Kim Kardashian Breaks Toe

Kim Kardashian has broken her toe; a fractured toe is painful but rarely disabling.

On November 1st Kim tweeted, "I knew my clumsiness would catch up with me at some point! I tripped on a suit case on the floor and broke my toe :-(."

Nearly one-fourth of all the bones in your body are in your feet. A broken (fractured) bone in your forefoot or in one of your toes is often painful, but rarely disabling. Most of the time, these injuries heal without operative treatment.

There are two types of foot fractures: stress fractures and general bone fractures. Stress fractures usually occur in the bones of the forefoot extending from the toes to the middle of the foot. Stress fractures are like tiny cracks in the bone surface. They can happen with sudden increases in exercise (such as running or walking for longer distances or times), improper training techniques, or a change in surfaces.

Most other types of fractures extend through the bone, and are called bone fractures. They may be stable, in which there is no shift in bone alignment, or displaced, in which the bone ends no longer line up properly. Bone fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. If the fracture does break through the skin, it is called an open fracture.

Because of the complex structures in the foot, there are some other, more specific types of fractures that can occur. For example, the fifth metatarsal, known as the little or pinky toe, is susceptible to a variety of different fractures. The relationship between the ankle and the foot can be compromised by an ankle-twisting injury, which may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is known as a Jones fracture, which occurs near the base of the bone and disrupts its blood supply. This injury may take longer to heal or require surgery.

Common symptoms for any type of foot fracture include pain, swelling, and sometimes bruising. Be sure to seek medical attention for any suspected foot fracture.

http://www.greatlakesfootandankle.com

Starting treatment now for fungal nails means your feet will be summer ready!

Many people don't realize they have a fungal nail problem and, therefore, don't seek treatment. Yet, fungal toenail infections are a common foot health problem and can persist for years without ever causing pain. The disease, characterized by a change in a toenail's color, is often considered nothing more than a mere blemish. Left untreated, however, it can present serious problems.

Also referred to as onychomycosis, fungal nails are infections underneath the surface of the nail, which may also penetrate the nail. Fungal nail infections are often accompanied by a secondary bacterial and/or yeast infection in or about the nail plate, which ultimately can lead to difficulty and pain when walking or running. Symptoms may include discoloration, brittleness, loosening, thickening, or crumbling of the nail.

A group of fungi, called dermophytes, easily attack the nail and thrive on keratin, the nail's protein substance. In some cases, when these tiny organisms take hold, the nail may become thicker, yellowish-brown, or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.

Nail bed injury may make the nail more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of Athlete's Foot or excessive perspiration.

You can prevent fungal nail infections by taking these simple precautions:

• Exercise proper hygiene and regularly inspect your feet and toes.
• Keep your feet clean and dry.
• Wear shower shoes in public facilities whenever possible.
• Clip nails straight across so that the nail does not extend beyond the tip of the toe.
• Use a quality foot powder (talcum, not cornstarch) in conjunction with shoes that fit well and are made of materials that breathe.
• Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active lifestyles.
• Disinfect home pedicure tools and don't apply polish to nails suspected of infection.

Depending on the type of infection you have, over-the-counter liquid antifungal agents may not prevent a fungal infection from recurring. A topical or oral medication may need to be prescribed, and the diseased nail matter and debris removed, a process called debridement. Note: Please consult your physician before taking any medications.

In severe cases, surgical treatment may be required to remove the infected nail. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured and prevents the return of a deformed nail.

Still Think High Heels are Worth It?

It’s not what fashion-conscious women want to hear—another warning about high heels. But wearing pump-style shoes often causes significant pain by irritating a common bony deformity on the back of the heel, called ‘pump bump.’ If left untreated, it can lead to bursitis or Achilles tendonitis.

What is Pump Bump?
Pump bump is common in young women who wear high heels almost every day. The rigid back of a pump-style shoe can create pressure that aggravates the heel bone when walking.

The bony enlargement can cause Achilles tendonitis or bursitis due to constant irritation from pump-style shoes. Those with high arches or tight Achilles tendons are especially vulnerable to developing pump bump if they work in high heels.
The medical term for the disorder is Haglund’s deformity. In addition to the noticeable bump, symptoms include:

• pain where the Achilles tendon attaches to the heel,
• swelling in the back of the heel, and
• redness in the area.

Treating Pump Bump
In the large majority of cases, pump bump is treated non-surgically by reducing inflammation, but this does not get rid of the bony enlargement. Pain relief is the primary treatment goal, so anti-inflammatory medications may be prescribed. Icing the back of the heel reduces swelling, and stretching exercises can relieve tension in the Achilles. Long-term, however, it’s best to avoid wearing high heels, if possible.

If your job requires wearing high-heeled shoes and you’re experiencing symptoms of pump bump, heel lifts placed inside the shoes may offer some relief. Wearing backless shoes or those with soft backs may also help decrease pressure on the area.


http://www.foothealthfacts.org/Content.aspx?id=1447

Fall Into Boots That Feel Good!

Leather or suede? Ankle or knee? Grey or black? Boho chic or cowboy cool? With so many stylish boots this season how can you possibly choose the perfect pair?

• Have feet measured, size can change throughout life! Keep in mind - your boot size may not fit the same in all styles and brands.
• Try boots on in the afternoon - feet tend to swell during the day.
• Buy for the larger foot - most feet are not the exact same size.
• Carry an insole when boot shopping in case a pair lack the proper arch support.
• Boots should feel comfortable when tried on in the store, there shouldn’t be a “break-in” period.
• A boot constructed of natural materials, like leather, will keep feet dry and comfortable during the winter months.
• Choose a boot with plenty of toe room, a firm heel counter and traction to ensure stability.

http://www.apma.org/boot-tips

Cold Feet?

Cold feet are most commonly a result of medical conditions that cause poor blood flow in the legs or feet, such as peripheral vascular disease (PVD), a blockage or narrowing of the arteries, Raynauds’s phenomenon (cold sensitivity which causes a spasm of the blood vessels), and heart disease. Some medications which cause constriction of blood vessels can also lead to cold feet or limbs. Beta blockers for high blood pressure, ergotamine medications for migraine headaches, and cold medications that contain pseudoephedrine may all cause this problem.

Other potential causes of cold feet include hormonal abnormalities such as hypothyroidism and adrenal insufficiency, nerve disorders such as peripheral neuropathy and fibromyalgia, and autoimmune disorders (lupus, scleroderma).

Because there is such a wide range of causes for cold feet, it is important to see a foot and ankle surgeon for diagnosis and treatment.

