The Achilles tendon, the largest and single strongest tendon in the body, connects the heel bone to the muscles in the back of your leg and thigh. The primary function of the Achilles tendon is to transmit the power of these muscles to the foot enabling walking and running.
Why do Achilles tendon injuries occur?
Achilles tendon injuries can occur especially when the tendon is subjected to strong forces such as very active sports: running, soccer, basketball, tennis, and baseball. Additionally, aging, and the Achilles tendons poor blood supply also increases your chance of injury. The area of the tendon with the poorest blood supply is the area (2 to 6 cm) just above its insertion into the heel bone. The blood flow to this area decreases as you get older. This means, older active individuals are more vulnerable to injury and need especially to take precautions such as wearing appropriate athletic gear, and doing proper stretching. Athletes and laborers who routinely put added stresses on their feet are vulnerable to Achilles tendon injuries. Weekend warriors who are not in proper condition and infrequently and who participate in athletic activities, also are at greater risk for Achilles tendon injuries.
Injury to the Achilles tendon can be sudden or gradual and the healing course can be lengthy. A careful history and foot physical by Dr. Sandall is needed to make the correct diagnosis and choose the right treatment plan.
If you experience pain, tenderness, swelling or stiffness anywhere along the tendons path you may have Achilles tendonitis or Achilles tendonosis. Dr. Sandall routinely evaluates for these conditions for a more severe ailment such as an Achilles tendon rupture. Someone with this condition, often found in men 30 to 50 years old, may have experienced the feeling like someone stepped on the back of their ankle or that a popping sound was heard or felt. Persons usually with Achilles tendon partial or full ruptures may bear weight but have difficulty pushing off it. This is a serious condition which requires prompt diagnosis and treatment by Dr. Sandall.
Upon examining your foot and ankle, Dr. Sandall will evaluate the range of motion of your ankle, palpate for tenderness and assess the thickness and consistency of the tendon as compared with the alternate foot and ankle. We do in office testing such as X-Rays, Diagnostic Ultrasound or order an MRI to further diagnose the extent of the injuries.
The mainstay of treatment for tendonitis or tendonosis is ice, rest and nonsteroidal anti-inflamatory drugs, but physical therapy, orthotic inserts and surgery may be needed in recalcitrant cases. In patients with tendon rupture, casting or surgery is required. Appropriate treatment of Achilles tendon injuries often leads to full recovery.
For more information about Achilles Tendonitis, call Arizona Foot and Ankle, Medicine & Surgery for an appointment at (480) 699-8762
Allergic Contact Dermatitis
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. 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, may mimic athlete’s foot.
The signs of athlete’s foot, may include, dry 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.
It is not easy to prevent athlete’s foot because it is usually contracted in dressing rooms, showers, and swimming pool locker rooms. 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 socks 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.
Fungicidal medication, used for athlete’s foot treatment, frequently fail to contact the fungi in the horny layers of the skin. Topical or oral anti-fungal drugs are prescribed with growing frequency.
In mild cases of the infection, it is important to keep the feet dry by dusting foot powder in shoes and socks. The feet should be bathed frequently and all areas around the toes dried thoroughly.
Consult Your Podiatrist
If an apparent fungus condition does not respond to proper foot hygiene and self care, and there is no improvement within two weeks, consult Dr. Sandall’s office. He will determine if a fungus is the cause of the problem. If it is, a specific treatment plan, including the prescription of anti-fungal medication, applied topically or taken by mouth, will usually be suggested. Such a treatment appears to provide better resolution of the problem, when the patient observes the course of treatment prescribed by the podiatrist; if it’s shortened, failure of the treatment is common.
Dr. Sandall has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.
For more information about Athlete’s Foot, call Arizona Foot and Ankle, Medicine & Surgery for an appointment at (480) 699-8762
This is a condition in which there is one or more abnormally short or overlapping toes metatarsals. This condition may result due to a congenital defect or it may be an acquired condition.
A bunion is an enlargement of the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. Since this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion can also occur on the outside of the foot along the little toe, where it is called a “bunionette” or “tailor’s bunion.”
A firm bump on the outside edge of the foot, at the base of the big toe.
