Foot specialist: October 2012

What to Do With Your Ingrown Toenail

An ingrown toenail is a common condition for both men and women. It happens when the corner or side of one of your toenails grows into the soft flesh of that toe. It usually affects one of your big toes and if not taken care of properly can lead to pain, redness, swelling and sometimes infection. This usually happens when the toenail breaks the skin and bacteria enters and causes an infection. Sometimes, skin may start to grow over the ingrown part of the nail.

Many people with ingrown toenails take care of the condition by themselves. Warm soaks and proper nail trimming may be what is needed, but sometimes it is best to see a foot specialist when you first feel the pain and the pressure. If the pain is severe or it is spreading, a podiatrist can usually relieve your discomfort and help you avoid more complications of an ingrown toenail.

\"Foot Specialist\"

If you have diabetes or another condition that causes poor circulation to your feet, go directly to your doctor rather than risk any complications.

What to Do With Your Ingrown Toenail

The signs and symptoms of an ingrown toenail include:

Pain and tenderness in your toe along one or both sides of the nail.
Redness around your toenail.
Swelling of your toe around the nail.
Infection of the tissue around your toenail.

There are many reasons why ingrown toenails develop some of which are congenital. For instance, your toenails may be too large. People whose toenails curl under are also prone to the condition. Stubbing a toe or having a toe stepped on or some other trauma can cause a piece of the nail to jam into the skin.

High heels are also a problem because the heel transfers most of your body weight toward the front of the foot. This puts more pressure on the big toe and often deforms them over the years. This can also lead to ingrown toenails.

However, the most common cause is cutting your toenails incorrectly causing them to re-grow into the skin. Tight hosiery or shoes with narrow toe boxes make matters worse.

What You Can Do About an Ingrown Toe Nail

Left untreated or undetected, an ingrown toenail can infect the underlying bone and lead to serious infection. If your symptoms are minor such as the toe being red and not very painful, and you don't have a complicated condition such as diabetes, you can take some simple measures at home to treat your ingrown toe nail.

Soak the foot in lukewarm water 2 or 3 times a day for 15 minutes. I always add Epsom salts but I'm told there's no scientific evidence this will heal anything or help the pain.
Massage the skin at the side of the toenail gently pushing it away from the nail.
Some suggest placing cotton under your toenail after soaking to help the nail grow above the skin edge. Some doctors say this is too risky because it traps bacteria.
However, do apply a topical antibiotic such as Neosporin or Polysporin or bacitracin. Cover the area with a band aid.

Preventing Ingrown Toenails

Wear sandals or other low-heeled open-toed shoes whenever possible.Wear low-heeled shoes that have enough room at the toes. If you wear stockings wear moisture-wicking socks so your toes move freely.
Keep your feet clean and dry.
Use a toenail clipper (not a fingernail clipper).
Cut your toenails across, going with the curve. Do not round the corners down and don't cut the toenails too short.

If you toenail becomes infected it is time to see a doctor such as a podiatrist (foot care specialist) or a dermatologist. You may need to take oral antibiotics for an infection and the doctor may have to remove the ingrown part of your nail.

What to Do With Your Ingrown Toenail

And I invite you to find more information on successful approaches for a healthy lifestyle by visiting http://www.upsideofaging.com Claim your free reports on how to stay healthy and energetic. Ruthan Brodsky, a nationally known author on health and aging, provides you with the information you need to keep your body and your mind active and productive regardless of your age.

Surgical Removal Of Foot and Ankle Ganglion Cysts

Ganglion cysts are the most common masses in the foot and ankle, and can often be difficult to eradicate since drainage usually results in an eventual refilling of the cyst. Surgery is often necessary for permanent removal of these compressible lumps. This article will discuss ganglion cyst treatment, especially surgical removal.

A ganglion cyst is essentially a benign, fluid-filled mass that develops near joints and tendons. While the exact cause is unknown, it is generally thought that a defect forms in the tissue surrounding a tendon or a joint that allows fluid from one of these areas to penetrate through into the surrounding tissue. This fluid becomes walled off by fibrous tissue that surrounds it, and the cyst forms. It is essentially a balloon of thick, jelly-like fluid that becomes thicker than the joint or tendon fluid from which it came. The cysts can start off small, and then quickly grow. It is also not uncommon for cysts to wax and wane in size. These cysts are generally benign, and cause few issues on their own. However, the location and/or size of these cysts can become problematic, especially in the foot and ankle.

