Hammertoes        Plantar Fasciitis and Heel Spurs        High Arch and Low Arch       Conditions of Toenails       Painful Feet      

Orthotics      Growing Pains       Sport Related Problems

Athlete's Foot is a condition caused by a fungal infection. The fungus usually lives in warm moist places such as around pool areas or in locker rooms. When the infection affects the foot it usually imbeds into the skin between the toes or on the sole of the foot. Shoe can often become a source of the problem because of perspiration. The best way to prevent fungal infections is to keep your feet clean and dry and use an over the counter athlete's foot powder. If you are prone to developing this type of problem, stronger topical medications are availible by prescription. In severe or chronic, unresponsive cases, oral medications i.e. Lamisil can be used.

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A Bone Spur can only be determined by x-ray. When seen on x-ray the spur is usually imbedded in muscle, tendon or ligament. Since muscle, tendon and ligament are elastic, the spur causes the muscle, tendon or ligament to shorten. As the foot moves, the shortened muscle, tendon or ligament become overstretched. This causes pain. Common areas of bone spurs in the foot are the toes, heel, great toe joint, the top of the foot, and the ankle. The location of the spur and the amount of discomfort determine the appropriate treatment. This may be as simple as a pad or cushion or may require a cortisone injection. Sometimes surgery may be necessary to permanently solve the problem.

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A Bunion is an enlargement of the bone on the inside of the foot just behind the great toe. The great toe gradually drifts and points toward the 2 ^nd toe. Bunions can occur on one or both feet. The tendency to develop a bunion is usually inherited, but can occur without a family history. Shoes, long periods of standing and walking, and increased physical activity, such as jogging or tennis can increase our risk of developing bunions. The front part of the foot gradually widens as our feet flatten when standing. The deformity gradually gets worse with time, making all shoes painful and difficult to wear. Because the bunion deformity is progressive, it should be evaluated early.

Treatment options depend on how painful the bunion is, the patient's lifestyle and the degree of the deformity. Options include wearing sensible shoes with a round toe box. Inserts for your shoes called orthotics are custom fitted to control the abnormal foot movement. In many instances surgery is recommended. As the bunion worsens, it becomes more difficult to treat surgically and the healing time can increase significantly. Over time, the joint in the big toe can become arthritic, lose its flexibility and become painful with nearly every step. At this stage the surgical treatments are limited and a joint replacement may be required.

The doctors of Adler Podiatry & Wound Care are are trained in all the latest techniques for the surgical repair of the bunion deformity. The selection of the procedure to be used is based upon the degree of the deformity, the underlying biomechanical cause of the bunion and the procedure that will get the patient back to activity in the shortest period of time. There are no magic procedures and no shortcuts to healing time. If you have further questions, please make an appointment for consultation.

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Corns, Calluses and Warts are areas of thickened skin resulting from irritation. Calluses are thick, painful skin on the bottom of the foot. When the thickened area occurs on top of the toes it is called a corn. Corns are usually caused by shoes pressing against the toes. They are made worse if the toe is crooked or contracted ( hammertoe ). Stylish or high-heeled shoes with pointed toes can aggravate these problems. The treatment should be directed at stopping the pressure or friction on the toe. You should typically avoid over the counter remedies, especially if they contain acids. Home remedies for calluses can include soft shoe inserts or pads. If the corns are on top of or between the toes, lambs wool or foam pads might be used. Warm water soaks and then buffing with a pumice stone may help. Creams and lotions can give temporary relief. CAUTION: All of these remedies can be especially dangerous if the individual has diabetes or poor circulation. Home remedies should be avoided when the person is a diabetic or has poor circulation. All diabetics should be seen routinely for foot exams. When any evidence or signs of foot problems appear in the diabetic, professional care should be sought immediately.

Warts are hard areas that can occur on the bottom of the foot. Plantar (bottom of the foot) warts are caused by a viral infection of the skin. They live within the upper layer of the skin. Because a virus causes them, they can spread. They are not highly contagious, but will often spread by contact to other areas of the foot. If you have plantar warts, do not pick at them and do not share your shoes with others. There are over-the-counter wart removers. They generally do not work because the skin is so thick and it is difficult for the medicine, which is an acid, to penetrate to the depth necessary to kill the wart. Warts can be quite persistent; it is best to catch them early and get treatment before they become established.

