Ganglion Cysts

A ganglion cyst is a fluid filled mass that forms along tendon sheaths (the thin coating around a tendon) or joint capsules (the envelope encompassing a joint). These cysts can vary in size, and can change in size or even disappear with possible recurrence later. These cysts often form in the wrists, but are commonly noted in the foot and ankle as well. While the exact cause is unknown, they can be secondary to a traumatic event or repetitive trauma to one area.

Ganglions are benign masses that present as a noticeable lump under the skin. They can cause numbness, tingling, or burning if they are located adjacent to a nerve, or pain if they cause pressure against a tendon or joint.

Diagnosis is typically clinical. Your physician will take your history and perform a physical exam on your foot, and will discuss the most appropriate course of action. Treatment options vary from conservative to surgical.

Fractures

The word fracture means a break of the bone, either partial or complete. These can be the result of trauma, an injury, or even the result of repetitive stress (stress fractures).

Fractures can vary in intensity ranging from avulsion fractures (small pieces of bones that get pulled off from the rest of the bone) to severe breaks that require surgery to repair.

Diagnosis is based on clinical exam and x-ray, though sometimes a CT scan or MRI may be necessary. Patients typically present with pain at the site of the injury in addition to the surrounding areas, swelling, bruising, difficulty or pain with walking, change in appearance of the foot or ankle, blisters (these should be treated promptly by a physician) or bone protruding through the skin (this is an emergency and needs medical attention immediately).

Plantar Fasciitis

Plantar fasciitis is inflammation of a ligament on the bottom of the foot known as the plantar fascia. The plantar fascia is a congruous with part of the Achilles tendon. It originates at the heel, supports the arch, and blends with tissue at the base of the toes. Plantar fasciitis occurs when this thick band of tissue becomes irritated and inflamed. Oftentimes this presents as heel pain, though pain can also occur in the arch of the foot. The cause of this issue is can be due to faulty structures of the foot such as flat feet, high arch feet, long periods of standing or walking, running styles, certain shoe wear, and tight muscles.

Symptoms include intense pain at the bottom of the heel or through the arch. Pain can occur gradually over time or after acute trauma. The pain is often worse after periods of inactivity such as sleeping or sitting for a long time.

Diagnosis is based on the history of the pain and the clinical exam performed by the doctor. There are several treatment options that range from stretching modifications, physical therapy, deep tissue therapy, medications, and possible surgical intervention in extreme cases. An X-Ray may be necessary to further exam the heel for possible contributing pathology. Over-the-counter foot orthotics or custom orthotics may also be recommended for short or long term pain relief.

Tendinitis

A tendon is a thick band of soft tissue that connects a muscle to a bone. Tendonitis is inflammation of the tendon most often caused by repetitive activity over time. This office will focus mostly on tendonitis of the foot or ankle, which includes but is not limited to Achilles tendonitis, posterior tibial tendinitis or peroneal tendinitis.

Symptoms includes pain at the site of the tendon and surrounding soft tissue. It can also include swelling, redness, tenderness, limited range of motion or difficulty walking.

Diagnosis is based on the history of pain and the clinical exam performed by the doctor. Based on the duration and severity of your symptoms your doctor may discuss with you treatment options that range from physical therapy, deep tissue therapy, possible injections (non steroidal), medication, and other conservative options. Occasionally, your doctor may discuss surgical options if a tendon is chronically injured or torn.

Ankle Sprain

A sprain is an injury to the ligament, or the band of tissue connecting a bone to another bone. Ligaments secure the joint and provide stability. Ankle sprains are an injury to one or more ligaments and often occurs on the outer ankle. Sprains can be acute but if left untreated can lead to ankle instability and chronic ankle pain.

Ankle sprains occur from a sudden fall or twist that forces the joint out of alignment. Previous ankle injuries can make you more susceptible to future ankle injuries. Symptoms of an ankle sprain include pain, swelling, bruising, tenderness, limited range of motion, difficulty bearing weight or walking.

Diagnosis includes a history of the pain and a clinical exam performed by the doctor. Fracture should be ruled out before proceeding with treatment. Ankle fractures can occur simultaneously with an acute ankle sprain and will need X-rays, which can be performed in the office. Sometimes an MRI may be necessary to determine the level of injury to the ligaments. Treatment includes but is not limited to low profile bracing or a walking boot followed by physical therapy.

Other Sprains/Strains of Lower Extremity

A sprain is an injury to the ligament, or band of tissue connecting a bone to another bone. Ligaments secure the joint and provide stability. A strain is an injury to a muscle. This office will focus primarily on sprains and strains of the foot and ankle. Sprains and strains can occur from repetitive activity, sudden falls or twists of the ankle or direct trauma to a muscle.