Great Lakes Foot & Ankle Institute does provide Peripheral Vascular Testing in office and can be scheduled at any time.

Is Foot Pain Ruining Your Golf Swing?

As you head to your favorite golf course this spring, make sure your feet are in shape before approaching the tee box. Your big toe, heel and ball of your foot are the spots most likely to cause pain that can ruin your golf swing.

Behind these pain-prone spots can lie stiff joints, stretched-out tissues and even nerve damage. But pain relief is possible and frequently does not require surgery.
Three conditions


The three most common foot conditions that can be the barrier to a perfect golf swing are neuromas, arthritis and heel pain.

• Neuromas are nerves that become thickened, enlarged and painful because they’ve been compressed or irritated. A neuroma in the ball of your foot can cause significant pain as your body transfers its weight from one foot to the other while swinging the club.
• Arthritis can cause pain in the joint of your big toe that makes it difficult to follow-through.
• Heel pain typically results from an inflammation of the band of tissue that extends from your heel to the ball of your foot. People with this condition compare the pain to someone jabbing a knife in their heel. Heel pain can make it uncomfortable for golfers to maintain a solid stance during crucial portions of the swing.


Other painful conditions

Several other painful conditions can also make the perfect swing difficult. Ankle arthritis or ankle instability can affect the proper weight shift during the golf swing. Some athletes and former athletes develop chronic ankle instability from previous ankle sprains that failed to heal properly. Achilles tendonitis can also contribute to balance-threatening instability during your golf swing. Ill-fitting golf shoes may cause corns and calluses that make standing uncomfortable.

Foot pain is not normal. With the treatment options available to your foot and ankle surgeon, a pain-free golf swing is clearly in view. When your feet aren’t in top condition, your golf swing won’t be either.


www.foothealthfacts.org

Back to school, back to sports! Make sure to protect your children’s feet.

Sever's Disease, also known as calcaneal apophysitis, is a disease of the growth plate of the bone and is characterized by pain in the heel of a child's foot, typically brought on by some form of injury or trauma. This condition is most common in children and is frequently seen in active soccer, football, or baseball players. Sport shoes with cleats are also known to aggravate the condition. The disease mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon contributes to Sever's Disease by pulling excessively on the growth plate of the heel bone (calcaneus).

Treatment includes cutting back on sports activities, calf muscle stretching exercises, orthotics, heel cushions in the shoes, icing, and/or anti-inflammatory medications. Note: Please consult your physician before taking any medications.


Baseball Shoes and Cleats

As with most athletic shoes, comfort is the most important element in choosing the right baseball shoe for you. Look for shoes with a roomy toe box that give your toes enough room to wiggle. The widest part of your foot should fit comfortably into the shoe without stretching the upper. Look for a snug heel to help keep your foot stable. Most importantly, remember to replace your baseball shoes after 70 to 75 hours of active wear.

For league play, cleats may be recommended to give you the traction needed for the surface in the diamond. Baseball cleats come in a variety of materials ranging from leather and synthetic materials (plastics) to rubber and metal. Be sure to follow the regulations of your league regarding the material allowed; many leagues no longer permit the use of metal spikes or cleats, particularly on artificial turf. Be sure to give yourself time to adjust to cleats by wearing them on the designated surface.


Basketball Shoes

Foot and ankle stability, shock absorption, and traction are the most important qualities for basketball shoes. If you are susceptible to ankle injuries, consider a high-top or three-quarter shoe that provides added support to key foot structures during play. Look for shoes that offer the following:

● A wide toe box with plenty of room for your toes to move around. Not enough room can lead to blisters, corns, and calluses.
● Lightweight, breathable material for uppers; generally, leather is recommended.
● Dense, abrasion-resistant soles that are low to the ground for better traction and support.
● A well-cushioned midsole for a shock-absorbing layer. An EVA or EVA-compressed layer is lightweight but not as durable or stable. A polyurethane layer has greater stability, but it is often heavier, too.
● Bend in the forefoot of the shoe, which is at the ball of the foot near the toes. Be sure there is less bend in the arch where you need the added support to keep the foot stable.
● A firm heel counter that fits snugly.
● Laces as the form of closure give you the ability to adjust for the support you need throughout the foot.

When buying basketball shoes, be sure to take the socks you plan to wear with them to ensure a proper fit. Have your feet measured standing up and fit the shoes to your larger foot. Walk around, turn, twist, and jump in each pair on a hard surface to see how your foot feels during each of these movements. Most importantly, make your choice based on comfort.


Soccer / Running Shoes

Our practice recommends sturdy, properly fitted athletic shoes of proper width with leather or canvas uppers, soles that are flexible (but only at the ball of the foot), cushioning, arch supports, and room for your toes. Try a well-cushioned sock for reinforcement, preferably one with acrylic fiber content so that some perspiration moisture is "wicked" away.

A running shoe is built to take impact, while a tennis shoe is made to give relatively more support, and permit sudden stops and turns. Cross training shoes are fine for a general athletic shoe, such as for physical education classes because they provide more lateral support and less flexibility than running shoes.


Football Shoes

When you are shopping for youth football shoes, the most important variable to take into consideration is the playing surface that you will be on most frequently. Before investing in a pair of shoes, review the schedule for the season and take note of the various playing surfaces that the child will be exposed to. Although most fields now are made of fieldturf, there are still those out there with Astroturf or real grass.

For fieldturf and real grass, a traditional style cleat is recommended. For young players, a shoe with molded cleats should suffice, while shoes with removable cleats are advisable for older kids who play at a faster speed and may need to customize their level of traction. If you will only be playing a few games on Astroturf, there is no need to buy a separate pair of turf shoes, especially for young children. In a pinch, regular athletic shoes will suffice for a game or two on turf.


Tennis Shoes

Tennis shoes need lots of cushioning and shock absorption to deal with all the forces placed on your feet during play and to keep your foot and ankle stable. Be sure to choose shoes specifically for racquet sports; running shoes, for example, don't have the support needed for the side-to-side movements common to tennis. Look for a tennis shoes that have a reinforced toe, wiggle room in the toe box, padding at the ball of the foot, sturdy sides, a low, well-cushioned heel that is not flared, and a firm heel counter for support.

When shopping for tennis shoes, follow these tips:

● Try on shoes with the socks you normally wear to make sure the fit is right.
● Go shopping at the end of the day when your feet are larger and fit your shoes to the larger of your two feet.
● Let your feet be your guide to fit. Choose only shoes that are comfortable in the store -- don't expect a wear-in period. The shoes should feel supportive, cushioned. and flexible, with some resistance in the heel for greater stability.
● Walk around the store in each pair you try on. Be sure to walk on a hard-surface, not just a carpeted floor. Emulate tennis play by jumping up and down in the shoes and making some fast turns to see how the shoes will really perform.

