Orthopaedic Associates of Chambersburg

TOPICS

• Bunions
• Hammertoes
• Heel Pain
• Foot and Ankle Injuries
• Neuromas (Nerve Tumor)
• Ingrown Toenails
• Fungal Toenails (Onychomycosis)
• Athlete’s Foot (Tinea Pedis)
• Corns and Calluses
• Plantar Warts (Verucca)
• Diabetes and Foot Health
• Orthotics
• Diabetic and Orthopedic Shoes

BUNIONS

SYMPTOMS:

• A firm bump on the outside edge of the foot at the base of the big toe
• Redness, swelling, or pain at the metatarsophalangeal joint
• Restricted painful motion of the big toe

CAUSES:

• Faulty biomechanics (the way we walk)
• Genetics
• Unstable great toe joint and abnormal motion
• Shoes
• Foot Injuries
• Neuromuscular Disorders
• Congenital Deformities
• Flat Feet

WHAT YOU CAN DO FOR RELIEF:

• Apply bunion pad around the boney prominence
• Wear wide shoes
• Apply ice to reduce swelling
• Avoid high heeled shoes

ORTHOPAEDIC ASSOCIATES TREATMENT PLAN:

• Silicone bunion pads
• Bunion “night splints”
• Orthotic Therapy
• Surgical Correction if conservative treatment is unsuccessful or if pain persists

SURGICAL OPTIONS:

• Depends on how severe the deformity is
• The surgery will remove the bony enlargement , restore normal alignment of the toe joint, and relieve pain
• A simple bunionectomy, which only removes the bony prominence, may be used for less severe deformities
• Severe bunions may require a more involved procedure which involves cutting the metatarsal bone and realigning the joint
• Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery

HAMMERTOES

WHAT IS A HAMMERTOE?

• A bending or contracture of the toe at the joint
• Usually affects toes 2 through 5
• More common in females than males

SYMPTOMS:

• Pain upon pressure at the top of the bent toe from footwear
• Formation of corns on top of the bent toe
• Redness and swelling
• Restricted motion of the toe joint
• Pain in the ball of the foot and at the base of the affected toe

CAUSES:

• Abnormal balance of muscles in the toes
• Hereditary
• Trauma
• Arthritis
• Shoes that are too tight

WHAT YOU CAN DO FOR RELIEF:

• Apply non-medicated hammertoe pad around bony prominence of toe
• Wear shoe with wide toe box
• Avoid high heeled shoes and tight fitting shoes

ORTHOPAEDIC ASSOCIATES TREATMENT PLAN:

• Padding with silicone hammertoe pads
• Orthotic Devices
• Surgical Options if conservative treatment is not successful

SURGICAL OPTIONS:

• For less severe deformities, the surgery will remove the boney prominence and restore normal alignment of the toe
• Severe hammertoe deformities may require fusion of the toe joint and possibly surgical alignment of the metatarsophalangeal joint of the affected toe
• Recuperation takes time and swelling and discomfort is common for several weeks following surgery

HEEL PAIN

CAUSES:

• Plantar Fasciitis
• Heel Spurs
• Injury
• Nerve Entrapment

PLANTAR FASCIITIS:

• Inflammation of the band of tissue (fascia) running along the bottom of the foot
• Common among athletes, especially runners
• Inflammation may be aggravated by poor shoes and lack of arch support
• Common signs are pain 1st thing in the morning and after prolonged periods of rest
• Orthopaedic Associates treatment plan for plantar fasciitis includes stretching, physical therapy, orthotic therapy, cortisone injections, and the possibility of surgical intervention if conservative treatment is not successful

HEEL SPURS:

• A boney growth on the underside of the heel bone, usually associated with plantar fasciitis
• Caused by a strain on the muscles and ligaments, especially the plantar fascia, on the bottom of the foot
• Biomechanical imbalance, running, or jogging, improper shoe wear, and obesity can all contribute to heel spur formation

EXCESSIVE PRONATION (Excessive inward motion; flat feet)

• Heel pain sometimes results from excessive pronation, or “inward motion”
• Pronation is the normal flexible motion and flattening of the arch of the foot
• Excessive pronation can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone, and thus may cause heel pain

OTHER POSSIBLE CAUSES OF HEEL PAIN:

• Rheumatoid Arthritis
• Neuroma or Bursitis
• Haglund’s Deformity (bone enlargement on the back of the heel )
• Sever’s Disease (pain in the heel usually in adolescent children)
• Achilles Tendonitis
• Bone Bruises or Calcaneal Stress Fractures

