Category Archives for Foot Conditions

Hammer toe


A hammer toe is a deformity of toe in which toe is curled downward instead of pointing forward. It can affect any of your toe but most commonly affects the second or third toe. Most of the time hammer toe may be present at birth, but it may also develop over time due to wearing poor-fitting shoes such as pointed and tight heels.

Causes of Hammer Toe

Your toe is designed in such a way that it has two joints that allow it to bend at the bottom and middle. Dislocation of the middle joint leads to hammer toe.

Common causes of hammer toe include:​

  • ​Arthritis
  • Wearing ill fitting shoes
  • High foot arc
  • Injury to toe
  • Tightened tendons and ligaments in foot
  • Pressure from Bunion

Signs and Symptoms of Hammer Toe

The most common symptom of hammer toe is discomfort while walking. It can also cause discomfort and mild to moderate pain when you try to move or stretch the affected toe. Symptoms of hammer toe include:

  • Pain during walking
  • Calluses or corns
  • Claw like toes
  • Inability to stretch and flex your toes
  • Toe that bends downward​

What to do if you notice these symptoms?

Visit your doctor especially podiatrist as soon as possible if you develop any of these symptoms.

​Who can diagnose and treat a Hammer Toe?

​A qualified and certified podiatrist can effectively diagnose and treat a hammer toe

Treatment of Hammer toe

A qualified podiatrist can help you in overcoming this problem. Your doctor can advise you OTC pads , cushions , or medicines to treat corns and bunions. However , if the pain still persists , your doctor may decide to surgically removes these bunions and corns. If you are unable to stretch and flex your toes , surgery is the treatment of choice to restore movements. Surgery can effectively remove deformed bone, reposition the toe , and realign your affected toes. Surgery is normally done by a podiatrist on outpatient basis and you can return home on the same day.​

What is a Bunion?


A bunion is a deformity of the proximal or base joint of big toe. It is basically a bony prominence from realignment and enlargement of joint at the base of big toe. It is a progressive bony deformity and most commonly affects women. The deformity can lead to many problems and may cause the foot to rub on shoes, which can cause pain, redness and inflammation of first metatarsoophalangeal joint. This bunion is also knows as tailor's bunion or bunionette.

What causes Bunions?

In most of the cases , cause of bunion is still unknown. There can be some hereditary or genetic tendency to have abnormality at this part of this joint. In some cases it is also associated with joint problems such as osteoarthritis and rheumatoid arthritis. However, regardless of the underlying causes, wearing tight or unfit shoes tends to make the disease worse. Wearing such shoes puts some extra pressure on the base of big toe and causes friction of underlying skin.

Symptoms and Problems of Bunions:

  • Pain
  • Difficulty in walking
  • Infection at base of toe
  • Wideness of foot
  • Arthritis of big toe
  • Deformation of second toe​

Treatment of Bunions

If pain and symptoms of bunion persists, consult a podiatrist as soon as possible.

The primary aim of management and treatment of patient with bunions t is to relieve pressure on the bunion and stop the progression of the deformity.

A podiatrist may recommend these treatments:

Padding and Taping: This is the first step in the treatment of bunions.Padding the bunion decreases pain and allows the patient to continue a normal and routine life. Taping helps in keeping the foot in a normal position, thus reduces stress and pain.

Medication: Anti-inflammatory drugs and steroid injections are often prescribed to relieve acute pain and inflammation caused by joint enlargement and deformity.

Physical Therapy: Physical therapy can be very helpful in providing relief of the inflammation and bunion pain. Ultrasound therapy is a very popular and effective technique for treating bunions without surgery.

Orthotics: A foot pad or Shoe insert may be helpful in stabilizing foot and ankle and may reduce symptoms and prevent worsening of the disease

Surgical Options: When early treatments or medications fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure, stress and repair the toe joint. Several surgical procedures and options are available to the podiatrist. The surgery will efficiently remove the bony enlargement, restore the normal anatomy and realignment of the toe joint, and relieve pain and inflammation.

Dellon Nerve Decompression (Surgical Management)


In the past, neuropathy was approached as a painful disease state for which symptoms could only be masked, but could rarely be cured. Some doctors subscribe to the theory that the nerve dies from the effects of neuropathy, and that the only treatment is to mask the pain and live with the disease.

We now know that the nerve is not dead, but has poor conducting abilities, similar to that of a short in electrical wiring. This is caused by the compression around and within the nerves. This compression is much like that seen in carpal tunnel syndrome where the hand experiences numbness, tingling and burning due to compression of the wrist nerve. In fact, if the compression continues long enough within the carpal tunnel, loss of muscular strength will also occur.

Dellon Decompression is an exciting new treatment option for patients that suffer from peripheral neuropathy, drop foot and neuritis. This procedure was developed by Dr. A. Lee Dellon, a Plastic Surgeon from John Hopkins University School of Medicine. This has truly been a revolutionary procedure that has helped thousands of patients. The surgical procedure for lower extremity neuropathy is similar to that done for carpal tunnel, and relieves pressure in the legs, ankles and feet. Studies have found that by performing a surgical nerve decompression, 80% of all patients have good to excellent relief from their neuropathic pain or numbness.

Small Fiber Peripheral Neuropathy


Peripheral nerves in a general sense, can be subdivided into large and small nerve fibers. Typically, small nerve fibers are affected before large nerve fibers. Small fiber neuropathy, aka: small fiber sensory neuropathy (SFSN), or C fiber neuropathy is a newer focus of neuropathy that is able to offer an earlier detection of neuropathy. Small nerve fibers are the nerve fibers near the skin's surface, which is why the symptoms deal with sensation. Usually the symptoms start in the feet and lower legs. The symptoms may include insensitivity to heat and/or cold, tingling, numbness, muscle weakness, cramps, pain, and other symptoms. Some people describe the pain as an electric shock, or walking on broken pieces of glass, or bags of ice on their feet. Sometimes people experience a loss in the ability to feel and do not even know it.

