are areas of hard, dense skin. Calluses are wider and flatter
and found on the soles of the feet. Corns are smaller and usually
found on the tops of toes, or between them.
Cause: Too much pressure upon the skin causes Corns
and calluses. The skin's response to this pressure is to grow
thick and hard, creating the corn. Most corns are seen on the
tops of contracted, hammered toes or frequently between toes.
Here the knuckle is causing too much pressure, or sometimes,
a spur between the toes projects out and creates the corn.
Treatment: There are a number of treatment options.
Trimming the corn or callus and applying a felt or moleskin pad
will give temporary relief. Purchasing wider shoes to decrease
the pressure will help. An orthotic support with a depression
to relieve the pressure on the ball of the foot will help a callus.
Corns can be eliminated permanently if the toe is straightened
and the pressure from the bone beneath the corn is eliminated.
Definition: Toes that are contracted are called
Cause: Toes are meant to be straight. However,
with time and wearing of shoes that are frequently too tight,
toes can become contracted so that the knuckles become very prominent.
These are painful in themselves or can cause painful corns and
occasionally ulcers that cause even more pain.
Treatment: Buying wider shoes can relieve pressure
and make the toes more comfortable. Hammertoes can be corrected
with a minor procedure to straighten the toes.
These are small, hard painful areas
of skin, usually found on the balls of the feet, but can be anywhere
on the skin of the feet. They may be solitary or found in clusters,
called "mosaic warts".
Cause:This is a viral infection of the outer layout
of the skin and they are quite contagious. If picked at, they
can be easily spread to your hands, friends or family.
Treatment: There are many treatments for warts,
but they are usually grouped as topical or surgical. Topical
treatments include application of acid preparations or freezing
the wart. Warts on the bottoms of the feet are often best treated by removal under local anesthesia and cauterizing the bases of
the wart so that the viruses are killed. There is usually little
discomfort with this procedure and patients are able to walk
Definition: pain in the bottoms of the heels, extending into the arch is most often defined as "plantar fasciitis" or "plantar fasciosis" - inflammation or disease of the plantar fascia ligament, which runs from the ball of the foot to the heel.
This is an ultrasound image of plantar fasciitis on the right window. The image is looking at the bottom of the heel (the sole of the foot is up). The thick white lines are the bottom of the heel bones and the outline of tissue entering from the right side is the plantar fascia. If there is inflammation, the tissue becomes thicker and darker at the insertion into the heel bone. The thickness can be measured on the ultrasound screen.
This is an X-ray of the bottom of the heel bone, the calcaneus, showing a heel spur.
Think of the arch being like a bow and this ligament being like a bowstring. When the foot bears weight, the arch elongates and puts tremendous tension on the ligament. The ligament pulls off on the bottom of the heel and this causes the pain. This can also cause heel spurs. The spurs, by themselves, are frequently not the cause of the pain, but are often more a result of the pulling of the ligament, which becomes inflamed. The ligament inflammation can be viewed directly using an imaging ultrasound machine. The thickness of the ligament is proportional to the inflammation. Pain is frequently seen in people whose feet pronate, or flatten out, too much. If the pain and inflammation is present for a prolonged period of time, there can be degeneration or disease of the ligament which is termed "Plantar Fasciosis" which is more chronic in nature.
Treatment: People often begin treatment before they come to the office by using anti-inflammatory medications, over-the-counter supports and exercises to stretch the Achilles tendon and the plantar fascia ligament.
There are many treatment options for heel pain. The good news is that open surgery is rarely necessary. These conditions are often successfully treated with orthotic supports that prevent the foot from pronating. These supports are easily transferred from shoe to shoe. Occasionally a cortisone injection is beneficial to relieve acute symptoms. If a spur is present, occasionally it may require surgical removal.
In recent years, a number of new techniques have become available that allow for definitive pain relief without having to proceed to open surgical release of the ligament or removal of the heel spur.
Definition: This is frequently referred to as
"Sever's Disease" or "Calcaneal Appophysitis".
This is an inflammation of the growth plate at the back of heels.
Cause: A boney growth
plate is present at the back of the heels between the ages of
8 to 14. It is attached by soft cartilage to the main portion
of the heel. The Achilles tendon inserts into the back of it,
coming from the calf muscle, and a strong ligament inserts into
it from the bottom. Pulling of these structures on the growth
plate causes pain and inflammation. This is especially true in
people whose feet pronate (arches flatten out) excessively. Common
sports associated with this condition include tennis, soccer,
football, basketball, baseball, and skateboarding.