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Cysts can sometimes be located near sensitive structures, such as nerve tissue, and the simple presence of the cyst expanding against this tissue can cause pain. Additionally, if the cyst is especially large or irregularly shaped, or if it is wrapped around joints or tendons, the function of the foot can be affected. This can lead to difficulty in walking, or pain. It is because of the above reasons that foot and ankle ganglion cysts are typically treated.

Surgical Removal Of Foot and Ankle Ganglion Cysts

Diagnosing ganglion cysts is usually done by an external exam, as they are either visible through the skin or can be felt under the skin surface. Ganglion cysts usually feel fairly distinct, and most physicians can make a confident diagnosis by feel alone. However, if the cyst has several bumps to it, feels unusual, or is deep or in an unusual location away from a joint or a tendon, the physician may prefer to get an MRI or ultrasound study to assess its size and appearance better.

The initial treatment of ganglion cysts can involve an attempt at drainage. Cysts usually can be drained, although smaller ones are sometimes difficult to accurately find through the skin. The old technique of hitting the cyst with a heavy book, like a Bible, is very traumatic, ruptures the cyst, and can create inflammation to the entire area. This treatment is not advised in modern medicine. The best technique for drainage is for needle and syringe drainage by a physician. The drainage is usually followed by an injection of a cortisone-like medication (corticosteroid) that reduces local inflammation and may scar the cyst origin to prevent regrowth. Unfortunately, this technique does not have a great chance of keeping the cyst from returning, as the cyst wall and the cyst origin remain in the body. The cyst typically regenerates its fluid shortly after drainage. Drainage and corticosteroid injection is safe and does work in some cases, especially for small cysts, and that is why it is attempted in the first place.

When the cyst returns and creates pain or functional limitation, that is the point at which surgery is considered. Surgical removal of cysts can be simple, or can be complex if the cyst is large or integrated into surrounding tissue. The surgical procedure for removing ganglion cysts involves making an incision directly over the area where the cyst lies, and careful separation of the cyst from the surrounding tissue without rupturing the cyst. Once the cyst ruptures, the fluid that remains can potentially become walled off again, and finding the exact ending margin of the cyst wall becomes more difficult once it is 'deflated'. The cyst must be removed in its entirety, including all of the cyst wall and the original connecting tissue. If this is not done, the cyst may simply reform. The complete removal of all this tissue is not always easy, and sometimes even the slightest of remaining tissue not visible to the surgeon can allow for a return.

Removing cysts often requires identification of several different lobes, or branches of the cyst, if it is not in one smooth piece. This exploration often requires the surgeon to gently move around surrounding vital tissues, which could have cyst material wrapped around them. This can result in a complicated removal process, and can increase the risk or likelihood of the cyst returning after surgery. It also places the surrounding vital tissue, like nerves, at risk for damage during the surgery. In rare cases, the expansion of the cyst has already damaged the surrounding tissue, and there may be lasting effects even after the surgical healing has completed.

In general, healing from removal of the cyst is successful and without complication. The skin heals readily, and deep scar tissue is not typically a problem as the cysts are usually more superficially located, aside from the base that stems from the underlying tendon or joint. An exception to this is cysts located along the back or sides of the ankle, where more tissue dissection is needed to reach the cyst. Weight bearing is usually immediately allowed, except for uncommon cysts on the bottom of the foot requiring an incision under the foot, and activity can usually be resumed in several weeks.

As one can read, ganglion cysts are a common foot mass that may be somewhat difficult to be rid of permanently. On its own, a ganglion cyst is usually benign and without significant symptoms. However, treatment is needed when the cyst causes pain or a limitation in one's activity. As a rule, one should always have a medical exam when a new mass appears on or under the skin. There are tumors that can be mistaken for cysts, and a physician can determine what the nature of the mass is. For foot and ankle masses, a foot specialist (podiatrist) is the best specialist to see first for evaluation.

Surgical Removal Of Foot and Ankle Ganglion Cysts

Dr. Kilberg provides compassionate and complete foot and ankle care to patients of all ages in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery. Visit the practice website of this Indianapolis foot surgeon for more information.

The Curly Toe - Causes and Treatment

Of the many conditions which result in a change in the shape or position of the toes, the curly toe stands out as a more unique deformity that is treated in a somewhat different manner than a standard toe deformity (like a hammertoe). This article will discuss this unique deformity, and ways to treat it effectively.

