Foot Ailments

Aaron Ben Pearl, D.P.M.
Board Certified, American Board of Podiatric Surgery

What causes athlete's foot
Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes.The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth.The warmth and dampness of areas around swimming pools, showers, and locker rooms, are also breeding grounds for fungi. Because the infection was common among athletes who used these facilities frequently, the term athlete's foot became popular.Not all fungus conditions are athlete's foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, also may mimic athlete's foot.

Symptoms
The signs of athlete's foot, singly or combined, are drying skin, itching scaling, inflammation, and blisters. Blisters often lead to cracking of the skin. When blisters break, small raw areas of tissue are exposed, causing pain and swelling. Itching and burning may increase as the infection spreads.Athlete's foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere.The organisms causing athlete's foot may persist for long periods. Consequently, the infection may be spread by contaminated bed sheets or clothing to other parts of the body.

Prevention
It is not easy to prevent athlete's foot because it is usually contracted in dressing rooms, showers, and swimming pool locker rooms where bare feet come in contact with the fungus. However, you can do much to prevent infection by practicing good foot hygiene. Daily washing of the feet with soap and water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture, help prevent the fungus from infecting the feet. Also helpful is daily use of a quality foot powder.

Avoid walking barefoot; use shower shoes.
Reduce perspiration by using talcum powder.
Wear light and airy shoes.
Wear socks that keep your feet dry, and change them frequently if you perspire heavily.

What causes a bunion?
A bunion is an enlargement of bone in the joint at the base of the big toe. Bunions are most often inherited. The myth that tight shoes cause bunions is not true – they do not cause bunions but they can aggravate them. Bunions can cause pain, swelling, and skin irritation. Bunions may also affect the adjacent smaller toes. When the big toes start to angle over, the big toe may cause increased pressure on the second toe or the second toe may be pushed upwards out of the way. This causes hammertoes and/or calluses on the smaller toes.

People with flat feet or really flexible feet are more prone to develop problems with bunions. Other causes are injury, rheumatoid arthritis and neurovascular disease. There are several types of bunions and several types of corrections for each.

What are the symptoms?
The severity of the deformity may not correlate to the degree of pain. For example, a bunion that looks severe may have no pain; while a mild looking bunion may be incapacitating.

Rubbing of shoes may cause a red, inflamed sac of tissue called bursitis. As time goes on pain may develop deep in this joint, limiting walking, exercise or even just standing comfortably. High heeled or pointed shoes will exacerbate these symptoms.

What are the treatment options?
When bunions are causing mild to moderate pain, the simplest solution to try is a wider, more accommodating shoe. This includes lower heels, softer leather, wider toe boxes and gym shoes. Cushions may provide relief from shoe pressure over the prominence. Anti-inflammatory medication may also provide relief. If the pain is severe or is not alleviated with these accomodations a visit to a podiatrist may be necessary.

What are diabetic foot problems?
Foot problems are the leading cause of hospitalization for the 16 million people in the U.S.A. who have diabetes. It is estimated that 15% of all diabetics will develop a serious foot problem at some time in their lives. Nervous system impairment (neuropathy) is one of these serious complications and results in loss of feeling in your feet and hands. This problem affects about 70% of people with diabetes. This is a serious problem for several reasons:

First, as opposed to your hands, your feet are hidden inside your shoes and socks and easily forgotten since they are out of view and often not looked at by your family doctor or endocrinologist during office visits. When you can't feel your feet you may purchase shoes that are too small and tight for your feet and socks that have wrinkles or creases in them. This can result in too much pressure on your feet and create corns and callouses, which, if not treated properly, can cause an open sore that can become infected.

Second, neuropathy not only damages the nerves that give your feet sensation but also the ones that control the muscles in your legs and feet. When these muscles are affected the foot begins to develop problems such as bunions, hammer and claw toes, stiff high-arched feet, or even a completely flat foot called a "Charcot" deformity.

Finally, neuropathy can affect the nerves that normally allow your feet to sweat and stay soft and supple. When this happens, your feet are much more likely to dry out and develop cracks in the skin called "fissures" which if not treated properly can can an open sore that can become infected.

What are the symptoms?
Unfortunately, you may not notice any symptoms until you develop an open sore. However, the presence of burning and tingling in your feet and toes are a sign of developing neuropathy and should be evaluated. The presence of corns and callouses, bunions, hammer and claw toes, and any other changes in the shape of your feet and toes should be a sign that something is wrong and be evaluated by your podiatric physician. Obviously, any area that is red and/or swollen, any bloody stains on your socks, or an open sore should be evaluated by your podiatric physician immediately to prevent serious complications.