Cancers of the Foot

There are many kinds of cancers of the foot. Some take the form of cysts and lesions, while others are more widespread.



Malignant melanoma is a skin cancer that is curable if caught early. Although it makes up only one percent of skin cancers, malignant melanoma accounts for over 60 percent of skin cancer deaths. It is estimated that approximately 30 percent of melanomas occur in the lower extremities, and that 3 percent occur in the feet.



Neoplastic disorders, usually called tumors, are the result of abnormal growth of tissue. Both benign or malignant tumors occur in the foot.



Osteochondromas are benign bone tumors under the toenail. Osteochrondromas account for about half of all benign bone tumors in the foot, occurring mostly in children and young adults. Unless they cause irritation to the surrounding tissue, they are generally not very painful. Sometimes, they can deform the toenail and cause an ingrown toenail. In rare cases, they are removed surgically.



A plantar fibroma is a benign tissue tumor or growth on the plantar, or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. There are a number of nonsurgical measures for treating plantar fibromas, such as orthotics. When these conservative measures fail to provide adequate relief of symptoms, surgical removal is a reasonable option.



Giant cell tumors are benign tumors of the tendon sheath. These masses are generally found on the toes, top of the foot, or sides of the foot. They can also occur deep inside the foot. They are firm irregular masses that are typically painful.


http://www.greatlakesfootandankle.com/library/1780/Cancer.html

Subungal Exotosis (bone spur under toenail)

Subungal exostosis is more commonly referred to as a bone spur under the toenail. This condition is generally caused by toe trauma, which results in the formation of a bony irregularity or prominence. The normal treatment for subungal exostosis is surgical removal. Other small tumors, called osteochondromas and enchondromas, can also form in the bone beneath the toenail.


http://www.greatlakesfootandankle.com/library/1941/SubungalExotosis(bonespurundertoenail).html

Overlapping, Underlapping Toes

Overlapping toes are characterized by one toe lying on top of an adjacent toe. The fifth toe is the most commonly affected. Overlapping toes may develop in the unborn fetus. Passive stretching and adhesive taping is most commonly used to correct overlapping toes in infants, but the deformity usually recurs. Sometimes they can be surgically corrected by releasing the tendon and soft tissues about the joint at the base of the fifth toe. In some extreme cases, a pin may be surgically inserted to hold the toe in a straighten position. The pin, which exits the tip of the toe, may be left in place for up to three weeks.


Underlapping toes usually involve the fourth and fifth toes. (A special form of underlapping toes is called congenital curly toes). The cause of underlapping toes is unknown. It is speculated that they may be caused by an imbalance in muscle strength of the small muscles of the foot. If deformed toes are flexible, a simple release of the tendon in the bottom of the toe will allow for them to straighten. If the deformity is rigid, surgery may be needed to remove a small portion of the bone in the toe.


http://www.greatlakesfootandankle.com/library/1908/Overlapping,UnderlappingToes.html

In-toeing

In-toeing and out-toeing occur when the feet are positioned too far inward or outward when walking. Both conditions may be observed in young children as they are learning to walk. By the age of two, most children outgrow these problems on their own. Beyond this age, verbal reminders and reassurance may be advised to make the child aware of the proper position of the foot. In persistent cases, children may be required to wear special shoes or foot supports to help train them to place their feet in the right position. These interventions are designed to reduce abnormal pressures on the foot structure and function while still in their formative development.


http://www.greatlakesfootandankle.com/library/1879/Intoeing.html

Hammertoes

Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Causes of hammertoe include improperly fitting shoes and muscle imbalance.

Treatment for the condition typically involves wearing shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions, or nonmedicated corn pads may also relieve symptoms.

In severe cases, hammertoe surgery may be recommended to correct the deformity.


http://www.greatlakesfootandankle.com/library/1871/Hammertoes.html

Hallux Varus

Hallux Varus is a condition in which the big toe points away from the second toe. It is a possible complication from bunion surgery. The condition has been linked to a number of other causes, including congenital deformity, tight or short abductor hallucis tendons, trauma, injury, or an absence or surgical removal of a fibular sesamoid.

Treatment may focus on stretching the abductor hallucis tendon through specific exercises or toe splints. In severe cases, surgery may be recommended. During the surgery, a small incision is made on the side of the toe and the toe is splinted in a neutral or straight position.


http://www.greatlakesfootandankle.com/library/1869/HalluxVarus.html

Hallux Rigidis (rigid big toe)

An unmovable big toe, known as Hallux Rigidus, is the most common form of arthritis in your foot.

Hallux Rigidus occurs as a result of wear-and-tear injuries, which wear down the articular cartilage, causing raw bone ends to rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The resulting stiff big toe can make walking painful and difficult.

Symptoms include:

● A bump, like a bunion or callus, that develops on the top of the foot.
● Pain in the joint when active, especially as you push-off on the toes when you walk.
● Stiffness in the big toe and an inability to bend it up or down.
● Swelling around the joint.

Pain relievers and anti-inflammatory medications are often prescribed to reduce swelling and ease the pain. Note: Please consult your physician before taking any medications. Applying ice packs or soaking the foot in contrast baths (alternating cold and hot water) may also help reduce inflammation and control symptoms for a short period of time.

A stiff-soled shoe with a rocker or roller bottom design and possibly a steel shank or metal brace in the sole can help alleviate the symptoms. These types of shoes add greater support when walking and reduce the amount of bend in the big toe.

When damage is more severe, a surgical procedure may be performed to remove the bone spurs, as well as a portion of the foot bone, and allow the toe more room to bend.


http://www.greatlakesfootandankle.com/library/1866/HalluxRigidis(rigidbigtoe).html

Hallux Limitus (stiff big toe joint)

Hallux Limitus is a condition that results in stiffness of the big toe joint. It is normally caused by an abnormal alignment of the long bone behind the big toe joint, called the first metatarsal bone. Left untreated, Hallux Limitus can cause other joint problems, calluses, and/or diabetic foot ulcers. Painful bone spurs also can develop on the top of the big toe joint.

Anti-inflammatory medications, cortisone injections, and/or functional orthotics are some of the common treatments for stiff big toe. Note: Please consult your physician before taking any medications. Surgery may be required if spurring around the joint becomes severe.


http://www.greatlakesfootandankle.com/library/1865/HalluxLimitus(stiffbigtoejoint).html

Digital Deformity

Many disorders can affect the joints of the toes, causing pain and preventing the foot from functioning as it should. People of all ages can have toe problems, from inherited to acquired.