Due to a variety of reasons (but mostly because of one's arch structure), the toes can gradually develop a change in their shape over the course of many years of standing and walking. The most common change is the development of the hammertoe, in which the first joint, or 'knuckle', of the toe pulls upward, while the middle of the toe flexes downward. Although rarely painful in and of itself, a hammertoe deformity can allow for excessive pressure from the top of a shallow shoe onto the toe. A corn will develop on the skin where the toe joint is prominent, which can eventually lead to pain. Another change that often develops is a rotation of the little toe towards the toe next to it. Often called a curly toe, this condition is the combination of a hammertoe deformity, and an actual inward rotation of the toe. The result of this abnormal toe position is usually a very painful corn that forms due to the pressure from the shoe on the toe, where the toe bone is now prominent due to the toe rotation. The difference between the corn that forms in this condition as opposed to that of a regular hammertoe is that this corn is less on the top of the toe than it is more along the side of the toe. The involved skin is still the 'top' of the toe technically, but the corn appears on the side because the top of the toe has rotated to the side. In this case, not only does the top of the shoe irritate the corn, but the side does as well. A second pattern of corn can also form along side the outer edge of the nail where pressure from the ground builds up due to the toe's rotation. This corn is often mistaken for an ingrown nail due to it's closeness to the nail edge itself. Removal of the side of the nail in this case will only temporarily relieve the symptoms, as the toe pressure from the rotation will allow a corn to form again despite the nail edge's removal.

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The little toe is not the only toe that can curl inward. This can also be seen in the other smaller toes, although the fourth toe (the one next to the little toe) is the primary toe outside of the little toe to develop this. However, this toe does not tend to develop the same sort of painful corn as the little toe, due to the unique position of the little toe on the outside of the foot.

The Curly Toe - Causes and Treatment

Treatment of this condition is fairly straight forward. One either conservatively lives with the condition or one has the toe straightened out surgically. Self-care with gentle filing of the corn with an emery board or pumice stone after bathing can flatten the corn and limit it's potential to cause pain. Taping the toe out of a rotated position has limited benefit, and may actually cause additional discomfort. The use of a wider and deeper shoe seems to give the most benefit by reducing the external pressure on the toe. Padding the toe with gel, foam, or felt pads can provide some pressure reduction, although they need to be applied daily. Topical corn removers should be avoided as they contain skin acids that can potentially harm the surrounding good skin and create a chemical burn on the toe.

Surgery to repair this condition is possible, and is usually quite effective. This fairly simple procedure combines a fixing or straightening of the hammertoe deformity (by removing a small amount of bone near one of the toe joints), as well as a procedure to straighten out the toe rotation. Fixing the rotation can involve plastic surgery techniques to re-rotate the skin back around, or a technique to partially fuse the little toe with the base of the toe next to it to keep it stable and straight. The plastic surgery technique uses various skin incision orientations to effectively push the toe back into a non-rotated position. The fusion procedure removes part of the space in between the little toe and the fourth toe, and then stitches the skin together. Once this heals, the bases of the two toes will be as one. This has no effect on the way the foot functions in walking, and cosmetically is barely noticeable. The end result is a little toe that cannot rotate out of position any longer. Recovery is fairly simple for both the bone and skin part of the procedure, with most people able to return to a normal shoe within three to four weeks. Complication rates are low, and the toe tends to stay in the corrected position for life.

The curly toe deformity is common, can cause discomfort in shoes, and yet is easily treated. Anyone suffering from this toe deformity should see their foot specialist (podiatrist) for evaluation and treatment options specific to their toe.

The Curly Toe - Causes and Treatment

Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website for more information.

A Lump in the Sole of the Foot - Plantar Fibromas Explained

Anytime one feels a lump in the body, mental alarm bells ring out with fears of cancer. This natural reaction is fairly universal for most people. When the lump is felt in the bottom of the foot, where it can cause pain with every step, the fear can be even greater owing to the noticeable symptoms the lump has when walking or standing. Fortunately, true malignant tumors of deep tissue in the foot are very rare. However, it is not uncommon for many people to develop a benign firm mass on the bottom of the foot arch called a plantar fibroma (or superficial fibromatosis).