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When used properly Cortisone can be safe and effective. Cortisone is a naturally produced chemical in your body. It is useful in treating inflammatory processes that result from injury or arthritis. It can, in many instances, halt the painful process permanently. In other instances, it is a useful addition to other treatments. Cortisone does not dissolve bone spurs, but can decrease swelling and inflammation in soft tissues.

If a cortisone injection is suggested and you have concerns, we encourage you to discuss them with us. Our goal is to provide you with the highest quality care. Part of providing care is ensuring that you are comfortable and understand the plan of treatment.

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Patients with Diabetes are particularly at risk to develop significant foot problems. These can lead to the loss of a toe, foot or leg. Did you know that:

    Foot infections are the most common cause of hospitalization for the diabetic patient.

    Foot related problems are responsible for significant time off work.

    Foot ulcerations can take weeks or months to heal.

There are two conditions associated with diabetes that put the patient at risk. The first is called neuropathy, a nerve condition that frequently affects the feet. There is a gradual loss in the patient's ability to feel sharp touch or pain. As the protective sensation is lost, the patient cannot feel the difference between hot and cold, sharp and dull, vibration or excessive pressure. This loss of sensation can become quite profound. Patients can step on sharp objects or cut themselves and not feel pain. They may burn themselves with scalding water and not be aware of it, and they can develop pressure sores and infections and experience little or no pain.

Because of this condition, diabetic patients must be constantly be aware of their feet and inspect them daily. They should avoid walking barefoot and avoid hot showers or baths. The temperature of the shower or bath water must be checked, usually with the elbow rather than the hand, prior to immersing the feet. It may be a good idea to have the water heater temperature lowered to prevent accidental burns. Avoid soaking the feet since this dries the skin and may cause cracking, leading to infection. Special care should be taken when trimming the toenails. Avoid sharp trimming of corns and calluses and over-the-counter corn removers. Shoe gear must be appropriately fitted to avoid areas of irritation. Frequently this condition causes a burning pain that makes sleeping difficult. Some patients may feel like their feet are ice cold and have difficulty warming them. Avoid using heating pads or hot water bottles to warm the feet since this can cause burns to the skin that may not heal and could lead to the loss of their foot or leg.

The second condition is a loss of circulation that can cause delay in healing of cuts or sores on the feet. In severe cases it can lead to gangrene and amputation. When present the skin may appear to be thin, hair growth on the foot or leg stops. In Caucasians the skin color turns reddish or blue. The feet are cool to the touch and can be very sensitive, making it painful to walk, even short distances.

Common problems the diabetic may encounter are ingrown or fungal toenails, thick calluses on the bottom of the feet and corns on or between the toes. Even these relatively simple problems can lead to serious complications and problems for the diabetic. We recommend that the diabetic patient have their feet checked on a regular basis, by a podiatrist. Skin irritation, sores and infections the patient should seek professional treatment by their podiatrist. If the foot appears to change shape, the arches appear to be falling or sudden onset of swelling is seen, please consult your podiatrist. The diabetic patient's best defense against problems including infections and possible loss of feet or legs is to inspect the feet daily and have regular foot exams. Keeping your blood sugar under control helps to minimize the development of problems and allows problems to heal faster when they occur. Check your blood sugar daily and see your medical doctor routinely. For more information about diabetes you can contact the American Diabetes Association at 1-800-DIABETES (343-2383) or visit their web site at http://www.diabetes.org.

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Hammertoes are toes abnormally bent at one or more joints. Hammertoes are not the caused by tight or ill-fitting shoes. Toes can become malformed because of arthritis or because of an imbalance in the way the foot and toe moves. We inherit our foot structure, just like we inherit the color of our eyes. Foot function or movement is determined by the alignment of the bones and joints in the foot. Over a period of years, if the foot continues to malfunction, tendons that move the toes up and down begin to pull the toe with unequal tension and the toe begins to buckle or become contracted. Normally, hammertoes by themselves are not painful. If the shoe has a tight or pointed toe box, the prominent knuckle of the toe rubs the shoe, producing an area of irritation that hardens forming a corn.

Conservative care may include padding, wearing wider shoes, thicker socks or using orthotics to correct the underlying imbalance. If the problem causes continual pain and cannot be managed, a surgical correction can be performed in office or at an outpatient surgical center.

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Heel Spurs is one of the most common of all foot complaints. It starts gradually without any history of injury. The pain, which appears to be localized on the inside of the heel, is present in the morning and after sitting or resting. After the first few steps in the morning the pain decreases. It may be present when standing still, but is very noticeable when sitting then getting up at the end of the day. Going barefoot aggravates the problem. Often the patient is overweight or wears shoes that are worn out. In an attempt to loose weight, the patient increases walking for exercise.