Treatment: Stretching the Achilles tendon prior
to running and wearing a cushioned heel lift can help prevent
this condition. Sever's disease usually responds very nicely
to an orthotic support to control the pronation and cushion the
Definition: An ingrown nail is present when the
side of the nail curves down into the flesh and causes pain,
and frequently infection.
Cause: Ingrown nails often run in families or can
be the result of an injury to the root cells at the base of the
nail. Nail fungal infections make the nails more thick and curved
and can also contribute to this condition.
Treatment: These can be treated temporarily or
permanently. A wedge of nail can be removed from the ingrown
portion to relieve the pressure and this usually makes the toe
comfortable for a few months. However the ingrown nail frequently
returns. For permanent relief, the toe is anesthetized with local
anesthesia. The ingrown portion of the nail is removed, leaving
the top, flat part alone. Once the root cells are exposed, they
are cauterized with a chemical so that the ingrown part will
no longer grow back. People are usually able to return to normal
Definition: Bunions are a boney bump on the first
metatarsal bone, at the base of the big toe.
Cause: This portion of the foot bone becomes prominent
when the first metatarsal and big toe shift out of alignment,
most often as a result of tight shoes or excessive pronation.
Treatment: Purchasing wide shoes can relieve pressure
on the bump. Bunions can be corrected with a minor surgical procedure
where the bump is removed and the bones are shifted back into
alignment. This is done on an outpatient basis and usually people
are able to walk on the foot that day and return to an athletic
shoe within a few weeks.
Definition: Diabetes is a medical condition that
effects many areas of the body including the feet, eyes, kidneys,
nerves and arteries. Some of the more dangerous problems involve
the feet. Problems that might be considered minor in non-diabetics,
like thick nails, corns or callouses, are dangerous with diabetics.
Some diabetics lose sensation in their feet so they can't feel
if they have a problem. Diabetics are more prone to infections
and ulcerations (forming holes through the skin). How significant
is this? Approximately 86,000 amputations are performed each
year on diabetics in the United States (American Public Health
Association). Comprehensive podiatric care and good control of
the diabetes is the best treatment for prevention of diabetic
Cause: Diabetes causes heightened levels of sugar
in the blood which goes on to effects many areas and tissues
of the body. Nerves begin to lose their function, beginning in
the toe tips. The arteries can become occluded so that inadequate
blood flow to the feet. Skin becomes dry, cracked and brittle.
Corns, calluses and ingrown nails that put pressure on the skin
can go on to cause infection and ulceration.
Treatment: Regular foot care is essential for prevention
of diabetic complications, including testing for loss of sensation
and ongoing education for home care. Debridement of corns, calluses,
ingrown nails that could cause skin breakdown at regular intervals
is essential. A prescription for protective shoes is given if
The Medicare Therapeutic
Shoe Program: Medicare
will provide a pair of therapeutic shoes and protective innersoles
each year to qualified diabetic patients.
Definition: Pain in the ball of the foot is caused by excessive pressure on the bones, joints and adjacent nerves. These include a number of different conditions. Pain beneath the joints is called "Capsulitis" or inflammation of the ligamentous capsule that surrounds the joint. Nerves that are located between the metatarsal bones where they join the toes can become pinched, swollen and inflamed. This is called a "Morton's Neuroma". Neuroma means tumor, but this is not a cancer-type tumor, but rather just a swollen, inflamed nerve. Pain beneath the base of the big toe may be from irritation to two small bones called "sesamoid bones". This is referred to as "Sesamoiditis". These are floating bones that everyone has that are similar to miniature knee caps. They can become bruised, crushed or fractured.
Cause: Any of the above conditions can become painful with injury. Some people just have a foot structure where the bones are too long, too low or out of alignment creating abnormal pressure at a specific location. Additional stress is caused by abnormal foot function during gait: excess pronation or supination (flattening of the arch or an unusual high arch). Sports that require being on the balls of the feet, like tennis, volleyball or basketball can contribute to these conditions.
Treatment: Often, these problems respond to conservative treatment with shoe changes, orthotic supports. Cortisone injection may give relief to a neuroma condition or joint inflammation. For neuromas that do not respond to orthotics or injections, cryosurgery (see cryosurgery section) has been found to be effective.