While sprains and strains affect different soft tissue, the symptoms often present in the same way. Symptoms include pain, redness, swelling, bruising, limited movement and difficulty weight bearing or walking.

Diagnosis of a sprain or strain will derive from a complete history of the injury and a thorough foot and ankle exam performed by the physician. Fracture must be ruled out, so x-rays may be performed in the office, if necessary. To promote a fast recovery, many treatment options will provided ranging from conservative care to surgical options.

Bunions

A Bunion results from changes in the front portion of the foot. When the big toe moves towards the 2nd toe rather than pointing straight ahead, a bump may be noticable on the outer edge of the foot. This malalignment is what causes a bunion. A bunion can also occur with the pinky toe moving towards the 4th toe and is referred to as a Tailor’s bunion. Worsening of the bunion occurs slowly over time.

Pain can occur when directly touching the bump, such as narrow foot wear rubbing against the bump. Pain can also occur deep in the joint and can result in limited and painful range of motion. Symptoms can also include inflammation, redness, burning, or numbness. Symptoms can be aggravated by improper footwear.

A bunion is often easily diagnosed by inspection and evaluation by the physician. However, an X-Ray is recommended to observe underlying bony changes in the foot. Non-surgical treatments include padding, splinting, orthotics, or possible steroid injections. Once conservative treatments are exhausted, surgery will be considered and discussed.

Hammer Toes

Hammertoe is a deformity formed by the contracture of the joints in the toes. This deformity can place abnormal pressure on the toes when wearing poor foot wear. In the early stages the joints are still flexible and can be treated with non-invasive measures. Over time, if left untreated the joints can become rigid and painful. These may require surgical intervention to correct the deformity and decrease pain.

The most common cause of hammer toe is a muscle or tendon imbalance. This imbalance causes the bending of the toe which will lead to symptoms over time. Some symptoms include pain, irritation when wearing shoes, the development of corns or callouses between the toes or on the ball of the foot, inflammation of the toes and contracture of the toe.

Diagnosis is often obvious due to the deformity. However, a physical exam will always be performed and oftentimes an x-ray to observe the bony changes. Hammer toe is a progressive disease and usually worsens with time. Non-surgical treatment includes shoe gear changes, and padding. When conservative care is exhausted then surgery will be discussed.

Neuromas

A neuroma is a thickening of the nerve in a body. In the foot and ankle, the most common neuroma is Morton’s Neuroma, or inter-tarsal neuroma. A neuroma is a painful condition, also referred to as a (pinched nerve). It is a benign growth, frequently found between the 3rd and 4th toes.

Symptoms include burning, numbness or tingling between the toes or pain in the arch of the foot. A common sign is the feeling of a “bunched up sock in the shoe” when walking. Causes include biomechanical deformities and improper foot wear.

In the early stages, non-surgical treatment is successful which includes padding, orthotic devices, and injection therapy. If conservative care is exhausted, surgery may be considered.

Nail Issues

Common nail issues include fungal/bacterial growths, thickened toenails, bruises under the toenails or ingrown toe nails. Nail issues can also arise secondary to diabetic changes in the foot.

Symptoms can include pain, obvious deformity, redness, tenderness.

Conservative treatment will include preventative measures and education on the causes these syndromes. In-office applications of medical-grade products may be offered to begin treatment as soon as possible to achieve pain relief and prevent future occurrence. Other modalities include reducing nail thickness in the office, topical medication, or possible procedures to remove the offending nail or nail border.

Neuropraxia/Neuritis

Neurapraxia is a disorder of the peripheral nerve system that can cause temporary motor or sensory function due to blockage of the nerve conduction cascade. Nerve condution studies may be ordered in order to make this diagnosis. Typically this type of nerve injury responds to non-surgical management such as physical therapy.

Flat Feet

Flat feet, or pes planus, is a structural deformity in the foot presenting in a collapse of the inner arch of the foot. This deformity can lead to a change in gait and may lead to injury. X-rays and gait analysis may be performed to assess the severity and consider treatment options such as orthotics, or possible reconstructive surgical intervention when necessary. Flat feet can also lead to bunions and tendinopathies.

High Arch Feet

High Arch Feet, or pes pes cavus, is a structural deformity in the foot presenting in a high inner arch of the foot. This leads to increased pressure on the ball of the foot. This deformity can lead to a change in gait and may lead to injury, commonly seen on the outside of the foot. X-rays and gait analysis may be performed to asses the severity and consider treatment options such as orthotics, or possible reconstructive surgical intervention when necessary. High arch feet can also lead to hammer toe, bunions, and calluses.