Redness, swelling, or pain at or near the MTP joint.
Corns or other irritations caused by the overlap of the first and second toes.
Restricted or painful motion of the big toe.
How Do You Get a Bunion?
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This can lead to instability in the joint and cause the deformity. They are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk, and our inherited foot type, our shoes, or other sources.
Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease.
Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.
Conservative Treatment For Bunion Pain
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. Podiatric medical attention should be sought at the first indication of pain or discomfort because, left untreated, bunions tend to get larger and more painful, making nonsurgical treatment less of an option.
The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. Dr. Sandall may recommend these treatments:
- Padding & Taping Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.
- Medication Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by joint deformities.
- Physical Therapy Often used to provide relief of the inflammation and from bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
- Orthotics Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
- Surgical Options When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available for Dr. Sandall to use. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.
A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint.
Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatric physician.
Wear comfortable shoes that conform to the shape of your foot.
Wear shoes with a wide and deep toe box.
Always fit the larger foot and have your feet sized each time you purchase shoes.
Apply a commercial, nonmedicated bunion pad around the bony prominence.
If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
Avoid high-heeled shoes over two inches tall.
Seek professional podiatric evaluation and assistance with uncomfortable or noticeable bunions.
Dr. Sandall has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.
For more information about Bunions, call Arizona Foot and Ankle, Medicine & Surgery for an appointment at (480) 699-8762
Corns are areas of thickened skin irritations that can occur on the foot. Calluses are thick, painful skin irritations that can occur on the bottom of the foot. If the thickened area is on top of the toes, we call it a corn. Corns are usually caused by shoes pressing against the toes. They are made worse if the toe is crooked or contracted (hammertoe). These areas generally represent areas of excessive pressure or friction in shoes or while walking on hard surfaces. Caution should be used whenever using any type of corn or callus removers because these medications contain acids that burn the thickened skin off. If you have diabetes, you should never use these medications without a physician’s guidance. These irritations will generally reoccur after use of these medications because the source of irritation is still present. Home remedies might include shoe cushions or pads, and if they are between the toes, pads might be used. Warm water soaks and then buffing with a pumice stone may help. Creams and lotions may be of some temporary help.
For more information about Calluses/Corns, call Arizona Foot and Ankle, Medicine & Surgery for an appointment at (480) 699-8762
Diabetic Foot Care
Diabetes is a lifelong chronic disease caused by high levels of sugar in the blood. It can also decrease your body’s ability to fight off infections, which is especially harmful in your feet. When diabetes is not properly controlled, damage can occur to the organs and impairment of the immune system is also likely to occur.
If you are suffering from diabetes, schedule an appointment with our office today at Arizona Foot & Ankle Medicine & Surgery: (480) 699-8762
With damage to your nervous system, you may not be able to feel your feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which can lead to an abnormal pressure on the skin, bones, and joints of the foot during walking and other activities. This can even lead to the breakdown of the skin of the foot, which often causes sores to develop. If you have diabetes, it is important to prevent foot problems before they occur, recognize problems early, and seek the right treatment when a problem does happen.
Diabetic Complications and Your Feet
When it comes to your feet, there are several risk factors that can increase your chances of developing foot problems and diabetic infections in the legs and feet. First of all, poorly fitting shoes are one of the biggest culprits of diabetic foot complications.
If you have red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new proper fitted shoes must be obtained immediately.
Additionally, if you have common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or orthotics from your podiatrist may be necessary to further protect your feet from other damage.
People who have long-standing or poorly controlled diabetes are also at risk for having damage to the nerves in their feet, which is known in the medical community as peripheral neuropathy. If you have nerve damage, you may not be able to feel your feet normally and you may also be unable to sense the position of your feet and toes while walking and balancing, which can cause even more harm to your feet.
Normal nerves allow people to sense if their shoes are too tight or if their shoes are rubbing on the feet too much. With diabetes, you may not be able to properly sense minor injuries, such as cuts, scrapes and blisters-all signs of abnormal wear, tear, and foot strain. The following can also compromise the health of your feet:
- Poor circulation
- Trauma to the foot
Diabetes can be extremely dangerous to your feet, so take precautions now. You can avoid serious problems such as losing a toe, foot, or leg by following proper prevention techniques offered by Dr. Sandall. Remember, prevention is the key to saving your feet and eliminating pain.