Plantar fibromas develop from a part of the foot known as the plantar fascia. The plantar fascia is a thick, strap-like dense tissue that connects the heel bone and the ball of the foot. This tissue is broad, traversing across the entire width of the foot in three distinct bands. It is essentially a thick ligament, and provides some rigidity to the arch of the foot. In some people, small nodules, or growths, can develop along the surface of the fascia, and can slowly expand over time. These growths can be single, multiple in number, or one mass with numerous areas of bulging. The nodules are well affixed to the fascia, and do not move when one tries to move the overlying skin around. In general, these nodules grow very slowly, and do not appear 'overnight'. However, they may seem to suddenly appear as most people cannot feel them until they become very large or develop pain. At times, people who rub their feet might notice them early on, but most people only notice the mass all of a sudden when it is big enough to expand the underlying skin or is tender to pressure. One can rest assured that these masses are benign, and conversion to a malignant cancer (fibrosarcoma) is almost unheard of.

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Symptoms are usually related to irritation of the fascia tissue and inflammation around the nodule when one stands on the foot and places pressure on the fibroma. Many of these plantar fibromas are painless masses that are not irritated by pressure on the sole of the foot. Some are painful, though, and can limit one's ability to comfortably walk. This is especially true when the mass pushes into a sensitive tissue, such as one of the many nerves found traversing the bottom of the foot above or below the plantar fascia. Barefoot walking and shoe use can be uncomfortable due to the 'lump', and other parts of the plantar fascia can become irritated as a result.

A Lump in the Sole of the Foot - Plantar Fibromas Explained

Treatment is geared towards either accommodating the mass to make those who suffer with it more comfortable, or removing it all together. It should be noted that if the mass does not cause any discomfort, it does not need to be treated. Its growth cannot be slowed or prevented with early treatment, and aggressive treatment of a non-painful plantar fibroma is not necessary. When there is pain involved, treatment with accommodation or removal is clearly recommended. Accommodating the mass involves the use of stretches to keep the fascia limber, anti-inflammatory medication, and accommodative inserts that pad and protect the area around the mass. In some people with painful plantar fibromas, this can help relieve, or at least temporarily control, the pain. If this is not effective, then surgery is typically needed to remove the mass itself. This surgery can run the range from simple to highly complicated depending on the size of the mass. Small plantar fibromas are easily removed with out too much tissue loss, and the resulting tissue gap can eventually fill with scar tissue to keep the structure of the plantar fascia intact. In any removal procedure, it is vital that all of the fibroma, along with a margin of normal fascia and the overlying under surface of the skin be removed to help prevent recurrence. Medium and large size fibromas are much more difficult to remove. Their removal causes large gaps in the plantar fascia, and can effect the stability of the bottom of the foot to a certain degree. This also leaves open an internal area that can be apt to developing scars and adhesions in the surface under and on the skin. At times, the resulting tissue can potentially be more painful than the original fibroma if healing is poor. These gaps need to be filled in if possible to maintain integrity of the fascia and limit scar tissue. Newer tissue grafts that act as scaffolds for whatever tissue is attached to them can help with this problem. The remaining fascia tissue will creep into these grafts, effectively restoring the fascia to a similar state as before surgery (and before the mass). Whether large or small, all plantar fibromas have a fairly high rate of recurrence, and even the best surgical technique cannot necessarily prevent this from happening. Simply put, some people quickly regrow these masses even after removal. This is not a sign so much for malignancy as much as it's a sign of a common problem after excision surgery for plantar fibromas. There is no way to effectively control this potential for regrowth after surgery unfortunately.

One final note should be made regarding plantar fibromas, and foot masses in general. As stated previously, true deep foot malignant tumors are very rare...but they do occur. It is recommended that a medical evaluation by a foot specialist (podiatrist) be performed to ensure that the mass felt is simply a common plantar fibroma. An MRI may need to be performed if there are unusual characteristics to the shape or location of the mass (or even if surgery to remove it is being planned). Less commonly, a biopsy may be considered if there is great abnormality or questionable findings on the exam. While all this may seem like a lot of time and money for a little mass, it can potentially make the difference between a healthy foot and a leg amputation if there truly is something more abnormal to begin with.

A Lump in the Sole of the Foot - Plantar Fibromas Explained

Over-Pronation, Fallen Arches and Flat Feet

Pronation and supination are commonly heard terms, often in association with fallen arches, high arches, flat feet etc. This article explains the meaning of these terms and looks in particular at the problem of over-pronation. You will read about the following:

1) What do the terms Pronation and Supination mean?
2) What exactly is over-pronation?
3) What are the consequences of over-pronation?
4) What can we do to fix the problem of over-pronation

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What do the terms 'Pronation' and 'Supination' mean?

Over-Pronation, Fallen Arches and Flat Feet

To understand the terms 'Pronation' and 'Supination', firstly we need to look at the gait cycle - that is the way we walk, or our 'walking pattern'.