What are the treatment options?
Treatment options depend on the symptoms you have and any associated foot and toe deformities present. The neuropathy is best treated by maintaining your blood sugar levels within the range that your family doctor or endocrinologist developed for you. If this does not help, the are a number of prescription medications that can be used to lessen the symptoms you have. If any structural problem exists in your feet, you should buy shoes that are made of soft, natural, breathable materials (leather, suede) which offer good soft support to the arches and plenty of room for the toes. It is best to buy your shoes at the end of the day when your feet are at their largest so that you don't buy shoes that are too tight. Purchase socks that are made of soft, breathable cotton and have no seams in them to avoid too much pressure on the tips of your toes. Inspect your shoes for any sharp seams or pressure spots and make sure that nothing has been misplaced inside your shoes (like car keys). Evaluate the bottom of your feet and in between your toes daily. If you can not reach your feet use a hand mirror to view these areas or have a family member help. Do not use "medicated" pads or "corn removing" products since they contain a strong acid which does not know the difference between good and bad skin and can create a chemical burn or even an open sore and infection. Also, do not trim your own callouses since you may go too deep, cause bleeding, and possibly even an open sore or infection.

What causes hammer toes?
The most common toe deformities are hammer toes, and bone spurs. These involve the lesser toes (2nd through 5th toes). In a hammer toe the toe is bent at the middle knuckle of the toe, A bone spur can occur anywhere on the toes but most commonly affects the 4th and 5th toes. Each of the deformities can create corns on the toes and in severe cases redness, swelling, and even an open sore. The corns develop because the skin is being crushed and irritated between the bones in your toes and your shoe.

People with flat feet, high-arched feet, or really flexible feet are more prone to develop these problems. Other causes are excessively long toes, muscle imbalance, injury, rheumatoid arthritis, and neurovascular disease. Over time, the mechanics of your foot and shoe’s that you wear increases the deformities. Woman are more frequently affected, probably because of the types of shoes they wear and use of tight stockings.

What are the treatment options?
When hammer toes are causing mild to moderate pain, the simplest solution to try is a wider, more accommodating shoe to allow room for the toes to move. This includes lower heels, softer leather, wider toe boxes, and tennis type shoe. Use of a pumice stone to thin any corns and callouses is sometimes helpful. Cushions (such as toe straightener’s) and various soft pads may provide relief from shoe pressure over the toes. We recommend that you never use a "medicated" corn pad since these contain a strong acid which does not know the difference between the bad and good skin and can lead to a chemical burn or deep open sore which can become infected.

When the hammer toes and claw toes are painful despite the conservative therapy options or you cannot find shoes that are comfortable, surgical correction should be discussed with your podiatric physician. The longer surgery is delayed in a symptomatic foot, the greater the amount of deformity that develops, and the more complicated the surgery becomes. Patients who have their symptomatic hammer toes and claw toes corrected earlier tend to have greater satisfaction after the procedure.

What does surgery involve?
The goal of surgical correction is to restore normal alignment and function of the toe joint. If the toes are still flexible the tight tendons can be released and the toe straightened through a small poke-hole in the skin. If the toe is rigid, the knuckle is straightened and returned to a normal alignment. A small pin is sometimes placed inside the bones to hold the toe in proper position while it heals. The pin does not stick out the end of the toe and very rarely needs to be removed. If the joint is destroyed from arthritis beyond repair, it may need to be replaced with an artificial joint. If a bone spur is the cause of the problem this is filed down through a small poke-hole in the skin.

Following surgery, the foot is bandaged and a post operative shoe is worn for one week. Athletic shoes may be worn after the first week. Exercise and prolonged standing are restricted for the first 6-8 weeks. A home exercise program is important for regaining the strength and flexibility. You may steadily resume activities and wear more fashionable shoe gear as healing occurs.

What causes ingrown nails?
A nail is ingrown when one or both sides of the nail grow into the skin of the toe. Ingrown nails can be caused by improper trimming of the nail, high heeled shoes or too narrow shoes, or toe deformities such as a bunion or overlapping toes that cause increased pressure on neighboring toes.

Irritation, redness, an uncomfortable sensation of warmth, swelling, pain and infection are some of the symptoms you may experience if you have an ingrown nail. Ingrown nails usually occur on the big toes, but not always.

Treatment
If you are prone to ingrown nails, cut nails rounded and keep them short. This will prevent them from growing into the tip of the nail.If the nail does become red and inflamed, you can soak the toe in warm water with Epsom salts. If this does not alleviate your symptoms, we would recommend making an appointment with our office.

What to expect at your visit
If the condition is mild, Dr. Pearl may be able to simply cut the nail properly to alleviate your symptoms. If the area is infected, you may need a course of antibiotics as well Dr. Pearl may have to numb the toe and then remove the small section of the nail that is causing the infection. If the condition tends to recur, there is a permanent solution. Dr. Pearl can numb your toe, remove the offending nail section and put a chemical in the area to sterilize the cells that make the nail so that the ingrown section of nail never grows back. This procedure has proven to be 95% effective with a high degree of patient satisfaction.

Arlington Foot & Ankle Sports Medicine

Arlington Foot & Ankle
Sports Medicine