The Plantar Fascia is a thick ligament that helps to support the arch of the foot. When standing our feet tend to naturally flatten. If the foot flattens more than it normally should, the muscles and fascia become strained. The muscles fatigue. During periods of rest, the tired foot muscles tighten. When you first get up the muscles that are tight hurt as you apply your full body weight to the foot. Even though the pain gradually decreases with each step, the pain indicates that an injury is occurring.

Home remedies can include warm water soaks, over-the-counter anti-inflammatory medications, heel pads, shoe inserts, and calf muscle stretching. Running shoes with support can help to reduce the pain. Wearing a shoe with a 1" heel reduces the pressure on the heel and may ease the pain.

When seeking professional help, expect to have an x-ray taken to assist in the diagnosis. It's not uncommon to see a "Heel Spur" on the x-ray. Treatment is tailored to the patient. Treatment may include a prescription anti-inflammatory drug, a cortisone injection, orthopedic taping of the foot to support the arch or perhaps custom-made insoles for your shoes called orthotics. When conservative treatment fails, an operative procedure may be required.

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The shape of your feet can be a good indicator for potential problems. It's not uncommon to see a patient with a high arch foot complain about ankle sprains or back pain. Individuals with low arch or flat feet often complain of fatigue in the feet and legs, especially after long periods of standing or walking. More important than the shape of your foot is how your feet work or function. Just like a car the alignment of the foot is important to the overall function of the foot. If the car is out of alignment, the tires wear out fast. If the foot is not well aligned, changes occur in the structure or shape of the foot. Areas of irritation such as corns or calluses develop. More serious problems such as bunions and hammertoes can develop. The abnormal foot function can also cause conditions such as heel pain (plantar fasciitis or heel spur), metatarsalgia or pain in the ball of the foot (neuromas, stress fractures, or tendonitis). If there is a family history of foot problems, it's not unusual to see juvenile or pediatric foot problems.

These foot imbalances or biomechanical abnormalities, if identified early enough, are often treated very successfully with orthotic therapy.

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Ingrown toenails are among the most common problems seen in all age groups. Patients tolerate them needlessly for fear of treatment. Improper trimming of the nails, tight shoes or an injury to the nail can cause ingrown toenails. They often occur in adolescents. Signs of infection are pain, redness, and drainage. This can be treated with warm water soaks using Epsom salts and topical antibiotic ointments. Most important is to remove the nail growing into the skin. When performed by your podiatrist, the treatment is virtually painless. After the procedure there is little pain and usually no restrictions of your activities.

Fungal toenails are toenails that have become infected with microorganisms called fungus. The infection is often the same organism that causes athlete's foot. As the fungus invades the nail and the nail bed, it often goes unnoticed because it rarely causes pain. It often starts at the end of the nail and works back under the nail, gradually lifting the nail off of the nail bed. As the toenail becomes separated from the nail bed, the nail root continues producing nail tissue. The new nail tissue "piles up" on the existing nail tissue that appears to thicken, but not grow. Once the fungus invades the root, or matrix, it causes the nail to become malformed and more difficult to treat.

In all stages of the disease, treatment can be difficult. Clipping the diseased portion of the nail away and applying an anti-fungal cream can be tried, but most of the over the counter topical remedies are not strong enough. Keeping the nail dry after bathing and treating the athlete's foot, if present, can improve treatment. In most stages of the disease, oral medications are most effective, with or without nail removal.

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Pain in the ball of the foot is often referred to as metatarsalgia. It may represent a stress fracture, neuroma, or tendonitis.

Stress fractures are common in the foot. They usually begin suddenly after increased walking or activity. The pain is accompanied by swelling. One telltale sign of a stress fracture is that the pain is present with any pressure on the foot and increases with increased standing and walking.

Neuromas cause sharp or cramping like pain that radiates into the toes. The neuroma represents a swollen nerve that has been repeatedly pinched, usually between the 3rd and 4th toes. It's usually not a tumor. The nerve gradually thickens and scars secondary to chronic irritation. The thickened nerve appears like a tumor. As the neuroma enlarges, sudden pinching of the nerve causes intense pain. The patient usually has to remove the shoe and massage the foot to get relief of the pain. If left untreated the symptoms usually worsen.