The gait cycle is broken down into 3 different phases:

1) Contact phase: Firstly the outside of your heel hits the ground. This is entirely normal and it's the reason why most people's shoes wear out faster on the outside heel area of the soles. Just after the heel strikes, pronation occurs. I.e. the foot flattens out and the ankle rolls inwards. At the same time, your lower leg rotates inwards from the knee down. The pronated foot is flexible and loose, allowing it to adapt to the ground you've just stepped on. Pronation is your natural 'shock-absorbing mechanism'.

This contact phase continues until the foot is completely flat on the ground.

2) Midstance phase: The foot is flat on the ground and in this part of the gait cylce your body weight passes over your foot as the body comes forward. This is where your foot supports your body weight. The midstance phase is the part of the gait cycle where an abnormally functioning foot such as an over-pronated foot (fallen arches) or an over-supinated foot (high arch foot) will manifest its problems.

This phase ends as your body weight passes forward eventually forcing your heel to rise off the ground. At this stage supination occurs and the opposite to pronation happens: the muscles tighten and the foot becomes a rigid lever for the leg muscles to pull against. Rigidity in the foot should occur as the foot is propelled forward towards the next step. With supination, the foot rolls outwards and the lower leg rotates externally.

3) Propulsion phase: this is where the foot pushes off the ground to propel the body forward. Body weight is picked up by the ball of the foot and lastly the weight is absorbed by the big toe as you push off with that foot.

It is important to understand that both pronation and supination are part of a normal, healthy walking pattern! Pronation (rolling inward) acts as a shock absorbing process and supination (rolling outward) helps to propel our feet forward.

What exactly is over-pronation?

Over-pronation occurs when we pronate too deep and for too long, not giving the foot a chance to 'recover' and supinate. The foot stays flexible at all times. Over-pronators use a lot more energy when walking. Worse, over-pronation causes an imbalance throughtout the entire body, putting excessive strain on the feet, legs, knees and lower back.

Other terms for over-pronation are 'fallen arches', 'dropped arches' or 'collapsed arches'. The term 'flat feet' is also often used. However, a true 'flat foot' is very rare. In fact, less than 5% of the population have completely flat feet (Pes Planus) with no arch present whatsoever. Most of us (90%) have a normal to low arch and only 5% have a high arch. People with a high arch (Pes Cavus) are also called 'over-supinators'. This means that the foot stays rigid at all times and lacks its natural shock-absorbing mechanism.

It's important to appreciate that you don't have to be flat-footed to suffer from over-pronation! In fact, the vast majority of people with a 'normal- to-low arch' suffer from over-pronation. Interestingly, the arches may appear quite normal when sitting (or even standing up-right), but when we start to walk the problem of over-pronation becomes evident...with every step we take the arches collapse and the ankles roll inwards.

Over-pronation can be caused by a number of factors. Weak ankle muscles, being over-weight, pregnancy, age or repetitive pounding on hard surfaces (like pavements and concrete floors) can all lead to over-pronation. Over-pronation is also very common with athletes, especially runners.

What are the consequences of over-pronation?

Whether you have a true flat foot or have a normal-to-low arch and suffer from over-pronation (like 70% of the population), in both cases your poor walking pattern may contribute to a range of different complaints.

Many people over-pronate, however there are no clear symptoms, no aches or pains or complaints - especially in younger people (under 40's).

When people reach 40 or 50, poor foot function will start to show and over-pronation will take its toll. Many years of over-pronation will result in wear and tear in the feet, ankle and knee joints and lower back. People will simply accept these common aches and pains as a sign of ageing. Very few people realise these complaints have a lot to do with their fallen arches!

So what are the most common complaints related to over-pronation?

Plantar Fasciitis is a very common condition caused by over-pronation. As the feet flatten, the Plantar Fascia (fibrous band of ligaments under the foot) is being overly stretched, leading to inflammation in the heel, where the fascia attach to the heel bone. Plantar Fasciitis causes chronic heel pain and sometimes a heel spur develops (bony growth at the heel bone).

With over-pronation the foot continues to roll inwards, when it should be pushing off and outwards. When the foot rolls inwards the lower leg will follow and rotate internally and stay in this position (instead of rotating externally with supination).

This puts a lot of strain on the leg muscles (especially the calf muscles), causing aching legs and shin splints. Also, the twisting of the lower leg displaces the patella (knee cap). The knee is a hinge joint, designed to flex and extend (like a door, if you like). It's not designed to rotate!

