FOREFOOT CONDITIONS

Athlete's Foot


Athlete's foot is a common condition that causes redness, itching, dry flaking skin, and increased odor, especially between the toes and on the bottom of the foot. In extreme cases it may also include cracks in the skin and blisters. It is a fungal infection that may occur on any part of the body, most notably in moist areas with skin folds. When the fungus infects the foot it is referred to as tinea pedis or athlete's foot. The same fungal organisms can also infect the toenails. This condition is common in feet due to the dark moist nature of our shoes, as well as walking barefoot in moist areas such as showers, locker rooms, and around swimming pools. It may be common in people whose feet sweat more often as well. This is why it is commonly referred to as Athlete's foot. Avoiding barefoot walking in moist areas, changing socks often if feet sweat, and practicing proper foot hygiene may help to reduce the growth and spread of fungus. There are several over the counter powders and creams used to treat athlete's foot, but in some cases prescription medications are required. We can fully evaluate you at our clinic, and recommend which treatment options are best for you!




Bunion (Hallux Valgus)


A bunion (medically termed Hallux valgus) is a bony bump that is noticed on the side of the foot where the big toe attaches to the foot. It may first be noticed as a small bump, but over time becomes more prominent. Some may even notice the big toe deviating towards the smaller toes, and in late stages the big toe can overlap or underlap the second toe. This can also start to cause calluses or deformations of the second toe. Some people may have had the bump for years before it becomes painful. Bunions can affect one or both feet, and they can affect children as well as adults. They may become more painful in certain shoes that are tighter fitting in the toes, or shoes made of firm materials like leather. The bunion is caused by misalignment of the metatarsophalangeal joint, the joint where the big toe connects to the foot. We can perform an xray to determine the amount of misalignment, and along with our exam, determine the potential cause and how to treat your condition. Some bunions may be treated conservatively, but ultimately surgery may be required to reduce pain and realign the toe with the foot. There are several possible types of procedures for bunion correction, and we will discuss the best options for you after your examination.




Brachymetatarsia


Brachymetatarsia is a fairly rare congenital deformity that is usually noticed early in a child's life. This condition usually affects the 4th toe and metatarsal, but may affect others as well. It can be seen on either 1 or both feet. This condition consists of abnormal shortening of the affected metatarsal. The toe is usually affected by being curled, as well as dorsiflexed at the metatarsophalangeal joint. Many parents may be concerned by the asthetic appearance of this deformity, but this can also become an issue with rubbing in shoes after the child grows older. Some choose to only monitor the deformity as long as it does not cause any pain or secondary issues. Surgical correction is required for resolution of the deformity through callus distraction using an external fixation rail or bone grafting.




Bursitis


A bursa is a fluid-filled sack over areas of bone for shock absorbtion or to allow a muscle/tendon to glide over the area. In the feet, bursas are most common at the heels and toes. The bursa can become inflamed with repeated pressure or trauma, resulting in pain, redness, and swelling to the area. They can be treated with cold compress and NSAIDs (if patient is able to take them). If there is repeated issues with bursitis, the bursa may be drained in the office, but they are likely to return. They may have to be surgically removed if found to be a common occurrence or the pain is severe.