Occasionally, open surgery will be necessary to correct these problems. This is done
on an out patient basis.
Definition: Joint pain, inflammation and deteriorization, as well as deformity can be caused by many types of arthritis.
Cause: Each type of arthritis attacks the joints in a different way and at different locations. Osteoarthritis most often attacks the big toe joint ("Hallux limitus-rigidus") and midfoot joint of the arch. Rheumatoid arthritis attacks the joints across the ball of the foot, often causing dislocations. Psoriatic arthritis attacks the joints of the ball of the feet as well as the toe joints. Gout usually attacks the big toe joint, but occasionally can attack any other foot or ankle joint. Gout has some special characteristics that will lead your doctor to this diagnosis. Gout rarely attacks women.
Treatment:The good news is that almost all the conditions can be relieved or improved upon. Treatment depends upon the type of arthritis and degree of involvement. Treatments may involve oral medication, injection, orthotic supports or surgery depending upon the need. Obtaining relief of painful arthritic conditions is particularly gratifying for both the doctor and the patient.
Definition: This is a condition where the big toe joint becomes arthritic, stiff and painful. The "hallux" is the Latin word for the big toe. As the joint becomes stiffer, it is referred to as "hallux limitus" and when motion stops it becomes "hallux rigidus".
Cause: This is either caused by an injury to the joint which with time causes erosion of the joint cartilage and bone spur formation or by poor foot structure and mechanics so that the joint wears out from abnormal stresses, just like the knee or hip joints do. People who pronate excessively have a higher tendency for this condition.
Treatment: If this is caught early, much of the progression of the arthritis can be halted with a proper orthotic to eliminate the pronation and relieve the stress from the joint. Anti-inflammatory medications and cortisone injections can give good temporary relief. For chronic conditions there are a number of surgical procedures that can give permanent relief.
Definition: This is an infection of the nail plate by a fungus, the same types that cause athlete's foot. This is seen when the nail becomes thick, discolored and sometimes flaky.
Cause: The nail plate is not live tissue and is susceptible to infection. In fact, it is normal for people to get fungal infections after age 60. Some patients are at greater risk - particularly diabetics, immunosuppressed individuals and people who live or work in moist environments.
Treatment: Most of the over-the-counter medications found at sores are not effective. Nail fungus can be treated with oral or topical medications. The oral medications are the most successful and are generally quite safe, though it is necessary to inquire about the medical history and perform liver function tests during the course of the oral medication. Topical medications can be effective and minimize the side effects. No nail fungus treatment works all the time.
**Not Fungal Nails: Just because your nail may be discolored, thick or loose does not mean it is fungal. There are a number of other conditions that can cause similar appearance to a nail fungal infection. These conditions, of course, will not respond to nail fungus treatments, since they aren't fungal in the first place. Your doctor can help determine what the cause of your nail condition and advise the best course.
Definition: This is a fungal infection of the
skin, causing either inflammation, blisters, flaking, redness,
oozing and/or itching.
Cause: Fungus is everywhere and can be acquired
by anyone, infecting the skin of the feet. Some of the people
are more susceptible including diabetics, individuals whose feet
perspire more, and those who work in greenhouses or are from
Treatment: Most athlete's feet infections will
respond to the over-the-counter medicated powders and creams.
The more severe infections will be treated with prescription
There are many kinds of sports
related injuries, some more prevalent due to the stresses of
specific sports. Many injuries are caused by faulty foot structure
and function and aggravated by improper shoes.
Treatment: The goal when treating athletes is to get them
safely back to participating in their sports as soon as possible.
If the condition is severe enough that they cannot participate
in their sport for a period of time, an alternative exercise
can usually be found to allow the athlete to stay in shape during
the rehabilitation period. Once the painful condition has resolved,
steps must be taken to prevent recurrence. If poor foot structure
or function is to blame, we can often correct this with a support
worn in the shoe. We offer both experience an d the latest technology
in the fabrication of orthotic support.
DISCLAIMER: *MATERIAL ON THIS SITE IS BEING PROVIDED FOR EDUCATIONAL AND INFORMATION PURPOSES AND IS NOT MEANT TO REPLACE THE DIAGNOSIS OR CARE PROVIDED BY YOUR OWN MEDICAL PROFESSIONAL. This information should not be used for diagnosing or treating a health problem or disease or prescribing any medication. Visit a health care professional to proceed with any treatment for a health problem.