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We create easy to read podiatric articles that detail conditions ranging from heel pain to foot surgery and everything in between. We match these with companion blogs that use current events for complete patient education. See article topics.

Nerve Disorders of the Foot and Ankle

Similar to well known nerve disorders in the hands, such as carpal tunnel syndrome, nerve disorders that affect the foot and ankle occur in patients for reasons ranging from stress to genetics. Nerve disorders of the foot should be addressed right away because they may be immobilizing in serious cases. Two of the most common nerve disorders of the foot and ankle are Interdigital Neuroma and Tarsal Tunnel Syndrome.

Interdigital Neuroma is caused by localized inflammation of one of the nerves that controls toe sensitivity in the frontal area of the foot. This inflammation is generally only found in the second or third interspace, and any other symptoms similar to Neuroma on other digits should be checked against other disorders. Symptoms include chronic burning or tingling sensations between the affected toes which can, at times, migrate to the toes themselves. This pain is often increased by walking, running, or by wearing shoes that compress the toes, such as high heels. A doctor should be consulted if this pain is chronic and if the symptoms get worse.

Typical examinations to determine the presence of Neuroma include radiographs, MRIs, and even bone scans of the affected area. Bone scans are only required if degeneration of bone is suspected, however. Surgery is often not required to alleviate the symptoms of Neuroma, and in many cases functional orthotics can be used to alleviate the stress of constant weight on the affected toes. Surgery is recommended for those patients that suffer from symptoms for 6 months or more, so reporting symptoms early can increase the rate of non-surgical recovery.

Tarsal Tunnel Syndrome, a condition that is less common than Interdigital Neuroma, is similar to Carpal Tunnel Syndrome in that it is caused by a compression of the nerve caused by any number of factors (mostly associ- ated with excess pronation). Typically seen in those that have either flatfeet or valgus heel positions, Tarsal Tunnel Syndrome has patients complaining of moderate to severe ankle pain that starts along the bottom of
the foot and often proceeds to the calf. Some more extreme cases occur with partial numbness and even atrophy of the foot and surrounding muscles.

If there is a good chance that someone has Tarsal Tunnel Syndrome, an EMG test is often used to diagnose the condition. If the diagnosis is positive, an MRI can be used to identify the compression of the nerve. Treat- ment with NSAIDS, functional orthotics, and rest off of the feet is often prescribed, but again, long standing symptoms require surgery, as do exacerbated symptoms caused by lesions present between nerves.

 


 

Foot Surgery

Foot surgery may be necessary for a variety of reasons, but it is normally reserved for cases in which less invasive procedures have failed to help with the problem. Cases in which surgery may be deemed necessary include, but are not limited to, surgically removing deformities of the foot (such as bone spurs and bunions), problems with arthritis that have caused severe bone issues within the foot, and reconstruction to attend to injuries caused by accidents and congenital malformation (such as club foot and flat feet). Foot surgery may be necessary for individuals of all ages and races.

If you find yourself in need of foot surgery, the reason why the surgery has been found to be necessary will dictate exactly what kind of surgery you need. If you have to have a growth, such as a bunion, removed, then you may undergo a bunionectomy. If your bones need to be realigned and fused together, then you may undergo a surgical fusion of the foot. If it is nerve pain and problems that you are enduring, then you may need to undergo surgery in which the tissue that surrounds the painful
nerve is surgically removed. Normally other, less serious treatments are first applied when a problem is discovered, but if those treatments are found to be ineffective, surgical techniques are considered and used.

Even though surgery of the foot is usually reserved as a last resort by most physicians, there are some ben- efits if you and your doctor choose to use surgery to fix the problem. The first is that the pain associated with the issue is normally relieved, which means that you can finally resume the activities your foot problem was preventing you from participating in. The second benefit is that, once you have the surgery completed, the problem is generally eliminated since it has finally been addressed.

History of podiatry has shown that foot surgery techniques continue to advance every year. Endoscopic surgery is just one of the many advancements that have been made in the field of foot surgery. As technology improves, foot surgical techniques will also continue to improve. Many procedures can now be completed using a very small incision and smaller, more refined instruments. Because of these better tools, surgeries are becoming less invasive, and recovery time has become a great deal shorter. Shorter recovery periods mean that you will be back on your feet in no time.

