Q.I have been diagnosed with a spur under my left heel- I have had 3 cortisone injections which helped for a couple of months. My doctor will not give any more cortisone shots. What else can be done for this condition?
A. Heel spurs are a result of instability in gait, causing stress on the heel bone and the attached soft tissue. A strain is placed on the muscles and ligaments beyond the normal extension, causing inflammation and possible growth of a bone spur. The effected ligament is known as
the plantar fascia, which connects the heel to the ball of the foot. The condition is worse after
being sedentary for a prolonged period of time and once the individual begins to walk it
resolves. This may also be caused by injury, bruising, shoegear that is not supportive, or
inflammation of a nerve or Achilles Tendon. Your doctor is correct in not administrating further
cortisone injections, this could cause a break down of soft tissue including tendon and
ligaments. Other treatment options include taping, anti-inflammatory medication, icing,
stretching exercises, physical therapy, and most importantly custom molded orthotics. The vast
majority of patients respond to conservative treatment, however, when exhausted, surgical
intervention may be necessary.
Q.“I’m an average 61 year old male in good health. About ten years ago, I accidentally kicked the leg of the couch with my right foot. These days, I sometimes feel like I have a lump under my foot when walking. No pain or other problems. The second and third toes are slightly bent, but otherwise OK. My question is whether further examination at this late date would provide any course of action. I don’t know the extent of the damage, if any, and what could be done anyway?”
A. It is difficult to say whether or not your incident with the couch is playing a role with the sensation of a lump under your foot. Depending on the direction the toes are bending it could be caused by a hammertoe, a neuroma, or an old fracture. If a fracture occurred at that time it would have healed by now. I would recommend an evaluation and based upon that, treatment can be determined if necessary.
Q.Hammertoe Treatment & Surgery - Why use a crest when toes already want to bend over? Why not cut a ligament/tendon to straighten instead of shortening?
A. A hammertoe is a contraction of one of the joints in toes two, three, four, or five. In this condition the toe is bent at the middle of the joint, which is called the proximal interphalangeal joint or PIPJ. A toe crest is a conservative form of treatment used help support the toe. This will help straighten the toe by decreasing the contraction of the toe and therefore lessen pain and/or a callus at the level of the joint. Surgical intervention is determined by the severity and location of the hammertoe. Treatments may consist of cutting the tendon located on the bottom of the toe, removal of a piece of bone at the level of the deformed joint and repair the tendon, or tendon transfer. Removal of bone at the level of the joint is also an option; the bone is then fused using a wire or absorbable material. This method may produce more shortening than the above procedures. The goal of the surgery is to decrease pain at the joint and to straighten the toe.
Q.I have been battling a foot fungus problem for a while. I’m allergic to Lamisil and have tried numerous over the counter treatments, none of which have helped. What else can I do?
A.It is possible for fungus to affect the skin and nails of the feet. Fungus likes a dark, moist environment that feet can provide. If the skin shows signs of dryness, itching, scaling, inflammation, or small blisters a fungus/Athlete’s foot may be present. It is possible to catch this from pool decks, locker rooms, and showers. Nail fungus (onychomycosis) may be caused due to microtrauma of the nail. Dermatophytes, molds, yeast, and some bacteria feed off of the nail causing thickening and discoloring. Drying well and not moisturizing between your toes can prevent fungus. Also changing sock if feet sweat excessively will help deter fungus as well as using talcum powder and shower shoes. Since your have exhausted the over the counter treatments, you should consider being seen by a podiatrist. They can determine if fungus is the cause of your problem and, if necessary, prescribe a topical medication. This may take weeks to resolve since toenail fungus is more difficult to treat compared to skin fungus.
Q.How are bone spurs treated-is surgery always necessary?
A.A bone spur can be the result of instability in gait causing stress on the bone. Also, strain placed on the muscles and ligaments beyond normal extension can cause inflammation and the possible growth of a bone spur or osteoarthritis. Osteoarthritis affects the cartilage of the joint, it is slowly worn away and therefore the bones no longer glide smoothly which may cause pain. The joint shape may change and a bone spur may grow on the edge of the bone. Bones spurs may be located in various locations of the foot: heel, toes, and the top of the foot. Treatment will depend on the location and cause of the spur, however, conservative treatment is recommended first. This may consist of taping, anti-inflammatory medication, ice/heat, stretching exercises, possible steroid injection, physical therapy and custom molded orthotics. Surgery may be necessary and again the procedure will depend upon the severity and location of the spur.
Q.When I first arise in the morning I have a terrible tingling sensation on the bottom of my feet. It goes away after a few minutes. What would cause this – I am on my feet a lot during the course of the day.