Flatfoot (Fallen Arches)
Flat feet are a common condition of the foot structure. In infants and toddlers, prior to walking, the longitudinal arch is not developed, and flat feet are normal. Most feet are flexible and an arch appears when children begin standing on their toes. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches.
Flat feet are usually associated with pronation, a leaning inward of the ankle bones toward the center line. Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated by Dr. Sandall.
Painful progressive flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.
Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive flatfoot. Note: Please consult your physician before taking any medications. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.
A ganglion cyst is a tumor or swelling on top of a joint or the covering of a tendon (tissue that connects muscle to bone). It looks like a sac of liquid (cyst). Inside the cyst is a thick, sticky, clear, colorless, jellylike material. Depending on the size, cysts may feel firm or spongy.
Call Arizona Foot & Ankle for an evaluation today.
- One large cyst or many smaller ones may develop. Multiple small cysts can give the appearance of more than one cyst, but a common stalk within the deeper tissue usually connects them. This type of cyst is not harmful and accounts for about half of all soft tissue tumors of the hand.
- Ganglion cysts, also known as Bible cysts, are more common in women, and 70% occur in people between the ages of 20-40. Rarely, ganglion cysts can occur in children younger than 10 years.
- Ganglion cysts most commonly occur on the back of the hand at the wrist joint but they can also develop on the palm side of the wrist. When found on the back of the wrist, they become more prominent when the wrist is flexed forward. Other sites, although less common, include these:
To discuss your ganglion in person, call Dr. Sandall’s office for an appointment: (480) 699-8762
Is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).
The term podiatrists and other healthcare professionals use to describe loss of motion in your big toe joint. The metatarsophalangeal, or MTP, joint of your big toe is the structure affected by this health problem.
Hammertoes are a contracture of the toes as a result of a muscle imbalance between the tendons on the top and the tendons on the bottom of the toe. They can be flexible or rigid in nature. When they are rigid, it is not possible to straighten the toe out by manipulating it. Frequently, they develop corns on the top of the toe as a result of rubbing on the shoe. They may also cause a bothersome callus on the ball of the foot. This occurs as a result of the toe pressing downward on the bone behind the toe. This area then becomes prominent and the pressure of the bone against the ground causes a callus to form. (Corns and Calluses)
They tend to slowly get worse with time and frequently flexible deformities become rigid. Treatment can be preventative, symptomatic or curative.
For an appointment to evaluate your condition, call Arizona Foot & Ankle at (480) 699-8762
Preventative treatment of hammertoe is directed toward the cause of the deformity. A functional orthotic is a special insert that can be prescribed by your podiatrist to address the abnormal functioning of the foot that causes the hammertoe. Functional orthotics can be thought of as contact lenses for your feet. They correct a number of foot problems that are caused by an abnormally functioning foot. Often when orthotics are used for flexible hammertoes, the toes will overtime straighten out and correct themselves. Calf stretching exercises are also helpful. Calf stretching can help to overcome part of the muscle imbalance that causes the hammertoe.
Symptomatic treatment of hammertoes consists of such things as open toed shoes or hammertoe pads. There are over the counter corn removers for temporally reducing the painful callus often seen with the hammertoe. These medications must be used with caution. They are a mild acid that burns the callous off. These medications should never be used for corns or calluses between the toes. Persons with diabetes or bad circulation should never use these products.
Curative treatment of hammertoes varies depending upon the severity of the deformity. When the hammertoe is flexible, a simple tendon release in the toe works well. The recovery is rapid often requiring nothing more than a single stitch and a Band-aid. Of course if several toes are done at the same time, the recovery takes take a bit longer.
Article provided by PodiatryNetwork.com.
Call Dr. Sandall for an appointment today at (480) 699-8762
Heel pain/Planter Fasciitis
The plantar fascia is a ligament which stretches from the heel to the base of the toes. When the ligament is stretched too far, it may become inflamed and cause heel pain. This condition is called Plantar Fasciitis. Patients experience discomfort in the heel and arch of the foot usually worst when getting up after sitting or lying down.
