Hallux is the medical term for the big toe. When the big toe possesses no motion, it is termed Hallux Rigidus. To confuse the topic, the big toe joint may appear to have normal motion, but this motion can be limited when weight is on the foot and during normal standing and walking. This is termed functional Hallux Limitus because it occurs during the normal functioning of the foot while walking. As with many conditions that affect the foot, functional conditions progress to structural deformities. As the condition progresses, a degenerative type of arthritis develops in the big toe joint.
Treatment
Initial treatment consists of using oral anti-inflammatory medications, cortisone injections, and/or functional orthotics. Oral medications and cortisone injections are useful in treating the pain associated with the condition, but will not stop the process because they do not address the underlying cause of the condition. Functional orthotics, however, are designed to treat the cause of the condition. These devices will generally fit into normal shoes and correct the underlying functional problem with the joint. Orthotics will not reverse what damage may have occurred but can slow or halt the ongoing damage to the joint.
If the condition progresses to the point of spurring around the joint, surgery may be indicated. Depending upon the degree of degeneration of the joint, surgery may consist of simply removing the bone spurs around the joint, a decompression osteotomy, or may require a total joint replacement or joint fusion. Following surgery, the use of a functional orthotic is useful to improve joint function.
If a painful callus exists on the bottom of the big toe it will frequently resolve and the pain subsides with the use of functional orthotics and/or surgery to improve the motion of the joint.
Bunions
One of the more common conditions treated by podiatric surgeons is the painful bunion. Patients with this condition will usually complain of pain when wearing certain shoes, especially snug-fitting dress shoes, or with physical activity, such as walking or running. Bunions are most commonly treated by conservative means. This may involve shoe gear modification, padding, and orthoses. When this fails to provide adequate relief, surgery is often recommended. Selection of the most appropriate surgical procedure for each patient requires knowledge of the level of deformity, a review of the x-rays, and an open discussion of the goals of the procedure.
Symptoms
The most common symptoms associated with this condition are pain on the side of the foot. Shoes will typically aggravate bunions. Stiff leather shoes or shoes with a tapered toe box are the prime offenders. This is why bunion pain is most common in women whose shoes have a pointed toe box. The bunion site will often be slightly swollen and red from the constant rubbing and irritation of a shoe. Occasionally, corns can develop between the 1st and 2nd toes from the pressure of the toes rubbing against each other. On rare occasions, the joint itself can be acutely inflamed from the development of a sack of fluid over the bunion called a bursa. This is designed to protect and cushion the bone. However, it can become acutely inflamed, a condition referred to as bursitis.
Causes
The classic bunion, medically known as hallux abductovalgus or HAV, is a bump on the side of the great toe joint. This bump represents an actual deviation of the 1st metatarsal and often an overgrowth of bone on the metatarsal head. In addition, there is also a deviation of the great toe toward the second toe. In severe cases, the great toe can either lie above or below the second toe. Shoes are often blamed for creating these problems. This, however, is inaccurate. It has been noted that primitive tribes where going barefoot is the norm will also develop bunions. Bunions develop from abnormal foot structure and mechanics (e.g. excessive pronation), which place an undue load on the 1st metatarsal. This leads to stretching of supporting soft tissue structures such as joint capsules and ligaments with the end result being gradual deviation of the 1st metatarsal. As the deformity increases, there is an abnormal pull of certain tendons, which leads to the drifting of the great toe toward the 2nd toe. At this stage, there is also an adaptation of the joint itself that occurs.
Treatment
Early treatment of bunions is centered on providing symptomatic relief. Switching to a shoe with a rounder, deeper toe box and made of a softer more pliable leather will often provide immediate relief. The use of pads and cushions to reduce the pressure over the bone can also be helpful for mild bunion deformities. Functional foot orthotics, by controlling abnormal pronation, reduces the deforming forces leading to bunions in the first place. These may help reduce pain in mild bunion deformities and slow the progression of the deformity. When these conservative measures fail to provide adequate relief, surgical correction is indicated. The choice of surgical procedures (bunionectomy) is based on a biomechanical and radiographic examination of the foot. Because there is actual bone displacement and joint adaptation, most successful bunionectomies require cutting and realigning the 1st metatarsal (an osteotomy). Simply “shaving the bump” is often inadequate in providing long-term relief of symptoms and in some cases can actually cause the bunion to progress faster. The most common procedure performed for the correction of bunions is the 1st metatarsal neck osteotomy, near the level of the joint. This refers to the anatomical site on the 1st metatarsal where the actual bone cut is made. Other procedures are performed in the shaft of the metatarsal bone (see procedures performed in the shaft of the metatarsal) and still other procedures are selected by the surgeon that is performed in the base of the metatarsal bone.