FOOT AND ANKLE INJURIES

TREATMENT IF AN INJURY OR ACCIDENT OCCURS:

• Rest: Resist activity and get off of your foot or ankle
• Ice: Place a bag of ice wrapped in a towel on the affected area in a20-minute-on, 40-minute-off cycle
• Compression: Lightly wrap an Ace bandage around the area of injury, do not pull too tight
• Elevation: Elevate your foot or ankle higher than your waist to reduce swelling
• If Bleeding: cleanse well and apply pressure with a gauze or towel and cover with a clean dressing
• Leave blisters unopened, use a compression bandage around the blister to provide relief
• Foreign materials such as slivers, splinters and sand can be removed carefully, but deep objects such as glass or a needle should be removed by your doctor
• If injury is dislocated, severely bleeding, extremely painful, a deep wound, or broken, please seek medical attention immediately by going to your doctor or the emergency room that day
• If you are diabetic or have vascular disease, do not attempt to self-treat. Seek professional advice from your doctor immediately

INJURY PREVENTION:

• Wear supportive shoes
• Wear hiking shoes or boots in rough terrain to prevent ankle injuries
• Don’t continue to wear shoes if they are worn unevenly
• The toe box in “steel toed shoes” should be deep enough to accommodate your toes comfortably
• Always wear hard-top shoes when mowing the lawn
• Don’t walk barefoot on paved streets or sidewalks
• NEVER walk barefoot if you are diabetic
• Watch out for slippery floors at home or at work
• If you get up during the night, turn on the light. Many fractured toes and other injuries occur while attempting to find one’s way in the dark

NEUROMAS (NERVE TUMOR)

ABOUT:

• A benign growth of nerve, usually between 3rdand 4th toes
• Causes pain and burning
• Affects women more than men
• May be caused by high or low arched foot
• Trauma to the area or improper footwear may also cause this problem

SYMPTOMS:

• Pain in the forefoot and between the toes
• Tingling and Numbness in the ball of the foot
• Swelling between the toes
• May feel as if you are walking on a “stone”

PREVENTION:

• Wear wider shoes with plenty of room
• Wear shoes with thick insoles
• Avoid high heels
• Massage the affected area and use an icepack for relief
• Use over the counter shoe pads

TREATMENT PLAN AT ORTHOPAEDIC ASSOCIATES:

• Padding and Taping
• Anti-Inflammatory Medications
• Injection Therapy: Sclerotherapy or Cortisone Injections
• Orthotic Devices
• Surgical Options if conservative treatment fails
• Surgical options may consist of decompression of the trapped nerve or removal of the nerve if the involved nerve is severely inflamed and painful

INGROWN TOENAILS

WHAT ARE INGROWN TOENAILS?

• Nails whose corners or sides dig painfully into the skin
• Usually occurs on the big toenail

CAUSES OF INGROWN TOENAILS:

• Improperly trimmed nails (should trim nails straight across)
• Heredity
• Shoe pressure
• Trauma

WHAT YOU CAN DO FOR INGROWN TOENAILS:

• Soak foot in warm salt water or soapy warm water
• Apply antiseptic and bandage to the area
• If you are diabetic or have vascular disease, please avoid self treatment and seek treatment from your doctor

TREATMENT FOR INGROWN TOENAIL AT ORTHOPAEDIC ASSOCIATES:

• Toe may be numbed appropriately with lidocaine (numbing medication)
• Ingrown toenail will be removed in a sterile manner
• If infected, patient will be placed on an antibiotic
• If this is a recurring problem , the nail matrix (place that nail grows from) can be killed with phenol treatment. This will prevent recurring ingrown toenails.

If interested in this treatment, please discuss it with your podiatric doctor.

FUNGAL TOENAILS (ONYCHOMYCOSIS)

WHAT IS ONYCHOMYCOSIS?