Furthermore, when the legs rotate inwards the pelvis is forced to tilt forward. This results in constant strain and stress on the lower back muscles.

What can we do to fix the problem of over-pronation?

There is no real cure as such for over-pronation, however a lot can be done to prevent it. The most effective way to minimise over-pronation and its effects on the body is by wearing orthotics inside the shoes.

An 'orthotic' (orthotic insole, shoe insert or orthosis) is a device placed inside the shoes with the purpose of restoring our normal foot function. Different types of foot orthotics are available, from special custom-made devices (prescribed by a Podiatrist) to so called 'off-the-shelf' orthotics which can be purchased from pharmacies, good quality shoe stores or specialty websites.

Orthotics correct the problem of over-pronation and they re-align the foot and ankle bones to their neutral position, restoring our natural foot function. In turn, this will help alleviate problems not only in the feet, but also in other parts of the body!

In addition to wearing an orthotic, it is recommended to wear supportive shoes with some degree of built-in 'motion control'.

Motion control shoes incorporate support features into the shoe. Shoes with adequate arch support and firm heel counters help control over-pronation and will stabilise the heel and ankle during walking. Some shoes also have side posts for extra lateral support. Firm midsoles reduce pronation and protect the ankles and knees from lateral stress. The inner side of the midsole may be made of a denser material (dual density midsoles) to reduce the amount of pronation. A heavy person who overpronates will need a heavier, more supportive shoe than a light person with the same degree of pronation.

Too many shoes these days are using soft materials all-around the shoes and are very 'floppy' giving no support or stability whatsoever. In summer, many people wear open footwear such as sandals and flip-flops which are even worse in biomechanical terms.

Over-Pronation, Fallen Arches and Flat Feet

Peter Van Dyke is a Dutch foot specialist and orthotist with a special interest in heel pain , heel spurs, Plantar Fasciitis and orthotics. He gives advice on effective remedies to help relieve aching feet and prevent further problems. He also works closely with a number of large orthotics manufacturers in Europe, the USA and Australia.

Pain On Top Of The Foot

The purpose of this article is to give you information seekers an easier way to diagnose your pain on the top of the foot. I have noticed that many people use "top of foot pain" as their "search" term.

I have listed the more common problems that we foot specialists see on a regular basis, but this list is not all inclusive. Pain can occur with or without a history of trauma. Sometimes repetitive action (or microtrauma as I like to call it) can create pain on top of the foot.

\"Foot Specialist\"

Hopefully this will help you in your search for answers.

Pain On Top Of The Foot

TENDONITIS- Diffuse pain on top of the foot which may also include swelling and even redness. There may or may not be a history of trauma.

GANGLION CYST- A spongy to firm lump on top of the foot that may or may not be freely moveable. The lump itself may not be painful on pressure, but pressing on it may cause pain beneath it.

MIDTARSAL FAULT- In people whose feet have a tendency to collapse (fallen arches), there ends up being a jamming of the bones on top of your foot that will lead to pain, with or without shoes. Generally, there will be no history of trauma.

NERVE ENTRAPMENT- There are small nerves running from the ankle down to the toes that are located right under the skin. These are sensory nerves (which give us feeling on the top of the foot). It is not uncommon for these nerves to become traumatized from the pressure of a shoe (mainly tied too tight) putting pressure on the nerve which is then "jammed" into a bony projection underneath it. This nerve is then entrapped and it becomes inflamed and thus painful or in some cases there will be numbness on part of the top of the foot.

STRESS FRACTURE- Without any history of trauma, a person can develop severe pain on the top of the foot usually in the metatarsal area. It will be a localized pain, possibly with some swelling and perhaps redness.

BONE SPUR- A bone spur in the foot is usually a result of arthritic changes in the foot, bone will overgrow and produce abnormal protrusions on top of the foot. Either damage to the specific joint or pressure from your shoe on the overgrowth of bone (bone spur) will cause pain.

SUPERFICIAL PHLEBITIS- Many of the veins on the top of the foot are directly underneath the skin. Since the foot is subject to trauma every step you take, at times the nerves will become inflamed and develop a superficial phlebitis. This is not as dangerous as a deep vein phlebitis seen in the leg, but medical care is warranted.

More detailed information on this subject matter can be found at my web site.