 


 

Orthoses

Orthoses are devices used to correct physical impairment caused by scoliosis, spina bifida, cerebral palsy, or foot deformities. Orthopedic devices control, guide, limit or immobilize body segments. They assist in move- ment; reduce weight bearing forces and aid in rehabilitation from fractures. They also correct the shape and function of the body.

Orthoses include ankle foot orthosis, thoracolumbosacral orthosis, knee orthosis and wrist hand orthosis. When ortho- ses were first made, plaster of Paris molds were made of
the patient and then materials like plastic, elastic, metal or a combination of those materials. Now braces for participants in contact sports are made from neoprene to allow move- ment but reduce the range of movement.

The Boston Brace is used to assist scoliosis sufferers. It is also called a low-profile or underarm brace. It fits under the breast to above the pelvic area in the front and below the shoulder blades to the tail bone in the back. By applying three point of pressure to the curve, the lumbar area is forced to flex, the abdomen is pushed in and the posterior is flattened.

The Charleston Bending Brace is only worn at night. A mold is made of the patient’s body bent towards the outward bulge of the curve. The design of the brace is built to correct the curve of the scoliosis. Repeatedly wearing this brace for eight hours should eventually correct the problem somewhat if not completely. The brace is good for patients with a curve of 20 to 36 degrees.

The Milwaukee Brace is used for mid-back curves. This brace consists of a plastic pelvic girdle and a neck ring. The pieces are connected in the front and back by metal bars. Pressure pads are place along the patient’s
curve pattern along the metal bars. This brace is rarely used but patients with a curve very high in the spine can benefit from wearing it.

A knee orthosis is a brace worn to give the knee strength. Osteoarthritis can cause significant pain in the knee resulting in immobility. Knee braces allow a person to remain active. Often therapy and drugs are used in con- junction with a knee brace.

Orthoses have changed over the decades. The materials used for the actual orthotic devices have evolved to include hydraulics as it appears in some knee braces that the patient adjusts to compensate for stability. When this is adjusted, it helps the knee by giving the sense of space between the bones which stops the pain that radiates when the bones rub together. Orthoses products stop pain and give patients the ability to move pain free.

 


 

Rheumatoid Arthritis in the Feet

Although rheumatoid arthritis actually attacks multiple bones and joints throughout the entire body, ninety percent of people who actually develop this condition usually do so in the foot or ankle area. Those who develop this kind of arthritis in the feet usually develop symptoms around the toes and forefeet first, before anywhere else. Rheumatoid arthritis appears to have a
genetic component. If it runs in the family, then you will be more likely to develop it as well.

Rheumatoid arthritis is an autoimmune disorder in which the body’s own immune system attacks the lining of the membranes surrounding the joints. This causes inflam- mation of the membrane lining, and the gradual destruc- tion of the joint’s cartilage and even bone.

Some of the most common symptoms that are associ- ated with RA include pain and swelling of the feet. Stiff- ness in the feet is also another common symptom that people experience. Those who have RA in the feet usually feel the pain in the ball or sole of their feet. This
can get to be very painful at times. A person's joints can even shift and become deformed after a period of time.

In order to properly diagnose RA in the feet it is usually necessary for a doctor or podiatrist to evaluate the area. Your doctor will also question you about your medical history, occupation, etc., to determine whether anything in your lifestyle may have triggered the condition. There are a number of tests that may be performed to help diagnose RA such as a rheumatoid factor test, although there is no one single test that will tell you for sure if you have RA. There are different X-rays that can be taken as well to determine if a person has RA in their feet.

There is a range of treatment options for rheumatoid arthritis. Treatment of RA is usually a lifelong process that includes a variety of methods of treatment and therapy. Your doctor can prescribe special shoes that should help with arch support as well as heel support. A physical therapist can help those with this condition learn exercises which will keep their joints flexible. Surgery may be needed to correct some of the issues with the feet, such as bunions, and hammertoes. Fusion is usually the most successful surgical option for rheumatoid arthritis. However, people need to keep in mind that there are some risks associated with these surgeries.