• infection underneath the surface of the nail caused by fungi
• Nail often becomes darker in color and foul smelling
• Debris may collect beneath the nail plate
• The fungus is capable of spreading to other toenails

CAUSES:

• Damp areas such as swimming pools, showers, or locker rooms
• Injury to the nail bed
• Diabetes, immunodeficiency, and circulatory problems make patients more susceptible to fungal nails
• Athlete’s Foot
• Excessive sweating

WHAT YOU CAN DO TO PREVENT TOENAIL FUNGUS:

• Proper foot hygiene
• Clean and dry feet daily
• Wear shower shoes in public areas
• Change socks and shoes twice a day if you sweat a lot
• Wear shoes that fit well and made of materials that breathe
• Avoid tight socks or hosiery
• Disinfect instruments used to cut nails
• Disinfect pedicure instruments

TREATMENT FOR TOENAIL FUNGUS AT ORTHOPAEDIC ASSOCIATES:

• Your doctor may take a toenail culture to confirm the presence of fungus
• Cutting and debridement of toenails
• Your doctor may prescribe a topical or oral antifungal medication such as Lamisil
• In some cases, surgical treatment may be required such as temporary removal of the infected nail or permanent removal of the toenail
• Permanent removal of a chronically infected and painful toenail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of the deformed nail

ATHLETE’S FOOT (TINEA PEDIS)

ABOUT:

• Skin infection of the foot occurring between the toes or on the soles of the foot
• Fungus attacks the feet because shoes provide dark, moist environment
• Dampness of public swimming pools, locker rooms, and showers can also breed fungus
• Allergic reactions, eczema, psoriasis, and rashes can also mimic athlete’s foot

SYMPTOMS:

• Dry Skin, Itching, Scaling, Swelling, and Blisters
• Blisters often lead to cracking of the skin
• Athlete’s Foot may spread to soles of the feet or to toenails
• It can be spread to other parts of the body

PREVENTION:

• Good foot hygiene
• Daily washing of the feet and drying between toes after showering
• Change shoes and socks regularly
• Avoid walking barefoot, use shower shoes
• Use foot powder in shoes to decrease sweating
• Avoid rubber or plastic shoes

TREATMENT PLAN AT ORTHOPAEDIC ASSOCIATES:

• Prescription foot cream or medication
• Antibiotic prescription if the athlete’s foot causes an infection

CORNS AND CALLUSES

WHAT IS A CORN?

• A small circular lesion on the skin of the foot
• Forms due to repeated pressure
• Has central core of hard material (unlike a callus)
• Hammertoes can cause corns from rubbing on the top of the shoes

WHAT IS A CALLUS?

• A thickened area of skin on the foot caused by pressure and repeated rubbing
• Causes can be from foot deformity or shoe rub
• The rubbing causes the skin to produce a layer of protective skin (a callus)

TREATMENT FOR CORNS AND CALLUSES:

• Over the counter padding or non-medicated corn or callus pads
• Wider shoes that do not rub
• Orthotics
• Paring or shaving of the lesion by your physician
• If deformity is bad enough, your doctor may recommend correcting the cause of the corn or callus which could be a hammertoe deformity or bony prominence
• It is important that you avoid trying to remove a corn or callus at home; you also should avoid using medicated corn or callus pads, serious infection could occur

PLANTAR WARTS (VERRUCA)

ABOUT:

• Caused by a virus which invades the skin through small cuts or openings
• Children and Teenagers are more susceptible
• Thrive in dark, moist environments like locker rooms or swimming pools
• Can spread to other parts of the body
• May spontaneously disappear, but also may recur in the same location

SYMPTOMS

• Can be painful, but are harmless
• Can be confused with corns and calluses
• Warts are hard and flat with a rough surface and may have a center of black dots
• May bleed

PREVENTION:

• Avoid walking barefoot
• Change shoes and socks daily
• Keep feet clean and dry
• Check children’s feet periodically
• Avoid direct contact with warts from a person or different part of your body

TREATMENT PLAN AT ORTHOPAEDIC ASSOCIATES:

• Initially treatment is conservative with prescription medication or in-office acid treatment
• If wart does not respond to conservative treatment, then surgery may be recommended by your doctor. Surgery entails excision of the wart under local anesthesia.

DIABETES AND FOOT HEALTH

ABOUT:

• 16 Million people in the US are affected by diabetes
• Marked by inability to manufacture or properly use insulin
• Can cause damage to kidneys, nerves, eyes, heart, feet, and blood vessels if sugars are poorly controlled
• 86,000 lower limbs are amputated annually due to complications from diabetes
• Diabetes is the leading cause of end stage kidney disease
• Diabetes is the leading cause of new cases of blindness of people 20 to 74 years of age
• Type I Diabetes is known as “Insulin Dependent Diabetes” and usually affects children and adolescents. This disease is caused by the inability of the pancreas to produce insulin needed for survival
• Type II Diabetes is know as “Non-Insulin Dependent Diabetes” and usually affects adults over the age of 40. This disease is caused by insulin resistance.