A.Peripheral neuropathy affects the long nerves of the body and is one possible cause of your tingling sensation. The symptoms may include pain, numbness, or tingling or burning sensations. There are various causes that lead to these symptoms, some of which are external while others are internal. External factors include anything that puts pressure on the nerve such as compression of it due to swelling of soft tissue, difference in anatomy where the nerve maybe impinged, or a tumor. Other common causes of neuropathy can include traumatic injuries, infections, exposure to toxins, vitamin deficiencies, alcoholism, metabolic diseases such as diabetes, and autoimmune diseases like Lupus. Preventative measures range from maintaining blood sugar levels and diet, the proper consumption of vitamins, to avoid repetitive motions and cramped positions. I would recommend that you seek medical treatment for a proper evaluation of your symptoms. A full work up may include muscle testing, blood work, and if necessary a nerve biopsy. The actual cause may not be identified, however, a proper check-up can exclude certain factors, allowing the nerve to recover and symptoms to subside. Medications are available to assist with the symptoms.
Q.What causes flat feet and how is this condition treated?
A.A flat foot deformity, also known as pes planus, denotes a flexible or rigid decrease in the arch of the foot. The deformity occurs due to over pronation, which is inward rolling of the foot.
Pes Planus can also be categorized as congenital or acquired. Congenital flat feet, in which the deformity has been present since birth, are typically flexible. A non-weight bearing arch is present, however, when weight is applied, the arch collapses. Acquired flat feet develop over time. The condition can be the result of a number of other foot related issues: improper shoe gear, faulty biomechanics of the foot, compensation for abnormalities of the foot, rupture of tendon/ligament, and most commonly a tight Achilles tendon. Treatment of flat foot deformity depends on the presence of pain. If no pain is present, then no treatment needs to be rendered aside from wearing proper shoe gear. Treatment for painful flat feet can vary from taping the foot for additional support, custom molded orthotics, stretching and range of motion exercises, and lastly surgical intervention.
Q.What is done for ingrown toenails and can they reoccur?
A.Ingrown toenails occur when the border of a nail digs into the adjacent skin causing pressure on the nail fold. Common causes for ingrown toenails include the shape of the nail, genetics, trauma, or improper cutting of the nail. Ingrown toenails can cause discomfort with or without pressure from shoe gear. Recurrence may occur depending on the cause.
Tenderness on palpation or a throbbing sensation are common complaints. If untreated, pressure on the nail fold can cause an infection. Signs of infection would include redness surrounding the nail border, increase in skin temperature, and/or pus drainage. Antibiotics may be warranted if such symptoms are present, however, the offending border would need to be addressed to avoid the pressure.
Initial home remedies may include Epsom salt soaks and massaging of the skin fold away from the nail for temporary relief; however, the ideal treatment would include removal of the nail border. This procedure, which is also known as a partial nail avulsion, can be performed in the office with a local anesthetic. Depending on the frequency of reoccurrence, one can determine whether to perform a temporary or permanent nail avulsion. Patients who have had an ingrown for the first time may consider a temporary procedure in which the nail border would be removed, however, over six to nine months as the nail grows, the border would grow back. For patients who get recurrent ingrown toenails, a permanent nail avulsion may be warranted. A chemical is used to prevent the return of the nail. Regardless of the type of procedure performed, the patient remains weight bearing and can return to full activity immediately.
Dr. Robert Califano and Dr. Brighid Lodge: Role in Wellness
Dr. Robert Califano and Dr. Brighid Lodge provide a full range
of services for the treatment of foot disorders for both children
and adults. Some of the more common conditions seen include heel and arch pain, bunions, arthritis, ganglions, hammertoes, sprains, fractures, ingrown nails, nerve entrapments, tendonitis and warts. Diabetic foot care is also available. The doctors will always pursue conservative therapy initially for these conditions. Treatment modalities may include supportive tape strappings, oral medications, injections, casting or custom orthotics. However if these approaches are unsuccessful, surgery may be indicated. Surgery is commonly performed on an outpatient basis. The doctors are on staff at Ellis Hospital including their affiliate The Bellevue Campus and the New England Surgery Center.
Dr. Califano has been in practice in the Capital Region since 1985. Prior to that time, he was in practice in San Diego where he served as president of the San Diego County Podiatry Association as well as Director of Podiatric Residency Program at Villa View Hospital. He is a graduate of the University of Hartford and the California College of Podiatric Medicine. He completed his residency in foot surgery at the Kaiser Foundation Hospital in San Francisco. He is board certified by the American Board of Podiatric Surgery. He has served as president of the Northeast division of the New York State Podiatric Medical Association and acts as a consultant to the New York State Education Department. He is chief of podiatry at the Century Same Day Surgery Center and The New England Surgery Center.
Dr. Lodge is a graduate of Kings College and the Temple University School of Podiatric Medicine. She served her residency in foot surgery at Our Lady of Lourdes Hospital in Binghamton where she was named resident of the year in 2004 and 2006.
Dr. Califano and Dr. Lodge are available to see patients both in Rotterdam and Latham.
This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