Rough calcium growths known as “bone spurs” are a common complication of plantar fasciitis. Forming on the bottom of the heel they pull on the heel bone and while they do not usually cause pain alone, they are a good indicator of the severity of the condition.
Remaining on the feet for many hours, having naturally tight calf muscles, wearing high heels, having flat feet or very high arches all add to the risk of developing Plantar Fasciitis.
The inflamed tissue runs across the bottom of the foot. Symptoms include stabbing pain near the heel. Pain might be worst in the morning.
Treatments include physical therapy, shoe inserts, steroid injections, and surgery.
Contact us now at (480) 699-8762 to schedule your consultation
If your toe is infected, one of these things might be to blame: You cut the nail too short, or you cut the cuticle around the nail.
Broken toes are often caused by trauma or injury. Symptoms of a broken toe include pain, swelling, stiffness, bruising, deformity, and difficultly walking.
Ingrown toenails are one of the most dreaded foot issues people don’t want to have. Besides the negative social stigma of ingrown toenails, there can be pain, discomfort, infection and often an unsightly appearance attached as well.
The biggest cause of ingrown toenails is easily preventable. Cutting your toenails too short and cutting them in a way where the two corners are tapered is the biggest culprit in causing ingrown toenails. The second most common cause of ingrown toenails is wearing shoes that are too short or too tight.
Ingrown toenails are when your toenail begins to grow into your skin. If not treated, it can lead to severe pain, infections and even surgery.
Any of your toe nails can become ingrown. In most cases, however, it’s one of the big toes that become ingrown. Symptoms of ingrown toenails include:
- Draining puss
If you notice any of these symptoms, it is important to treat it immediately. Early prevention and treatment can be done at home. If treatment is ignored or postponed, further, more extensive professional treatment will likely be needed.
How your ingrown toenail is treated will depend on how early it is caught and the severity of pain and discomfort it causes. There are both nonsurgical and surgical treatment options for ingrown toenails:
In the early stages, you can easily treat an ingrown toenail at home. Below are some at-home treatments:
- Soak your foot 3 times a day in warm water.
- Keep your foot as dry as possible when you’re not soaking them.
- Wear comfortable shoes that have plenty of room for your toes.
- Take ibuprofen or acetaminophen if you’re experiencing pain.
If severe pain, swelling, inflammation and discharge persists, the toenail is likely infected. At this point, it is important you make an appointment with one of our podiatrists. Toenail surgery may be necessary. During this procedure, a part of the infected nail will be removed. In extreme cases, the whole nail may be removed.
If you’re ingrown toenail is causing you persistent pain and swelling, call us today to make an appointment. At Advanced Foot & Ankle Center, we care about the health of your feet. Your feet are important and any kind of pain or discomfort can negatively affect your life. Our certified podiatrists use the latest technology and will do whatever is necessary to avoid surgical treatment for your ingrown toenail.
Arizona Foot & Ankle can set up treatment for your ingrown toenails. Call today for an appointment: (480) 699-8762
Metatarsalgia is a condition in which the ball of your foot becomes painful and inflamed. You might develop it if you participate in activities that involve running and jumping.
There are other causes as well, including foot deformities and shoes that are too tight or too loose.
Morton’s neuroma may be caused by pressure or injury, such as from running or use of high heels.
Morton’s neuroma may feel like a pebble in a shoe or a fold in a sock. There may be sharp, burning pain or numbness in the ball of the foot or toes.Treatment might include arch supports and foot pads, corticosteroid injections, strength exercises, wide-toe shoes, or surgery.
Onychomycosis (nail fungus)
Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage (the connective tissue found at the end of the bones in the joints) protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one’s ability to easily perform daily activities.
Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Some people refer to osteoarthritis simply as arthritis, even though there are many different types of arthritis.
Osteoarthritis appears at various joints throughout the body, including the hands, feet, spine, hips, and knees. In the foot, the disease most frequently occurs in the big toe, although it is also often found in the midfoot and ankle.
Osteoarthritis is considered a “wear and tear” disease because the cartilage in the joint wears down with repeated stress and use over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint.