The disorder can be caused by diabetes, alcoholism, or other conditions, but many times it is idiopathic. Identifying that you have small fiber neuropathy is the first step. Other tests to identify potential causes is the next step, as therapy often consists of treating the underlying cause, as well as relieving the symptoms.

Foot Drop & the Common Peroneal Nerve


Have you ever crossed your legs, only to find your leg tingling with a sensation of 'pins & needles?' Since the Common Peroneal nerve is relatively exposed, similar to the ‘funny bone' in your elbow, this is not unusual.

A nerve the thickness of a pen, the Common Peroneal Nerve crosses from behind your knee, around the outside of your knee, to enter the muscles of the outside of your leg. This nerve gets compressed between the white covering of the muscles and the underlying bone, the fibula. Many times this nerve becomes subtly compressed and goes unnoticed until you get foot drop.

This nerve is susceptible to compression and may cause symptoms like difficulty lifting up your foot or toes, so your foot drags. It may cause numbness or buzzing below your knee, or feel like your leg is going to "give out" on you. Depending on the severity of nerve compromise, several conservative and surgical treatment options exist.

Peripheral Arterial Disease (PAD)


Before we focus on neuropathy, let's discuss our circulatory system. There are many cases in which the vascular system may be the predominant cause of your leg pain. The artery, vein, and nerves all course together and ruling out peripheral arterial disease is important. PAD is narrowing or blockage of arteries that results in poor blood flow to your legs. When you walk or exercise, your leg muscles do not get enough blood and you can get painful cramps. Peripheral arterial disease is also called peripheral vascular disease or simply poor circulation. Just like clogged arteries in the heart, clogged arteries in the legs mean you are at risk for having a heart attack or stroke. Plaque buildup in the legs does not always cause symptoms, so many people can have PAD and not know it. People who do experience symptoms, such as pain or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause.

One in every 20 Americans over the age of 50 have PAD and it is estimated that over 8 million are undiagnosed. Early detection of PAD has been shown to save limbs and lives, so if you have any of the risk factors you should undergo PAD screening by your podiatrist yearly or more often if symptoms occur.

The exact cause of plaque buildup in the limbs is unknown in most cases. However, there are some conditions and habits that raise your risk for developing poor circulation.

Your risk increases if you:

  1. Are over the age of 50.
  2. Smoke or used to smoke. Those who smoke or have a history of smoking have up to four times greater risk of PAD.
  3. Have diabetes. One in every three people over the of 50 with diabetes is likely to have PAD.
  4. Have high blood pressure. Also called hypertension, high blood pressure raises the risk of developing plaque in the arteries.
  5. Have high blood cholesterol. Excess cholesterol and fat in your blood contribute to the formation of plaque in the arteries, reducing or blocking blood flow to your heart, brain, or limbs.
  6. Have a personal history of vascular disease, heart attack, or stroke. If you have heart disease, you have a one in three chance of also having PAD.
  7. Are African-American. African-Americans are more than twice as likely to have PAD as Caucasians.

What are the symptoms of PAD?

Most patients with PAD have little or no symptoms until the disease is advanced; that's why screening exams are so important. Those who do experience symptoms have reported the typical signs and symptoms:

Claudication: fatigue, heaviness, tiredness, cramping in the leg muscles (buttocks, thigh, or calf) that occurs during activity such as walking or climbing stairs. This pain or discomfort goes away with rest or once the activity is stopped and during rest.

Rest Pain: pain in the legs at night that often disturbs sleep

Wounds or sores that heal very slowly or not at all

Color changes to the skin on the feet and lower legs Cold, pale feet and legs Decreased hair and nail growth on the feet

How is PAD Diagnosed?

Your podiatrist will start with checking the pulses in your foot and ankle, examining the skin for changes and wounds that are poorly healing. Often an ABI (ankle-brachial index) is performed which compares the blood pressure in your anus to your ankles. A Doppler exam may be ordered. This test uses sound waves to measure the blood flow in the veins and arteries in your arms and legs. If any of these exams are abnormal, your podiatrist may refer you to a vascular surgeon to discuss options for treatment.

How is PAD Treated? The overall goals for treating PAD are to reduce any symptoms, improve quality of life and mobility, and prevent heart attack, stroke, and amputation. There are three main approaches to treating PAD: making lifestyle changes, taking medication, and in some cases, having a special procedure or surgery. Your physicians will determine the best treatment options for you, based on your medical history and the severity of your condition.

How Can I Prevent PAD?

The cornerstone of prevention is lifestyle changes.

Exercise is very important and you should aim for 30-45 minutes of moderate intensity exercise each and every day.

Stop smoking immediately and ask your doctor for help if you have difficulty with smoking cessation.

Keep your cholesterol and blood glucose levels down. Keep your blood pressure in the normal range.

Decrease stress.

If you are overweight or obese, aim for a normal weight and again, ask your doctor for help) A diet low in saturated fats, trans fats and cholesterol is also helpful.

More than anything, talk to your doctors about a comprehensive treatment plan that decreases your PAD risks.

One in every 20 Americans over the age of 50 have PAD and the incidence is higher in diabetics. Most patients have little or no symptoms until it is too late! Early detection of PAD has been shown to save limbs and lives, so if you have any of the risk factors you should undergo PAD screening by your podiatrist.