Toe deformities in adults result mainly from an imbalance of the tendons, causing them to stretch or tighten abnormally. People with abnormally long toes, flat feet, or high arches have a greater tendency to develop toe deformities. Arthritis is another major cause of discomfort and deformity. Toe deformities also can be aggravated by poorly fitting footwear, or if a fractured toe heals in a poor position.


The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, and overlapping and underlapping toes.


http://www.greatlakesfootandankle.com/library/1803/DigitalDeformity.html

Claw Toe

Claw toe is caused by nerve damage from diseases like diabetes or alcoholism, which can weaken muscles in the foot. The term stems from the toes' appearance—toes that look like claws digging down into the soles. Claw toe may lead to the formation of painful calluses. Claw toe worsens without treatment and may become a permanent deformity over time.

Common symptoms of claw toe include:

● Toes bent upward from the joints at the ball of the foot.
● Toes bent downward at the middle joints toward the sole of the shoe.
● Corns on the top of the toe or under the ball of the foot.
● Claw toe deformities are easier to repair when detected early. Splints or tape is used to hold the toes in correct position.


http://www.greatlakesfootandankle.com/library/1785/ClawToe.html

Bunions

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Varus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Varus. Bunions can also lead to other toe deformities, such as hammertoe.



Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain.



Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.



Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain cause by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

● The use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems.
● Removal of corns and calluses on the foot.
● Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth.
● Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.
● Exercises to maintain joint mobility and prevent stiffness or arthritis.
● Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.
● Surgical Treatment

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.


http://www.greatlakesfootandankle.com/library/1775/Bunions.html

Kaposi's Sarcoma (AIDS related)

Kaposi's Sarcoma is a cancerous lesion that can occur on the soles of the feet. The disease is usually associated with HIV infection and/or AIDS. The lesion is irregular in shape and has a purplish, reddish, or bluish-black appearance. Kaposi's Sarcoma lesions tend to spread and form large plaques or become nodular. The nodular lesions have a firm rubbery appearance.


http://www.greatlakesfootandankle.com/library/1884/Kaposi'sSarcoma(AIDSrelated).html

Kohler's Disease

Kohler's Disease is a spontaneous loss of blood supply to a particular bone in the foot.

Treatments may include cast immobilization, reduced activities and foot orthotics or inserts.


http://www.greatlakesfootandankle.com/library/1885/Kohler'sDisease.html

Maffucci's Syndrome

Maffucci's Syndrome is a very rare form of enchondromatosis that combines multiple enchondromas in bones anywhere in the body with benign soft tissue tumors (known as hemangiomas), which are associated with blood vessels. This condition tends to appear in the hands and feet, and has a greater tendency toward malignant transformation than Ollier's Disease.


Some form of injury or trauma to the toe results in the formation of this bony irregularity or prominence.


Maffucci's Syndrome only requires treatment in cases where the tumors are aggressive and begin destroying bone tissue. In these cases, surgical removal is recommended.


http://www.greatlakesfootandankle.com/library/1887/Maffucci'sSyndrome.html

Ollier's Disease

Ollier's Disease, also known as enchondromatosis, frequently occurs in the small bones in the hands and toes (phalanges) and the long bones behind the phalanges, called metatarsals. This condition is characterized by multiple enchondromas. Some form of injury or trauma to the toe results in the formation of the bony irregularity or prominence.


As with the majority of enchondromas, Ollier's Disease generally requires no treatment. Only in cases where the tumors are aggressive and begin destroying bone tissue do they require further attention, often surgical removal.


http://www.greatlakesfootandankle.com/library/1900/Ollier'sDisease.html

Seiver's Disease

Pain in the heel of a child's foot, typically brought on by some form of injury or trauma, is sometimes Seiver's Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel.

A tight Achilles tendon may contribute to Seiver's Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger children and is frequently seen in the active soccer, football or baseball player.

Sport shoes with cleats are also known to aggravate the condition.

Treatment includes calf muscle stretching exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.


http://www.greatlakesfootandankle.com/library/1924/Seiver'sDisease.html

Sever's Disease (Calcaneal Apophysitis)

Sever's Disease, also known as calcaneal apophysitis, is a disease of the growth plate of the bone and is characterized by pain in the heel of a child's foot, typically brought on by some form of injury or trauma. This condition is most common in children ages 10 to 15 and is frequently seen in active soccer, football, or baseball players. Sport shoes with cleats are also known to aggravate the condition. The disease mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon contributes to Sever's Disease by pulling excessively on the growth plate of the heel bone (calcaneus).


Treatment includes cutting back on sports activities, calf muscle stretching exercises, heel cushions in the shoes, icing, and/or anti-inflammatory medications. Note: Please consult your physician before taking any medications.


http://www.greatlakesfootandankle.com/library/1929/Sever'sDisease.html

Sports Injuries

Many sports are hard on the feet because of quick repetitive movements, constricting footwear, and/or increased exposure to injury or trauma. Following is a brief overview of some of the most common injuries that result from particular sports.


Martial Arts and Kick Boxing
Injuries commonly seen as a result of martial arts and kick boxing include plantar fasciitis, Achilles tendonitis, sesamoiditis, and ankle sprains. Stretching is recommended to help prevent injury; specifically, a minimum of 15 minutes of stretching before performing any kicking or punching.


Aerobics
Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot. That is why proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability.


Team Sports
Activities such as football, baseball, basketball, soccer, field hockey, and lacrosse often lead to ankle injuries as a result of play on artificial surfaces, improper footwear, and/or inadequate stretching.


http://www.greatlakesfootandankle.com/library/1937/SportsInjuries.html

Shin Splints

Shin splints refer to pain on either side of the leg bone that is caused by muscle or tendon inflammation. The problem is usually related to a collapsing arch, but may be caused by a muscle imbalance between opposing muscle groups in the leg.


Proper stretching before and after exercise and sports, corrective shoes, or orthotics (corrective shoe inserts) can help prevent shin splints.


http://www.greatlakesfootandankle.com/library/1930/ShinSplints.html

Osteochondromas are benign bone tumors that form in the bone beneath the toenail. Osteochrondromas account for about half of all benign bone tumors, and occur mostly in children and young adults. Unless they cause irritation to the surrounding tissue, they are generally not painful.