An injury may also lead to osteoarthritis, although it may take months or years after the injury for the condition to develop. For example, osteoarthritis in the big toe is often caused by kicking or jamming the toe, or by dropping something on the toe. Osteoarthritis in the midfoot is often caused by dropping something on it, or by a sprain or fracture. In the ankle, osteoarthritis is usually caused by a fracture and occasionally by a severe sprain.
People with osteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following:
- Pain and stiffness in the joint
- Swelling in or near the joint
- Difficulty walking or bending the joint
Some patients with osteoarthritis also develop a bone spur (a bony protrusion) at the affected joint. Shoe pressure may cause pain at the site of a bone spur, and in some cases blisters or calluses may form over its surface. Bone spurs can also limit the movement of the joint.
In diagnosing osteoarthritis, Dr. Sandall will examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. In some cases, deformity and/or enlargement (spur) of the joint may be noted. X-rays may be ordered to evaluate the extent of the disease.
To help relieve symptoms, the surgeon may begin treating osteoarthritis with one or more of the following non-surgical approaches:
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the inflammation and pain. Occasionally a prescription for a steroid medication is needed to adequately reduce symptoms.
- Orthotic devices. Custom orthotic devices (shoe inserts) can easily be ordered by Dr. Sandall. These are often prescribed to provide support to improve the foot’s mechanics or cushioning to help minimize pain.
- Bracing. Bracing, which restricts motion and supports the joint, can reduce pain during walking and help prevent further deformity.
- Immobilization. Protecting the foot from movement by wearing a cast or removable cast-boot may be necessary to allow the inflammation to resolve.
- Steroid injections. In some cases, steroid injections are applied to the affected joint to deliver anti-inflammatory medication.
- Physical therapy. Exercises to strengthen the muscles, especially when the osteoarthritis occurs in the ankle, may give the patient greater stability and help avoid injury that might worsen the condition.
When Is Surgery Needed?
When osteoarthritis has progressed substantially or failed to improve with non-surgical treatment, surgery may be recommended. In advanced cases, surgery may be the only option. The goal of surgery is to decrease pain and improve function. Dr. Sandall will consider a number of factors when selecting the procedure best suited to the patient’s condition and lifestyle.
Speak to Dr. Sandall to discuss your Osteoarthritis in our office. 1347 N Greenfield Road, Site 101 Mesa, Arizona 85205 (480) 699-8762
Pediatric Foot Care
Pediatric foot problems are referred to by podiatrists as podopediatrics. Dr. Sandall can treat Foot problems in your child may have appeared at birth, shortly thereafter, or once your child is walking.
If you suspect an issue, the sooner the treatment the better the outcome, in most cases.
Dr. Sandall see patients of all ages. Call for an appointment (480) 699-8762
A wart is a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, and the elderly.
Here at Arizona Foot & Ankle, we offer a wide variety of treatments that are less painful than other options. Come in for a visit with Dr. Sandall, and he will address the best treatment plan for your situation. (480) 699-8762
There are two types of plantar warts:
- A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional satellite warts.
- Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.
Plantar warts are caused by direct contact with the human papilloma virus (HPV). This is the same virus that causes warts on other areas of the body.
The symptoms of a plantar wart may include:
- Thickened Skin. Often a plantar wart resembles a callus because of its tough, thick tissue.
- Pain. Walking and standing may be painful. Squeezing the sides of the wart may also cause pain.
- Tiny Black Dots. These often appear on the surface of the wart. The dots are actually dried blood contained in the capillaries (tiny blood vessels).
Plantar warts grow deep into the skin. Usually this growth occurs slowly, with the wart starting small and becoming larger over time.
Diagnosis and Treatment
To diagnose a plantar wart, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a wart.
Although plantar warts may eventually clear up on their own, most patients desire faster relief. The goal of treatment is to completely remove the wart.
The foot and ankle surgeon may use topical or oral treatments, laser therapy, cryotherapy (freezing), acid treatments, or surgery to remove the wart.
Regardless of the treatment approaches undertaken, it is important that the patient follow the surgeon’s instructions, including all home care and medication that has been prescribed, as well as follow-up visits with the surgeon. Warts may return, requiring further treatment.
