Foot and Ankle Doctor Blog Space

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Correct your Hammertoes without going to the OR

Hammertoes are a painful and progressive deformity that commonly results from a muscle or tendon imbalance. There are tendons that run on top of toes known as extensors, which are responsible for pulling the toes up. There are also tendons that run on the bottom of toes known as flexor tendons that pull the toes down. When the flexor tendons become stronger than the extensor tendons the toes contract creating a hammertoe.

 

Patients often complain of pain when wearing shoes, contracture of toes, corns and calluses that form on top of the toes where the contracture is occurring and in between toes. Flexor tenotomy is a quick, minimally invasive procedure with few complications or risks.

 

There are no sutures needed or dressings that need to be changed. Patients will have a reduction in pain and do not need to take time off work. Flexor tenotomies give instant results, however it is not meant to be a cosmetic fix. Local anesthetic will be administered to the toe before the procedure begins. Once the toe is numb a small stab incision will be made on the bottom of the toe with a needle.

 

The needle is moved back and forth in a sweeping motion to cut the fibers of the flexor tendon. The toe will aggressively be moved up and down to ensure the fibers have been cut. Once the tendon has been cut the toes will immediately straighten and have increased flexibility. Patients will be shown how to splint their toe with adhesive strapping and educated on stretching the toe upwards. If you are suffering from painful toes come see us at Foot & Ankle Doctors, Inc

 

Dr. Nejad

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Tarsal Coalition In Children

If your child is complaining of foot or ankle pain that is unexplained by an injury come see us at Foot & Ankle Doctors, Inc where our physicians will examine for a tarsal coalition. Tarsal bones are bones located in the middle of the foot, the heel and the ankle. A tarsal coaltion occurs when there is an abnormal connection between two or more of these bones. This condition is usually present at birth, but your child may not show symptoms until later in life, usually around ages 9 to 16. Children with a tarsal coalition display the following symptoms

 

 Limp when walking

 

 Experience stiffness around the ankle and has decreased range of motion

 

 Tired legs

 

 Muscle spasms in the legs

 

 Flatfoot can be present in one or both feet

 

An x-ray and advanced imaging studies may be required to fully evaluate the condition before treatment is made. The goal of treatment is to reduce pain in your child’s foot. Our physicians at Foot & Ankle Doctors, Inc will take a conservative approach first by offering

 

 Physical therapy to increase range of motion

 

Custom orthotic devices to stabilize the foot and relieve pain

 

 Immobilization to remove stress from the foot and allow painful areas to rest

 

 Oral medication to reduce pain and inflammation

 

 Steroid injections to reduce pain and inflammation

 

If pain persists with conservative treatment, surgical intervention may be needed.

 

Dr. Dardashti

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Venous Ulcers..

Veins are thin vessels that transport blood from the body back to the heart. Veins contain valves that act like gates providing a continuous forward flow of blood. When valves become weakened and incompetent they allow blood to flow backwards and pool in the lower extremity. This pooling of blood stretches the skin and can lead to the development of venous ulcers.

Clinically, venous ulcers present as shallow irregular ulcers located over bony prominences. Varicosities, edema and skin discolorations are common findings associated with venous ulcers. Risk factors for developing venous ulcers are older age, obesity, previous leg blood clots, and history of leg swelling.

Treatment options include:

Debridement – can be sharp (with a blade or curette), enzymatic (topical ointments that are applied and eat away at the dead skin), mechanical debridement (wound scrub). Debridement aids in removal of dead and unhealthy tissue that hinders the healing process.

Dressings – promotes faster healing. Some dressings may contain antibiotic properties to prevent infection

Compression – there are two types of compression, inelastic and elastic. Unna boot is an example of inelastic compression. Unna boots provide static compression and aids in removing excess fluid from the lower extremities. It contains zinc an anti-bacterial and anti-inflammatory agents and calamine lotion to sooth skin irritation. Compression stockings are an example of elastic compression. Compressions stockings should provide at least 30mmHg of compression to aid in moving blood up the legs and reduce edema.

Skin grafting – to help close non-healing wounds, improve function and appearance of the leg

Surgery – to remove insufficient veins to prevent recurrence of venous ulcers

For treatment of venous ulcers please visit us at Foot & Ankle Doctors, Inc

Dr. Nejad

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Shooting Foot Pain – Tarsal Tunnel Syndrome

Tarsal tunnel is similar to carpal tunnel where a nerve is compressed producing sharp shooting pain. Tarsal Tunnel refers to a canal on the inside of the ankles. This canal allows tendons, nerves, arteries and veins to course along the ankle and into the foot. A sheath covers this canal to hold the structures in place. When this canal becomes compressed it pinches the tibial nerve in the canal causing a shooting pain.

Tarsal tunnel can be caused by:

  • Flat feet or “fallen arches” can compress the tibial nerve

  • Trauma or previous ankle injury causing swelling placing pressure on the nerve

  • Abnormal structures such as ganglion cyst, varicose veins, inflamed tendon, bone spur

  • Systemic diseases: arthritis, diabetes

Symptoms include tingling, numbness or shooting pain in the feet. Our doctors at Foot& Ankle Doctors, Inc will tap along the course of the tibial nerve, if symptoms are reproduced while performing this test it is an indication for tarsal tunnel. It is important to exclude the possibility of a pinched nerve in the lower back that can produce similar symptoms.