In some cases, osteochondromas may cause a deformity in the toenail or lead to an ingrown toenail. When problematic, osteochondromas may be removed surgically. However, they can recur after the procedure.


http://www.greatlakesfootandankle.com/library/1904/Osteochondromas.html

Osteochondritis (stiff ankle)

Osteochondritis are lesions that usually cause pain and stiffness of the ankle joint and affect all age groups. Osteochondritis is caused by a twisting-type injury to the ankle. Symptoms include swelling and ankle pain.


Immobilization of the foot and ankle for a period of time usually resolves the problem. In more severe cases, however, surgery may be prescribed. During the surgery, loose fragments of cartilage and bone are removed from the ankle joint and, in some cases, small drill holes are made in the defect to stimulate new blood vessels and help form scar tissue that will fill the defect.


http://www.greatlakesfootandankle.com/library/1903/Osteochondritis(stiffankle).html

Fractures

Nearly one-fourth of all the bones in your body are in your feet. A broken (fractured) bone in your forefoot or in one of your toes is often painful, but rarely disabling. Most of the time, these injuries heal without operative treatment.


There are two types of foot fractures: stress fractures and general bone fractures. Stress fractures usually occur in the bones of the forefoot extending from the toes to the middle of the foot. Stress fractures are like tiny cracks in the bone surface. They can happen with sudden increases in exercise (such as running or walking for longer distances or times), improper training techniques, or a change in surfaces.


Most other types of fractures extend through the bone, and are called bone fractures. They may be stable, in which there is no shift in bone alignment, or displaced, in which the bone ends no longer line up properly. Bone fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. If the fracture does break through the skin, it is called an open fracture.


Because of the complex structures in the foot, there are some other, more specific types of fractures that can occur. For example, the fifth metatarsal, known as the little or pinky toe, is susceptible to a variety of different fractures. The relationship between the ankle and the foot can be compromised by an ankle-twisting injury, which may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is known as a Jones fracture, which occurs near the base of the bone and disrupts its blood supply. This injury may take longer to heal or require surgery.


Common symptoms for any type of foot fracture includes pain, swelling, and sometimes bruising. Be sure to seek medical attention for any suspected foot fracture.


http://www.greatlakesfootandankle.com/library/1817/Fractures.html

Broken Ankle

According to the American Academy of Orthopaedic Surgeons, doctors have noticed an increase in the number and severity of broken ankles since the 1970s, due, in part, to the Baby Boomer generation being active throughout every stage of their lives.


The ankle has two joints, one on top of the other, and three bones. A broken ankle can involve one or more of the bones, as well as injury to the surrounding connecting tissues or ligaments.


There are a wide variety of causes for broken ankles, most commonly a fall, an automobile accident, or sports-related trauma. Because a severe sprain can often mask the symptoms of a broken ankle, every ankle injury should be examined by a physician.

Symptoms of a broken ankle include:

● Bruising.
● Swelling.
● Immediate and severe pain.
● Inability to put any weight on the injured foot.
● Tenderness to the touch.


Deformity, particularly if there is a dislocation or a fracture.
The treatment for a broken ankle usually involves a leg cast or brace if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to secure the bones in place so they will heal properly.


http://www.greatlakesfootandankle.com/library/1772/BrokenAnkle.html

Ankle Sprain Injuries

Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle. The severity of the sprain can impact the degree of damage as well as the type and duration of treatment. If not properly treated, ankle sprains may develop into long-term problems.


Primary symptoms of ankle sprains are pain following a twist or injury, swelling, and bruising.


Treatment includes resting and elevating the ankle and applying ice to reduce swelling. Compressive bandages also may be used to immobilize and support the injury during healing. Serious ankle sprains, particularly among competitive athletes, may require surgery to repair and tighten the damaged ligaments.


To prevent ankle sprains, try to maintain strength, balance, and flexibility in the foot and ankle through exercise and stretching, and wearing well-fitted shoes.


http://www.greatlakesfootandankle.com/library/3568/AnkleSprainInjuries.html

Diagnostic Procedures: Radiographs (X-Rays)

X-rays help determine whether a bone has been fractured or damaged by conditions such as an infection, arthritis, or other disease.

Other reasons for conventional X-rays on your feet are to:

● Evaluate changes in the bones from infections, arthritis, or other bone disease.
● Assess whether a child's bones are growing normally.
● Locate foreign objects (such as pieces of glass or metal) in a wound.
● Determine whether bones are properly set after treating a fracture.

Pregnant women, especially those in their first trimester, are advised against having X-rays because the radiaiton may harm the unborn child.

Diagnostic Procedures: Ultrasound

Ultrasound is a very effective tool for diagnosing a wide variety of foot and ankle problems, particularly soft tissue problems. Ultrasound uses sound waves on the body in a way much like radar uses sound waves. The waves hit a targeted area and are bounced back to a recording device, which produces an image. Ultrasound is a completely safe, noninvasive, and painless diagnostic procedure.

Common problems for which ultrasound may be prescribed include:

● Bursitis.
● Heel spurs or plantar fasciitis.
● Injuries of the ligaments, tendons, or cartilage.
● Morton's neuroma.
● Presence of foreign bodies.
● Soft tissue masses.
● Tarsal tunnel syndrome.
● Tendonitis or tears in a tendon.

Diagnostic Procedures: Computed Tomography (CT Scan)

Computed tomography (CT) examination (also known as a CAT scan) is used in podiatry to help diagnose and treat foot or ankle problems. A CT is a kind of X-ray device that takes cross sectional images of a part of the body, giving the physician a three-dimensional image. CT scans are often superior to conventional X-rays because they can more accurately pinpoint a suspected problem. Common foot problems a CT exam can help diagnose include: arthritis, deformities, flat feet, foreign bodies, fractures, infection, and tumors.

Pregnant women, especially those in their first trimester, are advised against having a CT exam or any X-ray examination because the radiaiton may harm the unborn child.

Diagnostic Testing: MRI

Magnetic resonance imaging (MRI) is sophisticated diagnostic equipment used to diagnose an array of health problems or conditions, including:

● Arthritis.
● Fractures.
● Infections.
● Injuries of the tendons, ligaments, or cartilage.
● Tumors.

MRI's use no radiation like conventional X-rays or CT scans. They employ large magnet and radio waves to produce three-dimensional images. MRIs are very good at portraying soft tissues and bones in your feet and ankles.

People with the following conditions may not be good candidates for a MRI:

● Conditions that requires a heart pacemaker.
● Artificial heart valves.
● Electronic inner ear implants.
● Electronic stimulators.
● Implanted pumps.
● Metal fragments in eyes.
● Surgical clips in the head (particularly aneurysm clips).
● Individuals with dental fillings or bridges, a replacement hip or knee, or tubal ligation clips are generally safe to have a MRI.