If there is no response to treatment, further diagnostic evaluation may be necessary. In such cases, the surgeon can perform a biopsy to rule out other potential causes for the growth.
Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove warts themselves. This can do more harm than good.
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Posterior Tibial Dysfunction
The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.
PTTD is often called “adult acquired flatfoot” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn’t treated early.
Get treatment at Arizona Foot and Ankle, located in Mesa, Arizona.
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change.
For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen.
Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward.
As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.
Because of the progressive nature of PTTD, early treatment is advised. If treated early enough by Dr. Sandall, your symptoms may resolve without the need for surgery and progression of your condition can be arrested.
In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.
In many cases of PTTD, treatment can begin with non-surgical approaches that may include:
- Orthotic Devices or Bracing. To give your arch the support it needs, your foot and ankle, Dr. Sandall may provide you with an ankle brace or a custom orthotic device that fits into the shoe.
- Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while.
- Physical Therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
- Shoe Modifications. Dr. Sandall may advise changes to make with your shoes and may provide special inserts designed to improve arch support.
When Is Surgery Needed?
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Arizona Foot & Ankle will determine the best approach for you.
Running and Sports Injuries
Whether an athlete is a recreational, competitive, or elite runner, foot and ankle health is essential for optimal performance.
Runners are susceptible to overuse injuries including heel pain (plantar fasciitis), Achilles tendonitis, sesamoiditis, neuromas, tendonitis, sesamoiditis, neuromas, capsulitis of the second toe, stress fractures, posterior tibial tendonitis (or PTTD), and calcaneal apophysitis in children and adolescents.
Evaluation by Dr. Sandall will help the athlete determine the underlying cause of pain and the best course of treatment. Custom orthotic devices are often used for treatment of these conditions.
See Dr. Sandall at Arizona Foot & Ankle at 1347 N Greenfield Road, Suite 101 Mesa, Arizona. 85205 (480) 699-8762
A sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint.
Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe “pushes off” during walking and running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.
Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. They are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequent wearing of high-heeled shoes can also be a contributing factor.
Types of Sesamoid Injuries in the Foot
There are three types of sesamoid injuries in the foot:
- Turf toe. This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Turf toe may result in an injury to the soft tissue attached to the sesamoid or a fracture of the sesamoid. Sometimes a “pop” is felt at the moment of injury.
- Fracture. A fracture (break) in a sesamoid bone can be either acute or chronic.
- An Acute Fracture is caused by Trauma – A direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint.
- A Chronic Fracture is a Stress Fracture (A hairline break usually caused by repetitive stress or overuse) – A Chronic esamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest.
- Sesamoiditis. This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure to the sesamoids. Often, sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.
In diagnosing a sesamoid injury, Dr. Sandall will examine the foot, focusing on the big toe joint. Dr. Sandall will press on the big toe, move it up and down, and may assess the patient’s walking and evaluate the wear pattern on the patient’s shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.
Non-surgical treatment for sesamoid injuries of the foot may include one or more of the following options, depending on the type of injury and degree of severity:
- Padding, Strapping or Taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension.
- Immobilization. The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot.
- Oral Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the pain and inflammation.
- Physical Therapy. The rehabilitation period following immobilization sometimes includes physical therapy, such as exercises (range-of-motion, strengthening, and conditioning) and ultrasound therapy.
- Steroid Injections. In some cases, cortisone is injected in the joint to reduce pain and inflammation.
- Orthotic Devices. Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot.
When is Surgery Needed?
When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. Arizona Foot & Ankle will determine the type of procedure that is best suited to the individual patient.
Tarsal Tunnel Syndrome
The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel—arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.
What Is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.
Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.
Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:
- A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with “fallen” arches can produce strain and compression on the nerve.
- An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
- An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
- Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve.
Patients with tarsal tunnel syndrome experience one or more of the following symptoms:
- Tingling, burning, or a sensation similar to an electrical shock
- Pain, including shooting pain
Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.
Sometimes the symptoms of the syndrome appear suddenly. Often they are brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.