Capsulitis


Details to Come Soon




Fractures


A fracture is a broken bone. Bones can break in different types of ways. There are also more common types of fractures in certain areas of the foot and ankle. Depending on which bone is broken, and how it is broken, will determine how your fracture is treated. A simple fracture is when a bone is broken, but both parts of the bone are still in place, and fracture lines line up well. The joints near the fracture stay within limits of normal alignment. A compound fracture is also known as an open fracture. This occurs when there is trauma that causes a piece of bone to pierce through the skin, or the force of trauma breaks the skin, exposing the fractured bone beneath the skin. This is an urgent situation and should be treated immediately. Fractures can also be described by the pattern of the fracture. A transverse fracture is when there is a horizontal or straight fracture line. An oblique or spiral fracture describes a fracture line that is oblique or twists at an angle. A comminuted fracture occurs when the bone fractures into several pieces. These fractures are also unstable, and can potentially lead to bone or joint malalignment. Causes can include trauma or a force greater than the bone can withstand. Osteoporosis or other diseases can cause weakness in the bones and make them more susceptible to fracture. There are also stress fractures (discussed more under its own tab) that is caused from overuse. Symptoms include severe pain or tenderness, bruising, swelling that does not resolve at night, and possible deformation or misalignment. If you suspect a foot or ankle fracture, we will confirm through X-ray or other advanced imaging, then treat through conservative treatment with cast or fracture boot. With certain types of fractures, surgery may be required for stabilization of the fracture site, or correction of malalignment due to the fracture. The base of the 5th metatarsal is prone to fracture, called a Jones Fracture. This is due to the pull of the peroneus brevis tendon, which can apply enough pull to cause fracture. This can usually be treated nonoperatively, but in some cases may require surgical intervention.Toe fractures are common, and usually only require use of a fracture shoe to heal, unless the fracture involves a joint and has changed the alignment. Lisfranc Fractures occur in the midfoot. These can occur more commonly in sports such as soccer or football, where the ball of the foot is planted and the foot is forcibly flexed through the midfoot. Similarly, this type of injury may occur if a person steps in a hole while falling forward.




Frostbite


Frostbite occurs when tissues are exposed to extreme cold, to the point the water within the tissues starts to freeze. This causes the tissues to die. The feet are especially susceptible to cold injury since they are the furthest part of the body from the heart. Mild cold exposure can cause dryness, pain, and irritation to the skin. Increased exposure can lead to burning and or numbness, as well as temporary skin changes such as blisters. If exposure continues, it can lead to finally the tissues becoming completely numb from tissue death. Frostbite can be avoided by preparing to be in the cold with appropriately warm clothing and limiting time of exposure. If frostbite does occur, the affected skin should be rewarmed once out of the cold conditions, using warm (not hot) water. Dry heat such as a fire, radiator, or blow dryer are not recommended due to potential for heat damage to the tissue. Medical care should be sought for care, and also treatment of any other skin concerns along with it such as blisters and chance of infection.




Gangrene


Gangrene is tissue death due to lack of blood supply. There are 2 types of gangrene known as wet gangrene or dry gangrene Dry Gangrene occurs when there is decreased blood flow to the tissue from peripheral artery disease due to things such as atherosclerosis, diabetes, or tobacco use. Many people will live with peripheral artery disease without gangrene, until they suffer from a traumatic occurrence, even as small as stumping their toe. After the trauma, their tissues do not have adequate blood flow to heal, so gangrene occurs. This can be avoided through early detection of diseases that make a person more susceptible to peripheral artery disease. It can also be avoided by avoiding tobacco use. After dry gangrene occurs, a person should seek medical care. Wound care to the affected area, as well as vascular testing and other testing to find the cause may be required. If vascular disease is identified, referral will be placed to a vascular surgeon to evaluate for possibility of reperfusion. Sometimes when treatment is initiated quickly, most if not all of the tissue can be saved. Other times, long term wound care can be used to allow for as much healing as possible. With this, auto-amputation may occur, where tissues that do not survive eventually separate away from the healthy tissue. In some cases, surgery may be suggested to reach a level of healthy tissue, so long term wound care can be avoided. Proper wound care is a necessity with dry gangrene to avoid it converting to wet gangrene. Wet gangrene is when there is tissue death due to lack of blood flow in the presence of infection. This can occur when there is a rapidly developing infection which reduces blood flow to the involved tissues. Wet gangrene can also occur from dry gangrene if infection sets in during the presence of dry gangrene. Wet gangrene is an urgent condition and can require hospitalization. Antibiotics are needed to treat the infection, and evaluation for interventions similar to dry gangrene are also used to treat it.




Gout


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Hallux Rigidus


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Hammertoes


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Ingrown Toenails


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Jones Fracture


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Neuroma (Morton's Neuroma)


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Polydactyly/Syndactyly


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Sesamoid Injuries


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Stress Fractures


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Tailor's Bunion (Bunionette)


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Toenails


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Turf Toe


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Webbed Toes


Details to Come Soon