In most cases, a full exam of the foot and ankle via MRI lasts between 60 and 90 minutes.

Pregnant and noticing changes in your feet?

Pregnant women need to observe good foot health to prevent pain and discomfort. Since the body undergoes changes and acquires a new weight-bearing stance, women should wear shoes with broad-based heels that provide support and absorb shock. Additional body weight also calls for more support, to prevent foot "breakdown."

The expectant mother often experiences more than ordinary swelling of her feet and ankles, which can aggravate existing foot conditions and promote inflammation or irritation. Pregnancy also triggers the release of hormones that enhance loose ligaments, which can contribute to foot strain. To help overcome these problems, allow time each day to stay off your feet. Elevate the feet and legs when you are sitting to help prevent and reduce swelling. Don't sit for long periods of time. If problems do develop, please contact our office.

Fungal Nails

Since fungal nails are usually more resistant and more difficult to treat than Athlete's foot, topical or oral antifungal medications may be prescribed. Permanent nail removal is another possible form of treatment for fungal nails.

After a fungal nail infection has cleared up, you can take steps to prevent the infection from coming back.

Keeping the fungus under control will help prevent a fungal infection of the skin from reinfecting the nail. Before bed, thoroughly wash and dry your feet, and apply a non-prescription anti-fungal cream to the entire foot from the ankle down. Use the cream every night, then gradually apply it less often. Keep your feet dry. Dry feet are less likely to become infected. Apply powder to your dry feet after you take a shower or bath.

Other tips:

● Don't share nail clippers or nail files with others.
● Don't share shoes or socks with others.
● Try not to injure your nail, such as by cutting it too short (trauma to the nail may lead to infections).
● Wear dry cotton socks, and change them two or three times a day if necessary.
● Wear dry shoes that allow air to circulate around your feet (tight, enclosed, moist shoes contribute to fungal toenail infections).
● Wear shower sandals or shower shoes when you are at a public pool or shower.
Prevention

Follow basic foot care guidelines and you more than likely can head off most common foot fungus problems.

Athlete's Foot

A chronic infection caused by various types of fungus, Athlete's foot is often spread in places where people go barefoot such as public showers or swimming pools. The condition ranges from mild scaling and itching to painful inflammation and blisters. It usually starts between the toes or on the arch and may spread to the bottom and sides of the foot.

General treatments

Depending on the type of infection you have, various kinds of medication may be used in treating your fungal problem. Successful treatment usually involves a combination of medication and self-care.

If your condition is not serious, over-the-counter and prescription powders, lotions, or ointments can often help treat scaling, itching, and inflammation. Consult us before taking any medication. Foot soaks may help dry excessive perspiration, but you should contact our office first. If your Athlete's foot does not improve, we may prescribe stronger medication.

Freiberg's Disease

Freiberg's Disease usually begins as a pain in the ball of a child's foot. Its onset is often linked to an injury to the growth plate of one of the long bones behind the toes, called metatarsals. The loss of blood flow to the growth plate causes pain. Freiberg's Disease is most frequently seen in adolescents between the ages of 13 and15. It is three times as likely to occur in females than in males.


Treatment for Frieberg's Disease consists of reducing pressure under the affected bone. This may require the use of crutches and/or prescription of a custom orthotic.

Raynaud's Disease

Raynaud's Disease is a disorder that affects the hands and feet. It is caused by contraction of the smooth muscles controlling the small arteries supplying circulation into the hands and feet. This contraction, called a vasospasm, makes the arteries so small that they restrict blood flow. Exposure to cold temperature can often bring on a vasospasm.



Raynaud's Disease has no known cause and is most common in young women. Staying warm and regular exercise to maintain healthy blood circulation throughout the body can help offset the disease.

Gout

Gout (also known as gouty arthritis) is a condition caused by a buildup of the salts of uric acid (a normal byproduct of the diet) in the joints. A single big toe joint is the most commonly affected area, possibly because it is subject to so much pressure in walking. Attacks of gouty arthritis are extremely painful. Men are more likely to be afflicted than women. Diets heavy in red meat, rich sauces, shellfish, and brandy have been linked to gout. However, other protein compounds in foods, such as lentils and beans, may play a role.



The main symptom of gout is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen. The pain lasts for around three or four hours and then subsides. However, pain in the same toe usually returns within a few months.



Gout can be controlled by with prescription medications and diet. Note: Please consult with your physician before taking any medications. The application of ice or cooling lotions helps alleviate pain and swelling during an acute phase. In some cases, specially-made shoes are prescribed to relieve the pain associated with gout.

Arthritis

Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. Although the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.

If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence. However, early diagnosis and proper medical care can limit or slow the damage.

Symptoms of arthritis in the foot and ankle include:

∙ Early morning stiffness.
∙ Limitation in motion of joint.
∙ Recurring pain or tenderness in any joint.
∙ Redness or heat in a joint.
∙ Skin changes, including rashes and growths.
∙ Swelling in one or more joints.
∙ Forms of Arthritis

Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or wear and tear arthritis. Aging usually brings on a breakdown in cartilage, and pain gets progressively more severe. Dull, throbbing nighttime pain is characteristic, and may be accompanied by muscle weakness or deterioration. Many of these symptoms can be relieved with rest. Overweight people are particularly susceptible to osteoarthritis. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.

Rheumatoid arthritis is a major crippling disorder and the most serious form of arthritis. It is a complex, chronic inflammatory group of diseases, often affecting more than a dozen smaller joints during its course. In the foot, it frequently affects both ankles and toes.

Arthritis of the foot and ankle can be treated in many ways, including:

∙ Physical therapy and exercise.
∙ Anti-inflammatory medication and/or steroid injections into the affected joint. Note: Please consult your physician before taking any medications.
∙ Orthotics or specially prescribed shoes.

Visit Great Lakes Foot & Ankle Institute's Webpage

Wear Patterns

Examining old shoes before buying new ones can help you evaluate your wear patterns and buy new shoes with a better fit and style that compensates for the stresses you place on shoes.

What are your shoes trying to tell you? Here is a translation of basic wear patterns:

•A bulge and wear to the side of the big toe means too-narrow fit or you have a bunion.
•Outer sole wear means you turn your foot out. Orthotics may help.
•Toe-shaped ridges on the upper means your shoes are too small or you have hammertoes.
•Wear on the ball of the foot means your heel tendons may be too tight.
•Wear on the inner sole means you pronate or turn your foot inward. Inner liners or orthotics may help.
•Wear on the upper, above the toes means the front of your shoe is too low.