Pain On Top Of The Foot

Dr. Mitnick is a foot specialist with over 25 years of clinical practice treating conditions of the foot, ankle and lower leg. For more information on various foot, ankle and leg conditions visit: www.foot-pain-explained.com

The Importance of Foot Hygiene in Foot Health

The importance of good foot hygiene goes far beyond the need to keep the feet from becoming dirty and developing odor. Proper foot hygiene can prevent the development of numerous foot problems, and for some individuals may save their leg from amputation. This article will discuss the way people can properly care for their feet and keep them healthy for years to come.

Foot cleanliness is an important part of keeping the body clean. Anyone who has ever walked barefoot can relate to that when the soles of the feet become soiled. However, even those who wear shoes all the time are still at risk for 'soiling' of the feet. This soiling comes not from dirt but from the natural shedding of the skin, combined with sweat residue, sock lint, or shoe debris if one does not wear socks. All of this material provides a good platform upon which bacteria and fungus can accumulate, and eventually this can cause skin infections. The most common infection seen in the skin is that from a fungus.

\"Foot Specialist\"

This infection is commonly called Athlete's foot, and millions of humans (if not nearly all) suffer from this condition from time to time. While this condition is easily treated, the long term presence of fungus can distract the skin's immune system and lead to the sneaking in of bacteria into the cracks and skin ripples that are found in Athlete's foot. Bacteria is also present in soil and on walking surfaces exposed to other bacteria (like in kitchens and baths), and barefoot walking can potentially expose the skin to these organisms. Bacterial infections are not as benign as Athlete's foot, and can enter the skin and spread up the foot into the body. For diabetics and others whose immune system is not as strong, these infections can pose a serious risk to the health of the foot and leg, and occasionally they result in an amputation if the infection is serious enough.

The Importance of Foot Hygiene in Foot Health

By washing the foot, especially in between the toes, the debris and soil that fungus and bacteria accumulates on is removed, and the skin is left with a healthy top surface. Vigorous scrubbing is not necessary, and can lead to skin irritation if one is too aggressive. Careful removal of soap residue is needed, as is the careful drying of the foot and toes to prevent skin irritation from lengthy water exposure.

Another important aspect of good foot hygiene is to keep the feet well moisturized. From time to time, especially in the winter, the foot skin will dry out. For some, this is a result of genetics or diseases which reduce the moisturization of the skin. With drier skin comes more cracks and crevasses that bacteria and fungus can use to enter the skin. Dry skin can also potentially painful cracks so deep that a wound develops. The practice of soaking the foot to either make it moister or to remove fungus or bacteria only makes this worse, as soaking depletes the skin of vital oils that help keep it moist. Some bacteria also thrive in foot baths, and frequent soaking can sometimes cause infections. The daily application of a good moisturizing cream to the feet can keep the skin moist and its surface smooth. It is important not to place the moisturizing cream in between the toes, as this area is at risk for fungus development that can also follow overly moist toe spaces.

Toenails are often ignored when foot hygiene is taken into consideration. Like every other part of the foot, the toenails need care and maintenance to prevent problems from developing. Nails that are too long are at greater risk of breaking off when the toe is stubbed. This can lead to pain, inflammation, and possibly infection of the skin around the nail itself. Nail damage can also lead to the introduction of fungus under the nail itself. The nail will become discolored, thickened, and misshapen from this infection. It is treatable, but a nail fungus infection requires a lot of time for eradication. Keeping the nails short can prevent some of this nail injury by reducing the likelihood of the nail lifting up during an injury event. In turn, this can reduce the chance that a nail fungus will develop. Although generally benign, nail fungus is still a chronic infection and should be avoided. However, not all changes to a nail's color or appearance is simply a fungus. Any color change in a toenail should be evaluated by a foot specialist or dermatologist, as some skin cancers or body-wide disease appear as changes to a toenail.

When trimming nails, care must be taken not to cut too deep into the skin sides. The reason for this involves ingrown nails. Ingrown nails develop as a result of genetics or gradual pressure injury to a nail. Contrary to popular belief, they are not caused by cutting the nail, as the nail grows from the deep end of the toe, which is not affected by the way it is cut. However, by cutting the nail too short into the side of the skin, one irritates the skin. A reaction then develops which causes skin inflammation. The inflamed skin becomes irritated against the ingrown nail that did not previously bother it, and pain subsequently is felt. Infection can follow as bacteria becomes trapped within the swollen skin border. While this condition is easily and permanently treated in-office by a foot specialist, avoiding it by trimming the nails without cutting into the skin may be an easier option.