It is very important to seek early treatment if any of the symptoms of tarsal tunnel syndrome occur. If left untreated, the condition progresses and may result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated.
The foot and ankle surgeon will examine the foot to arrive at a diagnosis and determine if there is any loss of feeling. During this examination, the surgeon will position the foot and tap on the nerve to see if the symptoms can be reproduced. He or she will also press on the area to help determine if a small mass is present.
Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Studies used to evaluate nerve problems—electromyography and nerve conduction velocity (EMG/NCV) —may be ordered if the condition shows no improvement with non-surgical treatment.
A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:
- Rest. Staying off the foot prevents further injury and encourages healing.
- Ice. Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Oral Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
- Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
- Physical Therapy. Ultrasound therapy, exercises, and other physical therapy modalities may be prescribed to reduce symptoms.
- Injection Therapy. Injections of a local anesthetic provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
- Orthotic Devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
- Shoes. Supportive shoes may be recommended.
- Bracing. Patients with flatfoot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount of pressure on the foot.
When Is Surgery Needed?
Sometimes surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.
Your podiatrist, Dr. Sandall at Arizona Foot & Ankle will determine how to best reduce your pain.
Call Dr. Sandall for an evaluation today. (480) 699-8762
Tailor’s bunion, also called a bunionette, is a prominence of the fifth metatarsal bone at the base of the little toe. The metatarsals are the five long bones of the foot. The prominence that characterizes a tailor’s bunion occurs at the metatarsal “head,” located at the far end of the bone where it meets the toe. Tailor’s bunions are not as common as bunions, which occur on the inside of the foot, but they are similar in symptoms and causes.
Why is it called a tailor’s bunion? The deformity received its name centuries ago, when tailors sat cross-legged all day with the outside edge of their feet rubbing on the ground. This constant rubbing led to a painful bump at the base of the little toe.
Often a tailor’s bunion is caused by an inherited faulty mechanical structure of the foot. In these cases, changes occur in the foot’s bony framework, resulting in the development of an enlargement.
The fifth metatarsal bone starts to protrude outward, while the little toe moves inward. This shift creates a bump on the outside of the foot that becomes irritated whenever a shoe presses against it.
Sometimes a tailor’s bunion is actually a bony spur (an outgrowth of bone) on the side of the fifth metatarsal head.
Regardless of the cause, the symptoms of a tailor’s bunion are usually aggravated by wearing shoes that are too narrow in the toe, producing constant rubbing and pressure.
Arizona Foot & Ankle will take the best care of you and your feet. Call today for an appointment. (480) 699-8762
The symptoms of tailor’s bunions include redness, swelling, and pain at the site of the enlargement. These symptoms occur when wearing shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation.
Tailor’s bunion is easily diagnosed because the protrusion is visually apparent. X-rays may be ordered to help the foot and ankle surgeon determine the cause and extent of the deformity.
Treatment for tailor’s bunion typically begins with non-surgical therapies. Dr. Sandall may select one or more of the following:
- Shoe Modifications. Choose shoes that have a wide toe box, and avoid those with pointed toes or high heels.
- Padding. Bunionette pads placed over the area may help reduce pain.
- Oral Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
- Icing. An ice pack may be applied to reduce pain and inflammation. Wrap the pack in a thin towel rather than placing ice directly on your skin.
- Injection Therapy. Injections of corticosteroid may be used to treat the inflamed tissue around the joint.
- Orthotic Devices. In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.
When Is Surgery Needed?
Surgery is often considered when pain continues despite the above approaches. In selecting the procedure or combination of procedures for your case, Dr. Sandall will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
Talk with Arizona Foot & Ankle to find out which option is best for you. (480) 699-8762
Toe deformities are common problems that occur due to abnormal positioning of the foot bones, inadequate biomechanics, and diseases such as arthritis affecting bones and tissues of the foot. Toe deformities not only affect the alignment of the bones, joints and tissues in the foot, but may also affect alignment of the weight bearing joints such as the hips or knees resulting in further problems. The most common toe deformities are hammertoes, claw toes, and mallet toes.
See Dr. Sandall at Arizona Foot & Ankle to find out how we can best treat your condition. Call today for an appointment: (480) 699-8762