Your Footprint

When you take a step, your foot typically hits the ground heel first and rolls toward your toes, flattening the arch slightly. As you push off the ball of your foot, your arch springs back and does not touch the ground. That's how normal feet are supposed to work. Unfortunately, many feet aren't normal.

Overpronation occurs if your foot rolls too much toward the inside. This can cause arch strain and pain on the inside of the knee. Underpronation occurs if your foot rolls too much to the outside. Underpronation can lead to ankle sprains and stress fractures. You can relieve foot pain by compensating for these tendencies, but first you need to determine which way your feet roll.

One method for determining which kind of pronation you have is the watermark test: Put your feet into a bucket of water, then make footprints on a piece of dark paper.

•If your footprint looks like an oblong pancake with toes, you pronate excessively or may have flat feet. Try molded-leather arch supports, which can be purchased in many drug stores. And when shopping for athletic shoes, ask a sales clerk for styles with "control" features—soles designed to halt the rolling-in motion. If arch supports or sports shoes don't help, please contact our office for a custom-molded orthotics.

•If there's little or no connection in your footprint between the front part of the foot and the heel, you under-pronate or have a high arch. This means a lot of your weight is landing on the outside edge of your foot. Ask for "stability" athletic shoes, which are built with extra cushioning to remedy this problem. If you are prone to ankle sprains, wear high-top athletic shoes that cover the foot and ankle snugly to minimize damage from twists.

Heel Pain (Plantar Fasciitis)

Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.



Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy. Note: Please consult your physician before taking any medications. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat the heel pain.

Diabetic Foot Care

According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.

Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation. With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can lead to a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When a wound is not healing, is at risk for infection and infections spread quickly in diabetics.



When a diabetic foot becomes numb, it may be at risk for deformity. One way this happens is through ulcers. Small, unattended cuts become open sores, which may then become infected. Another way is the bone condition CharcotFoot. This is one of the most serious foot problems diabetics face. It warps the shape of the foot when bones fracture and disintegrate, and yet, because of numbness there is no pain, and the individual continues to walk on the foot. Our practice can treat diabetic foot ulcers and early phases of Charcot (pronounced "sharko") fractures using a total contact cast and prevent more serious damage or deformity. This treatment allows the ulcer to heal by distributing weight and relieving pressure. For Charcot Foot, the cast controls foot movement and supports its contours



If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts, and nail discoloration. Get someone to help you, or use a mirror.

Here's some basic advice for taking care of diabetic feet:
• Always keep your feet warm.
• Don't get your feet wet in snow or rain.
• Keep feet away from heat (heating pads, hot water pads, electric blankets, radiators, fireplaces). You can burn your feet without knowing it. Water temperature should be less than 92 degrees. Estimate with your elbow or bath thermometer (you can get one in any store that sells infant products).
• Don't smoke or sit cross-legged. Both decrease blood supply to your feet.
• Don't soak your feet.
• Don't use antiseptic solutions (such as iodine or salicylic acid) or over-the-counter treatments for corns or calluses.
• Don't use any tape or sticky products, such as corn plasters, on your feet. They can rip your skin.
• Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office for treatment.
• Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes.
• Wash your feet every day with mild soap and warm water.
• Wear loose socks to bed.
• Wear warm socks and shoes in winter.
• When drying your feet, pat each foot with a towel and be careful between your toes.
• Buy shoes that are comfortable without a "breaking-in" period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time.
• Don't wear the same pair of shoes everyday. Inspect the inside of each shoe looking for foreign objects, protruding nails, or any rough spots inside before putting them on. Don't lace your shoes too tightly or loosely.
• Choose socks and stockings carefully. Wear clean, dry socks every day and always wear socks with shoes. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops or garters.
• Never wear sandals or thongs (flip-flops) and never go barefoot, indoors or out.
• In the winter, wear warm socks and protective outer footwear. Avoid getting your feet wet in the snow and rain and avoid letting your toes get cold.
• Don't file down, remove, or shave off corns or calluses yourself.

Contact our office immediately if you experience any injury to your foot. Even a minor injury is an emergency for a patient with diabetes.

Diabetes and Your Feet

According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.

Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.

With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it's at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror.

Here's some basic advice for taking care of your feet:
• Always keep your feet warm.
• Don't get your feet wet in snow or rain.
• Don't put your feet on radiators or in front of the fireplace.
• Don't smoke or sit cross-legged. Both decrease blood supply to your feet.
• Don't soak your feet.
• Don't use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
• Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
• Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes.
• Wash your feet every day with mild soap and warm water.
• Wear loose socks to bed.
• Wear warm socks and shoes in winter.
• When drying your feet, pat each foot with a towel and be careful between your toes.
• Buy shoes that are comfortable without a "breaking in" period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don't wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don't lace your shoes too tightly or loosely.
• Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.

When your feet become numb, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced "sharko") foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn't hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast.

The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot's movement and supports its contours if you don't put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.

Our Doctors

All our professionals at maintain the highest levels of accreditation and pursue ongoing education to stay abreast of the latest trends in podiatry.

Stephen Frascone, D.P.M.

Dr. Stephen Frascone earned his Bachelor of Science degree from St. John's University in his home state of Minnesota, and completed his postgraduate medical training at the Iowa College of Podiatric Medicine and Surgery in 1993. He then completed a three year surgical residency at St. John Hospital - North Shores in Harrison Twp. He also completed a fellowship in traumatology and reconstructive foot and ankle surgery at The University Clinic for Traumatology in Vienna, Austria. Dr. Frascone is Board Certified, a Diplomate of the American Board of Podiatric Surgery, a Fellow of the American College of Foot and Ankle Surgery, and is certified as a wound care specialist by the American Academy of Wound Management. His specialty interests include endoscopic and arthroscopic procedures, elective reconstructive foot and ankle surgery, diabetic preventative care and chronic wound management.

Matthew Hansen, D.P.M.
Dr. Hansen earned his Bachelor of Science degree in chemistry from Madonna University in Livonia, Michigan. His post graduate medical training was completed at the Ohio College of Podiatric Medicine in Cleveland, Ohio. He then completed a three year podiatric surgical residency at St. John North Shores Hospital in Harrison Township, Michigan. Dr. Hansen is Board Certified in foot surgery, as well as reconstructive foot and ankle surgery by the American Board of Podiatric Surgery. He is a member of the American College of Foot and Ankle Surgeons.His extensive surgical training involves reconstructive foot and ankle surgery, flatfoot procedures, arthroscopic and endoscopic techniques, diabetic limb salvage, and wound care management.

