Our Podiatrist, Dr. Clark, treats the following conditions of the foot and ankle:
· Persistent pain in your feet or ankles
· Changes in the nails or skin on your foot
· Severe cracking, scaling, or peeling on the heel, foot, or toes
· Blisters or redness on your toes, feet, or ankle
· Burning, tingling, or numbness in your feet
· If you are a diabetic and have any foot/ankle concerns such as wound/sores of the foot/ankle or if you have thick toenails that are difficult to cut on your own
· Any other problem or concern that you think you may have with your foot or ankle, such as: ankle pain or instability, bunions, heel pain, spurs, hammertoes or clawtoes, neuromas, ingrown toenails, thick toenails that are difficult to trim by yourself, warts, painful corns and calluses.
Services that Dr. Clark provides include, but are not limited to:
· Listening to you about the concern you have with your toenails, toes, foot, or ankle to be able to get an accurate history of the problem to aid in diagnosis and treatment
· Perform a detailed physical exam of the lower extremity to be able to correctly assess any ankle or pedal deformities/problems that could be contributing to your concern
o This exam includes extensive testing of neurologic (nerves) and vascular status (blood flow) of the lower extremity as well as assessing the dermatologic (skin) and musculoskeletal (bony deformities) abnormalities of the foot to be able to determine the factors that may be contributing to your foot or ankle concern. Dr. Clark may or may not need to assess your gait (walking pattern) to be able to further aid in the diagnosis
· Ordering and performing appropriate diagnostic testing to aid in diagnosis and treatment, such as:
o Blood labs (to assess for infections, inflammatory markers, gout, etc.)
o Advanced imaging of the lower extremity (MRI, CT Scan, etc.)
o EMG or Nerve Conduction Studies to assess for nerve entrapment/damage
o CT Angiograms to assess blood flow to the extremity (as in the case of a non-healing ulceration of the extremity)
· Provide a detailed diagnosis and treatment plan
o Dr. Clark will discuss the diagnosis with you and give a detailed description of the causative factor(s) of the problem(s) so you understand why the problem is occurring so that the treatment plan can address those causes to prevent the problem for recurring
o Provide a detailed treatment plan that addresses both the short-term solution as well as the causative factors for your problem(s) so that you get both immediate symptomatic relief, as well as long-term relief and prevention of the problem from recurring. Part of your treatment plan might be performing minor procedures in the office (such as ingrown toenail removal, injections, or removal of small skin abnormalities) or a recommendation for surgical intervention to fix the problem should all non-surgical options have already failed.
· Perform minor procedures in the office or more-complex surgeries in the operating room at a nearby hospital or surgery center
o Some toe, foot, or ankle problems may require a minor procedure in the office to be able to adequately treat the problem (such as ingrown toenail removal, injections, or removal of small skin abnormalities). These minor procedures can typically be performed in the office with injection of local anesthetic so that you remain comfortable and feel no pain during the procedure.
o Surgical intervention to fix the problem may be required should all non-surgical options have already failed. Dr. Clark has performed thousands of procedures during his training and career and is well-qualified to perform any surgery of the foot or ankle should it be required to correct your problem.
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 exercising, stretching, and wearing well-fitted shoes.
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 Valgus). 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 Valgus. 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 caused by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:
- 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.
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.
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 generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).
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.
Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired 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.
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.
Diabetes and Your Feet
Diabetes is a lifelong chronic disease that is 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.
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 your podiatrist. Remember, prevention is the key to saving your feet and eliminating pain.
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.
Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas.
Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist’s instructions.
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.
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.
Toenail Fungus - Onychomycosis
Toenail fungus, or onychomycosis, is an infection underneath the nail caused by fungi. The nail may become brittle and appear gray, yellow, brown or black. Typically, there are no painful symptoms, however, the toenail might change in appearance or shape. If someone ignores toenail fungus, the infection can spread and possibly impair your ability to work and walk. The infection can spread to the skin of your feet.
Fungi live in warm, moist environments such as swimming pools, locker rooms and showers. When a person has a cut or separated areas of the toenail, fungi can enter the skin and cause toenail infections.
It is important to call Sole Foot and Ankle Specialists if you notice any discoloration, thickening , deformity or pain of the toenails. Various treatment options are available but first it must be determined that you have a fungal infection. This is simply done by looking at a small piece of nail under a microscope. Not all nails that are thick or deformed are infected with fungus.
Our practice offers several treatment options:
1. Topical medication
2. Oral antifungal medication
3. Laser Treament
At Sole Foot and Ankle Specialists we use an FDA approved laser that is applied to the infected nail and surrounding nails. The treatment lasts about 10 minutes and there is no recovery time. For more information on Laser Toenail Fungus Treatment please click here.
The podiatrists at Sole Foot and Ankle Specialists will provide an after treatment plan, as well as prescribing different products to in order to reduce the likelihood of reinfection.
Sole Foot and Ankle Specialists also recommend the purchase of SteriShoe, an ultraviolet shoe sanitizer that sanitizes the inside of shoes by using germicidal ultraviolet (UVC) light. For more information on SteriShoe, please click here . We also recommend the use periodic use of Fungi Foam and Fungi Nail post treatment with either the laser or oral medication
Some helpful tips in order to prevent reinfection:
- Practice good foot hygiene – keep your nails short and keep your feet dry. Wear synthetic socks – synthetic socks wick away moisture and keep feet dryer than cotton or wool socks. Consider changing your socks more than once daily and also wear breathable shoes as much as possible.
- Avoid going barefoot in public. Wear shoes around public pools and lock rooms.