Properly fitting shoes are another consideration in foot hygiene. Shoes are worn for many reasons, although the basic reason for shoes is to protect the feet from the ground. This protection is at risk when one wears poorly fitting shoes simply for fashion or convenience. Shoes that are too tight, too narrow, or too shallow will cause skin irritation to occur where the shoe rubs the skin. If the irritated area is over a prominent bone, such as on the toes or sides of the foot, the skin may start a process to protect itself. This process leads to the formation of corns and calluses, which is simply a thickening of the top layer of the skin created to protect the skin. Corns and calluses can cause pain, and in some cases (especially in diabetics and the elderly) can lead to the development of wounds underneath them. By reducing the shoe pressure on the skin through the use of a properly sized and fitted shoe, the development of corns and calluses can be slowed or even eliminated.

When a shoe is worn that is too big for the foot, the foot will move and piston within the shoe during walking. This ultimately can lead to toenail bruising as well as foot pain. When purchasing shoes, one's foot should be measured by a knowledgeable shoe clerk and the shoe fitted to that size, considering length AND width. A foot's width is often ignored when purchasing shoes, especially given that many retailers have scaled back the selection of different widths in stock. In the long run, purchasing shoes at a quality shoe store that carries many widths is better that the convenience of a discount retailer that has more styles but less sizing variations. The style of the shoe needs to be considered as well. Someone with a wide foot due to bunions and flat feet should not be in a tight pair of pointed flats. Unfortunately, many people stubbornly refuse to change shoe types out of concern for fashion or the inability to change old habits.

As one can see, the importance of foot hygiene involves much more that just the act of keeping the foot free from dirt and odor. Keeping the skin and nails healthy prevents the development of infections, and keeping the skin smooth and comfortable prevents the development of painful lesions that can limit activity and the enjoyment of life. Making time for the foot during daily body care can pay off in a big way over the long run.

The Importance of Foot Hygiene in Foot Health

Foot Pain Signs, Symptoms & Diagnosis

When it comes to foot pain, everyone is different, but the most common sign is going to be discomfort in one or more parts of the foot. The first thing a foot pain sufferer needs to do is to make sure the source of the pain isn't coming from something that isn't easily fixed, such as an ill-fitting pair of shoes or a high pair of heels. With those common culprits removed from the picture, it's a good idea to notice things like where the pain starts and if it migrates at all, what time of day and during what activity the pain is most acute, a particular event that might have caused the pain, any lingering health concerns that might have attributed to the pain and so on.

The symptoms of foot pain are pretty much common sense. Anything that you feel in your foot that isn't right. Things like swelling that won't go away, random numbness for no apparent reason in the feet, unexplained redness and either the feet being too warm or too cold without any cause. Considering how important your feet are to your basic health and wellbeing, don't' wait for one of these specific symptoms to worsen before you go seek the advice of a doctor.

\"Foot Specialist\"

Diagnosing foot pain is a fairly straight-forward affair. A podiatrist, is a foot specialist, and goes to school for a lot of years to be able to hold someone's foot in their hands and listen to the type of pain you're suffering from and be able to tell you what the problem is. You should expect your doctor to ask you about the types of shoes you wear and what physical activity you engage in that might have resulted in the foot pain. If the doctor is unable to diagnose your condition by touch, medical science has equipped the intrepid doctor with several tools that might just do the job.

Foot Pain Signs, Symptoms & Diagnosis

X rays are used to take a picture of the inside of your foot using low doses of radiation. While excessive exposure to x-rays has proven to be bad for you, getting an x-ray once in a while won't hurt. The x-ray can tell the doctor if there are small breaks, fractures or fissures that could be causing your foot pain.

MRI machines (magnetic resonance imaging) can be used in the same way as the x-ray to see inside your foot without having to cut you open. The MRI machine uses magnets to make images on a computer screen. The doctor can then tell if there are any problems with the bones and the soft tissue inside the foot. It can also help pinpoint small fractures that might not be clear on the x-ray.

If the doctor thinks it's arthritis that's causing your foot pain, he can request a synovial fluid analysis. Don't let the big medical name fool you, it's a straight forward procedure where the doctor takes fluid samples from the joints in the foot and tests them to see if the surrounding joint is arthritic.

A proper diagnosis is extremely important to ensure that you are properly treating and curing your type of foot pain.

Foot Pain Signs, Symptoms & Diagnosis

Dave Wilson writes a free newsletter to help people relieve their footpain. You can grab a copy for free here: Foot Pain Relief Free Newsletter. For further information on Foot Pain please visit Foot Pain or Foot Pain Symptoms.