Laura LaMar, D.P.M.
Dr. Laura LaMar earned her Bachelor of Science degree from Michigan State University, and completed her postgraduate medical training from the Temple University School of Podiatric Medicine in Philadelphia Pennsylvania in 2000. She then went on to complete a three year podiatric surgery residency at St. John North Shore Hospital in Harrison Township, Michigan. She is Board Certified in foot surgery, as well as reconstructive foot and ankle surgery by the American Board of Podiatric Surgery. She is a member of both the American Podiatric Medical Association, as well as the American College of Foot and Ankle Surgeons. Her specialty interests include reconstructive foot and ankle surgery including diabetic limb salvage as well as trauma, surgery, arthroscopic procedures, pediatric procedures, sport related injuries, wound care as well as forefoot surgery.

Jonathan M. King, D.P.M.
Dr. Jonathan M. King was raised in Rigby, Idaho and completed his undergraduate degree work at Idaho State University. He later received his Doctorate of Podiatric Medicine degree from Des Moines University in Iowa. He went on to complete a three year podiatric surgical residency at Henry Ford Macomb Hospital in Clinton Township, Michigan. In addition to his extensive training in the medical and surgical management of the foot and ankle, he also received specialized training in arthroscopic, traumatology and reconstructive forefoot and rear foot surgery. He practiced in the Phoenix, AZ Metro area previously before joining Great Lakes Foot and Ankle. He and his wife and three boys are glad to be back in Michigan.

General Statistics

Foot and ankle problems usually fall into the following categories:

•Acquired from improper footwear, physical stress, or small mechanical changes within the foot.
•Arthritic foot problems, which typically involve one or more joint.
•Congenital foot problems, which occur at birth, are generally inherited.
•Infectious foot problems, which are caused by bacterial, viral, or fungal disorders.
•Neoplastic disorders, usually called tumors, which are the result of abnormal growth of tissue and may be benign or malignant.
•Traumatic foot problems, which are associated with foot and ankle injuries.

The top foot problems are:

•Bunions - misaligned big toe joints that can become swollen and tender, causing the first joint of the big toe to slant outward, and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. Surgery is frequently performed to correct the problem.
•Hammertoe - a condition, usually stemming from muscle imbalance, in which the toe is bent in a claw-like position. It occurs most frequently with the second toe, often when a bunion slants the big toe toward and under it, but any of the other three smaller toes can be affected. Selecting shoes and socks that do not cramp the toes will alleviate aggravation.
•Heel spurs - growths of bone on the underside, forepart of the heel bone. Heel spurs occur when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. With proper warm-up and the use of appropriate athletic shoes, strain to the ligament can be reduced.
•Ingrown nails - toenails whose corners or sides dig painfully into the skin. Ingrown toenails are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity and poor foot structure. Women are much more likely to have ingrown toenails than men. Ingrown nails can be prevented by trimming toenails straight across, selecting proper shoe style and size - not too tapered or shallow - and paying special attention to foot pain.
•Neuromas - enlarged benign growths of nerves, most commonly between the third and fourth toes. They are caused by tissue rubbing against and irritating the nerves. Pressure from ill-fitting shoes or abnormal bone structure can also lead to this condition. Treatments include orthoses (shoe inserts) and/or cortisone injections, but surgical removal of the growth is sometimes necessary.
•Plantar fasciitis (heel pain) - usually caused by an inflammation on the bottom of the foot. Our practice can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.
•Sesamoiditis - inflammation or rupture of the two small bones (sesamoids) under the first metatarsal bones. Proper shoe selection and orthoses can help.
•Shin splints - pain to either side of the leg bone, caused by muscle or tendon inflammation. It is commonly related to excessive foot pronation (collapsing arch), but may be related to a muscle imbalance between opposing muscle groups in the leg. Proper stretching and corrective orthoses (shoe inserts) for pronation can help prevent shin splints.
•Stress fractures -incomplete cracks in bone caused by overuse. With complete rest, stress fractures heal quickly. Extra padding in shoes helps prevent the condition. Stress fractures left untreated may become complete fractures, which require casting and immobilization.

When To Call a Doctor

People call a doctor of podiatry for help diagnosing and treating a wide array of foot and ankle problems. Please contact our office if you experience one of the following:

•Persistent pain in your feet or ankles.
•Changes in the nails or skin on your foot.
•Severe cracking, scaling, or peeling on the heel or foot.
•Blisters on your feet.
•There are signs of bacterial infection, including:
•Increased pain, swelling, redness, tenderness, or heat.
•Red streaks extending from the affected area.
•Discharge or pus from an area on the foot.
•Foot or ankle symptoms that do not improve after two weeks of treatment with a nonprescription product.
•Spreading of an infection from one area of the foot to another, such as under the nail bed, skin under the nail, the nail itself, or the surrounding skin.

Thickening toenails that cause discomfort. Heel pain accompanied by a fever, redness (sometimes warmth), or numbness; tingling in the heel; persistent heel pain without putting any weight or pressure on your heel; or pain that is not alleviated by ice or over-the-counter painkillers (such as aspirin, ibuprofen or acetaminophen). Diabetics with poor circulation who develop Athlete's Foot.

What is a Podiatrist?

A podiatrist, also called a doctor of podiatric medicine, is a specialist who provides medical diagnosis and treatment of foot and ankle problems, such as bunions, heel pain, spurs, hammertoes, neuromas, ingrown toenails, warts, corns and calluses. A podiatrist also renders care of sprains, fractures, infections, and injuries of the foot, ankle and heel. In addition to undergraduate medical school training, podiatrists also attend graduate school for a doctorate degree in podiatry. Podiatrists are required to take state and national exams, as well as be licensed by the state in which they practice.

According to the American Podiatric Medical Association, there are an estimated 15,000 practicing podiatrists in the United States. Podiatrists are in demand more than ever today because of a rapidly aging population. In addition, according to the association, foot disorders are among the most widespread and neglected health problems affecting people in this country.


Typically, podiatrists:

•Consult with patients and other physicians on how to prevent foot problems.

•Diagnose and treat tumors, ulcers, fractures, skin and nail diseases, and deformities.

•Perform surgeries to correct or remedy such problems as bunions, clawtoes, fractures, hammertoes, infections, ruptured Achilles, and other ligaments and tendons.

•Prescribe therapies and perform diagnostic procedures such as ultrasound and lab tests.

•Prescribes or fits patients with inserts called orthotics that correct walking patterns.

•Treat conditions such as: bone disorders, bunions, corns, calluses, cysts, heel spurs, infections, ingrown nails, and plantar fasciitis.