RISK FACTORS FOR DIABETES TYPE II:

• A family history
• Obesity
• Prior history of developing diabetes while pregnant
• Being over the age of 40

PROPER DIABETIC FOOT CARE:

• Wash Feet Daily
• Inspect Feet and Toes Daily
• Lose Weight and Exercise
• Wear Thick, Soft Socks
• Stop Smoking and Don’t Drink
• Cut Toenails Straight Across and Never Remove Calluses by Yourself
• Don’t Walk Barefoot
• Don’t Wear High Heels, Sandals, and Pointed Shoes
• Be Properly Measured and Fitted Every Time You Buy Shoes
• See Your Podiatric Doctor For Foot Care and Checkups

TREATMENT PLAN AT ORTHOPAEDIC ASSOCIATES:

• Routine Toenail and Callus Care every 9 weeks by your doctor
• May be fitted for extra depth diabetic shoes or sneakers
• Consider orthotics for extra protection. Discuss this with your doctor

ORTHOTICS

WHAT ARE ORTHOTICS?

• Professionally prescribed shoe inserts, made either from the impression of one’s foot or a computer analysis of the foot
• They are designed to treat common foot ailments by controlling foot function and limiting excessive motion
• They treat abnormal walking patterns, and improve structural foot problems
• They provide arch support, shock absorption, and reduction of pressure points
• Orthotics are customized to the individual patient’s needs

HOW ARE CUSTOM ORTHOTICS DIFFERENT FROM OVER THE COUNTER INSERTS?

• Over the counter (OTC) inserts mainly provide cushioning and may offer some arch support
• OTC inserts are standardized and mass produced, the are not suitable for everyone
• Wearing the wrong type of shoe insert can harm feet, especially for people with diabetes or arthritis
• A podiatrist can determine whether an orthotic is an appropriate treatment based on individual evaluation; not all feet are the same
• Custom orthotics are physician prescribed and are fabricated to specific patient needs
• Custom orthotics can be used to offload pressure related problems, may offer a specific amount of arch support; and can be customized to patient activities, sports and also to patient weight
• A custom orthotic will last for many years in comparison to an OTC insert, which may last for only a few months

WHAT CONDITIONS ARE CUSTOM ORTHOTICS USED TO TREAT?

• Bunions
• Hammertoes
• Heel Pain
• Flat Feet
• Abnormal walking or gait
• In-toeing or Out-toeing
• Metatarsalgia (pain in the ball of the foot)
• Plantar Fasciitis
• Tendinitis
• Ligament Disorders
• Support and protection of the Diabetic foot

DIABETIC AND ORTHOPEDIC SHOES

WHO CAN GET SHOES FROM OUR OFFICE?

• Anyone is eligible to be fitted for shoes by our podiatrist
• We have a wide variety of both orthopedic and diabetic shoes as well as running shoes
• Shoe styles range from sneakers, running shoes, walking shoes, hiking shoes, men’s dress shoes, women’s dress shoes, mary janes, oxfords, and loafers
• Extra depth orthopedic and diabetic shoes are recommended for anyone with foot discomfort or anyone in need of extra foot protection
• Our running shoes are also highly endorsed and are worn by high level athletes
• If you would like to purchase shoes, you will be measured appropriately by our podiatrist and a specific shoe type will be recommended for your foot type
• Most patients are not covered for shoes through their insurance company, however, diabetics are usually covered for one pair of extra depth shoes per year
• We strongly encourage all of our patients to call their insurance company to see if they would be covered for orthopedic or diabetic shoes

MEDICARE’S THERAPEUTIC SHOE BENEFIT

• Since 1993, Medicare has covered certain therapeutic shoes and inserts for persons with diabetes
• Medicare covers diabetic shoes and inserts if the following criteria are met:

• Previous amputation, or
• History of foot ulceration, or
• History of pre-ulcerative callus to the feet, or
• Peripheral Neuropathy, or
• Foot Deformity, or
• Poor Circulation

• Patients also require a prescription for shoes from their medical doctor or to be fitted for shoe by a podiatric doctor as well as a letter from the patient’s physician stating that the patient does have diabetes (these letters are all handled by the staff at Orthopaedic Associates when you are fitted for shoes and your family doctor is notified appropriately)

* All above information is from American Podiatric Medical Association and the “American College of Foot and Ankle Surgeons”