Corns and Calluses
Corns and calluses are areas of thick skin that result from excessive pressure or friction over a boney prominence. When these areas develop on the bottom of the foot they are called calluses. When they occur on the top of the toes they are called corns. They can also occur between the toes, the back of the heels, and the top of the foot. The thickening of the skin is a normal body response to pressure or friction. Often times they are associated with a projection of bone called a bone spur. Not all areas of thickened skin are corns or calluses. Plantar warts, inclusion cysts, and porokeratosis also cause a discreet thickening of the skin that resembles corns and calluses.
Symptoms
Calluses
The most common area for the formation of calluses on the bottom of the foot is in the area of the ball of the foot. This is a weight-bearing area where the long bones behind the toes called metatarsals, bear the greatest amount of weight and pressure. If one or more of these long bones (metatarsals) is out of alignment then excessive pressure is generated in the area producing a callous. The callused area can be very discreet and have a “core” or they can be more dispersed covering a larger area. These areas can become quite painful as the skin thickens. People who have diabetes are at risk of these areas breaking down producing sores or ulcerations that can become infected. People with diabetes should not try home remedies and should see a doctor for treatment.
Corns
Corns are areas of thick skin that most commonly occur on the top of the toes. Generally, there is an associated hammertoe deformity, which causes the toes to rub on the top of the shoes. Professional treatment is directed at correcting the hammertoe deformity. Small corns can also occur on the side of the little toe next to the toenail. A small bone spur causes this problem. Professional treatment consists of removing the bone spur. Bone spurs also cause corns between the toes.
Soft corns are areas of white moist skin between the toes. They most commonly occur between the fourth and fifth toes. They can be very painful and if not treated can form small ulcerations or sinus tracts that can become infected. An acute athlete’s foot can mimic the soft corn. The soft corn is due to an irregularity in the shape of the bone in the fourth or fifth toes.
Treatment
Treatment of Calluses
There are numerous over-the-counter treatments for corns and calluses. Some of these remedies have an acid in them that burn the callous off. Care should be taken when using these medications. If used incorrectly they can cause a chemical burn to the skin. Additionally, these remedies are only temporary because the source of the pressure has not been alleviated. Professional treatment consists of using a special shoe insert called a functional orthotic that corrects foot function. In certain instances, surgery may be recommended. Surgery is directed at correcting the alignment of the offending bone. Cutting out the callous will only make the condition worse if the underlying boney problem is not corrected. Metatarsal surgery is discussed in another section.
Treatment of Corns
Home treatment should be directed at reducing the pressure between the toes with cotton or a foam cushion and using an antibiotic ointment to reduce the risk of infection. Over-the-counter corn removers should never be used in this area because of the risk of increased damage to the skin resulting in infection. Professional treatment consists of removing the irregular-shaped bone that causes the development of the corn. Some patients prefer that the doctor simply trim down and pad the calloused areas. This is a common form of treatment in patients with diabetes.
Haglund’s Deformity
Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against the shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).
To help prevent a recurrence of Haglund’s deformity:
- wear appropriate shoes; avoid shoes with a rigid heel back
- use arch supports or orthotic devices
- perform stretching exercises to prevent the Achilles tendon from tightening
- avoid running on hard surfaces and uphill
Symptoms
Haglund’s deformity can occur in one or both feet. The symptoms include:
- A noticeable bump on the back of the heel
- Pain in the area where the Achilles tendon attaches to the heel
- Swelling in the back of the heel
- Redness near the inflamed tissue
Causes
Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes, or women’s pumps, can cause this irritation.
To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include:
- A high-arched foot
- A tight Achilles tendon
- A tendency to walk on the outside of the heel
Treatment
Nonsurgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Nonsurgical treatment can include one or more of the following:
- Medication. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
- Ice. To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Exercises. Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for a patient who has a tight heel cord.
- Heel lifts. Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel.
- Heel pads. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking.
- Shoe modification. Backless or soft-backed shoes help avoid or minimize irritation.
- Physical therapy. Physical therapy modalities, such as ultrasound, can help to reduce inflammation.
- Orthotic devices. Custom arch supports control the motion of the foot.
- Immobilization. In some cases, casting may be necessary.
If nonsurgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case. It is important to follow the surgeon’s instructions for postsurgical care.
Hammertoe
Hammertoe is a contracture (bending) deformity of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.
Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to nonsurgical treatment.
Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
Symptoms
- Pain or irritation of the affected toe when wearing shoes.
- Corns and calluses (a buildup of skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending on their location.
- Inflammation, redness or a burning sensation
- Contracture of the toe
- In more severe cases of hammertoe, open sores may form.
Causes
Hammertoes may be aggravated by shoes that do not fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.
Treatment
Although hammertoes are readily apparent, to arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.
Hammertoes are progressive—they do not go away by themselves and usually, they will get worse over time. However, not all cases are alike—some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.
Morton’s Neuroma
A neuroma is the swelling of the nerve that is a result of a compression or trauma and may result in permanent nerve damage. When the neuroma is present in the space between the third and fourth toes, it is called Morton’s Neuroma. This is the most common area for a neuroma to form. Another common area is between the second and third toes. Neuromas can occur in one or both of these areas and in one or both feet at the same time. Neuromas are very rare in the spaces between the big toe and second toe, and between the fourth and fifth toes. Neuromas have been identified in the heel area, resulting in heel pain.