Tendonitis is an inflammation in the ball of the foot. One of the most common areas for pain is just behind and under the base of the second toe. The symptoms are similar to those associated with the neuroma. Tendonitis is often seen in runners and in women who wear stylish shoes with high heels.

Home remedies for Metatarsalgia, Neuromas, Stress Fractures and Tendonitis includes wearing firm-soled shoes with plenty of room in the toe area; over-the-counter anti-inflammatories such as Advil, Tylenol, Motrin or Alieve. If the circulation is good, ice can be applied to the bottom of the foot for no more than fifteen minutes.

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Biomechanics is the foundation of understanding the foot, allowing us to evaluate how our joints and muscles function during  activities i.e. walking and running.

Orthotics are custom designed shoe inserts used to control foot movement. The science of motion as it relates to the body is the study of biomechanics. When our joints, muscles, and tendons move within normal limits, our bodies can remain pain free. However, when a joint exceeds its range of motion or a tendon is stretched beyond its limits or a muscle is used to stabilize rather than for movement, pain often develops. The orthotic controls movement of the foot, ankle, leg, knee, thigh, hip, and back. When motion is kept within a normal range the likelihood is that potential overuse syndromes such as shin splints can be avoided. Orthotics can also be used in the treatment of leg length disorders, low back problems, arthritis and to protect diabetics from foot from injury. A common use for orthotics is the prevention of foot problems, such as bunions and hammertoes.

Since our foot structure is inherited, the tendency to develop foot problems is predisposed. The way we walk, the shoes we wear, the stress applied to our feet such as during running, and the amount of time we are on our feet, contribute to the development of foot problems. Just as the dentist may prescribe braces to correct abnormal alignment of teeth, orthotics are used to correct abnormal movement of the foot. Orthotics are one of the only ways to prevent adult foot problems from developing. If there is a family history of foot problems, you may be at risk and your feet should be checked.

Orthotics are made from an impression of the foot taken with either plaster or foam, or the newest technique, a computerized image of the foot. Orthotics are made from different materials, rigid or soft, depending on the age of the patient, activity the orthotic is designed for and the type of shoe the patient intends to wear the orthotic in. Orthotics are transferable from one shoe to another. Following a complete history and biomechanical examination, your doctor will discuss the type of orthotics specifically for you.

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Infants may have certain foot problems, if identified early enough, can be treated and corrected before they lead to life long problems. Problems present at birth, such as feet turning inward and overlapping toes can usually be treated successfully with simple casting techniques.

Growing pains should not be ignored. Growing children sometimes complain of pain in the legs at night. This may represent faulty mechanics in the foot with increased stress on the muscles in the legs causing pain at rest. Children 8 to 15 years of age often complain of heel pain. This usually occurs during physical activity and resolves with rest. Both conditions when identified usually respond relatively quickly to treatment, allowing the child to painlessly enjoy normal activities.

Other common foot disorders that can be treated include in-toeing and out-toeing, flat feet, curved feet, toe walking, inflamed growth plates in the bones, leg cramps and night cramps, ingrown toenails, athlete's foot, and other skin conditions. Don't hesitate to contact us when your young athlete suffers from a sport related injury. Children will often not complain about pain associated with their sport. The demands of soccer, baseball, dance, and gymnastics on the growing child will often uncover underlying developmental problems.

If there is a family history of foot problems parents should not automatically expect that their children may "grow out of it." Your child deserves to be evaluated by a specialist. At Podiatry Associates of Florida we have your child's best interest at heart. If you have concerns about your child's feet, please make an appointment and let's discuss your concerns and evaluate your child.

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Sport Injuries include problems i.e. shin splints, arch pain, heel pain, Achilles tendonitis, ankle injuries, stress fractures, tendon injuries of ankle, toenail injuries, nerve injuries and blistering of the skin. 

Today, shoes have been specifically developed for many of the common athletic activities. Before attempting a specific activity, always properly stretch the involved muscle groups. Stretching is as important after exercise as before. Check your shoes for abnormal wear patterns. Remember, pain is a warning sign. When the pain is recurrent, you should seek professional help.

Following a particularly rigorous workout, areas of soreness are often eased with the use of an over-the-counter anti-inflammatory such as Tylenol, Advil or Alieve. Icing the area can also be useful. If pain persists, make an appointment with us to evaluate your condition and make recommendations for your treatment. Many sports related problems are biomechanical in nature and are easily treated with orthotics.