Symptoms
Causes
A puncture wound or laceration that injures a nerve can cause a neuroma. These are called traumatic neuromas. Neuromas can also result following a surgery that may result in the cutting of a nerve.
Treatment
To address the abnormal movement of the metatarsal bones, a functional foot orthotic can be used. These devices are custom-made inserts for the shoes that correct abnormal function of the foot. The combination treatment of cortisone injections and orthotics can be a very successful form of treatment. If, however, there is significant damage to the nerve, then failure of this treatment can occur. When there is permanent nerve damage, the patient is left with three choices: live with the pain, chemical destruction of the nerve, or surgical removal or decompression of the nerve.
Plantar Fasciitis
Heel pain is most often caused by plantar fasciitis, although other things, such as stress fractures or nerve injuries, can be to blame. While faulty foot structure is the most common cause of plantar fasciitis, it can also result from wearing shoes that are worn out or are not designed for the sport in which you’re participating. Proper stretching of the Achilles tendon stretched can help get rid of this pain, but continued pain should be checked out to rule out a fracture or other cause.
Symptoms
- Pain on the bottom of the foot near the heel
- Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking
- Greater pain after (not during) exercise or activity
Causes
The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.
Treatment
More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.
Rest. Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running or step aerobics).
Ice. Rolling your foot over a cold water bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day.
Nonsteroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation. Using the medication for more than 1 month should be reviewed with your primary care doctor.
Exercise. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.
- Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.
- Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.
Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to a flat foot and chronic pain.
Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful.
Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone.
Physical therapy. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia.
Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive—it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.
Surgery. Surgery is considered only after 12 months of aggressive nonsurgical treatment.
Skin Conditions
Athlete’s Foot is a fungal infection that usually occurs between the toes but can also affect other areas of the foot.
Diabetic Foot Ulcers are open sores or wounds that occur in approximately 15 percent of patients with diabetes and are commonly located on the bottom of the foot.
Warts are a viral infection caused by the human papillomavirus (HPV). They are often mistaken as corns or calluses. They occur when HPV enters the skin through a small cut or abrasion. Children and teenagers are more susceptible to getting warts than adults.
Symptoms
Athlete’s Foot Symptoms: Dry skin, peeling skin, itching, burning, swelling, and blisters.
Warts Symptoms: Warts look like small rough growths on your skin.
Causes
Athlete’s Foot Causes: Fungus thrives in warm, damp environments, which are commonly found inside your shoe, around pools, and in showers.
Warts Causes: Warts are spread by touching, scratching, or contact with skin shed from another wart. If left untreated, wart clusters can form.
Treatment
Athlete’s Foot Treatment: Treatment includes a prescription for an anti-fungal, as well as, encouragement to keep your feet dry, and to wear proper footwear around pools and in public places like showers.
Warts Treatment: If self-care approaches have not helped, your podiatrist can provide you with a few options: prescription-strength salicylic acid, Cryotherapy, minor surgery, or laser treatment.
Tarsal Tunnel
Tarsal tunnel syndrome is a compression or squeezing of the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.
Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.
Symptoms
Patients with tarsal tunnel syndrome experience one or more of the following symptoms:
- Tingling, burning, or a sensation similar to an electrical shock
- Numbness
- Pain, including shooting pain
Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.
Sometimes the symptoms of the syndrome appear suddenly. They are often brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.
It is important to seek early treatment if any of the symptoms of tarsal tunnel syndrome occur. If left untreated, the condition progresses and may result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated.
Causes
Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:
- A person with flat feet is at risk for developing tarsal tunnel syndrome because the outward tilting of the heel that occurs with fallen arches can produce strain and compression on the nerve.
- An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, or arthritic bone spur.
- An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
- Systemic diseases, such as diabetes or arthritis, can cause swelling, thus compressing the nerve.
Treatment
Many treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:
- Rest. Staying off the foot prevents further injury and encourages healing.
- Ice. Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
- Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
- Physical therapy. Ultrasound therapy, exercises, and other physical therapy modalities may be prescribed to reduce symptoms.
- Injection therapy. Injections of a local anesthetic provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
- Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
- Shoes. Supportive shoes may be recommended.
- Bracing. Patients with flatfoot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount of pressure on the foot.
Sports Injuries
Athletes’ feet and ankles are prime candidates for injuries whether you participate in sports regularly or are a “weekend warrior."
Sprains & Fractures
A fracture is a break in your bone, while a sprain is a soft tissue injury. They can be difficult to determine, but we'll take care of it for you!
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Nerve Entrapments & Neuromas
Nerves may be compressed for a wide variety of causes. A neuroma is the swelling of the nerve that is a result of a compression or trauma.
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We work with children at all developmental stages to assess their foot care needs and treat foot and ankle injuries that interrupt kids’ play.
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