Treatment for tarsal tunnel syndrome starts with conservative options to reduce inflammation, pressure and or limit motion to the tarsal tunnel:

  • Rest

  • Ice

  • Oral medication

  • Immobilization/bracing

  • Steroid injection

  • Physical therapy

  • Orthotics

In cases where conservative treatments fail, surgery may be required in which case a tarsal tunnel release will be performed.

Come see us at Foot& Ankle Doctors, Inc for more information

Dr. Dardashti

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Stiff Painful Big Toe – Hallux Limitus

A stiff big toe that is painful to move is a sign of degenerative arthritis and is known as hallux limitus. It can be a disabling condition preventing patients from walking normally and performing their daily activities. Hallux limitus is a progressive condition that gets worse overtime and can eventually lead to a “rigid” toe that patients describe as a “frozen big toe.”

Hallux limitus can be caused by:

 Abnormal foot structure or biomechanics

 Overuse or wear and tear of the joint

 Trauma

 Inflammatory diseases – ex. Rheumatoid arthritis, Gout

Symptoms and treatment of hallux limitus vary depending on the stage of the condition. Early stage symptoms include pain and stiffness when walking, standing for extended periods of time or squatting. Later stages present with swelling of the big toe, difficulty wearing shoes, formation of a bump on top of the toe as well as stiffness.

Treatment options include the use of nonsteroidal anti-inflammatory medications, custom orthotics, shoe modifications and corticosteroid injections. In some cases surgery may be an option to reduce pain. Surgical options include:

 Cleaning the joint and removing pieces of bone that limit motion

 Fusing the big toe to prevent further degeneration of the joint

 Replacing the joint of the big toe with an implant

If you are experiencing pain or stiffness in your big toe come see our physicians at the Foot & Ankle Doctors, Inc.

Dr. Nejad

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Getting Rid of Ingrown Toenails

Ingrown toenails are a painful nail condition where the nail curves downwards and grows into the soft tissue surrounding the border of the toenail. The big toe is commonly affected with an ingrown nail and can be a result of:

 Trauma

 Ill-fitting shoes

 Improper trimming of the nail

 Thick fungal nail

Patients complain of a red swollen nail edge(s) that are painful upon touch. If the skin surrounding the nail becomes pierced bacteria can grow in the area leading to an infection, and antibiotics may be needed. If you are suffering from an ingrown toenail come see us at Foot & Ankle Doctors, Inc.

At Foot & Ankle Doctors, Inc. we offer various treatment options patients can choose from:

 Partial removal of the offending nail

 Complete removal of the offending nail

 Permanent removal of the offending nail

Dr. Farshid Nejad

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Ganglion Cysts- Foot Lumps

If you are noticing a fluid like lump on your foot, you probably have a ganglion cyst. Ganglion cysts are not cancerous and do not spread to other areas, however cysts may appear at multiple locations. They commonly appear on the hands and wrists and feet. Ganglion cysts form lumps beside joints or tendons and is filled with a viscous fluid. Irritation at a joint or tendon is believed to cause the formation of a ganglion cyst. They may grow in size or disappear spontaneously.

At Foot& Ankle Doctors, Inc we offer a variety of treatment options, which include:

  • Monitoring – if the cyst is painless intervention may not be needed since it may disappear completely on its own

  • Aspiration – placing a needle into the cyst to remove fluid and allow the cyst to decompress

  • Shoe modifications – padding may be used to reduce irritation and pressure of the cyst

  • Surgery – involves removing the cyst and a portion of the joint capsule or tendon sheath

It is important to note that regardless of the treatment option ganglion cysts may return, even with surgery.

Dr. Dardashti

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Turf Toe.. More Serious Than You Think

Turf toe sounds like a minor injury that only involves a single toe, however it can be a career ending injury like it was for Deion Sanders. It commonly occurs in athletes who play sports on artificial turf, hence the name “turf” toe. This injury occurs when athletes bend their big toe beyond its normal flexibility. Cleats often get stuck in divots in artificial turf leading to hyper extension of the toe. Hyper extension of the big toe can take place every time the athlete pushes off with their toes to start running. This motion occurs multiple times during every game and practice eventually over time the big toe becomes sprained.

The severity of the injury is graded from 1 to 3

Grade

Injury

Treatment

1

Mild sprain

  • RICE – rest, ice, compress, elevate

  • Taping the toe to restrict movement

  • Non-steroid anti-inflammatory medication

2

Partial tear of the capsule and ligaments

  • Same as Grade 1 + walking boot to immobilize the big toe joint

3

Complete tear of the capsule and ligaments

  • Same as Grade 1 + walking boot or cast for immobilization

 

Physical therapy should also be implemented to prevent stiffness in the joint and gain adequate range of motion. Surgery is often not needed, but is an option for some cases.

Foot& Ankle Doctors, Inc recommend athletes who return to sports should have their shoes modified with a steel shank or stiff insoles to restrict hyper extension of the toe.

Dr. Nejad

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What is a neuroma?

What is a neuroma? “-Neur” is root for nerve and “-oma” is root for swelling or tumor.

Neuroma is a benign over growth of nerve tissue. Neuromas commonly occur in the interspace between the 3rd and 4th toe and are referred to as a Morton’s Neuroma.

Overgrowth of the nerve in the small interspace leads to compression in that area creating pain and irritation. Symptoms include a tingling, burning or numbing sensation, and pain in the ball of the foot.

Shoes are the culprits when it comes to neuromas, especially high heeled shoes or shoes that cause the toes to be squished together. With repeated irritation the nerves become swollen and inflamed leading to the development of a neuroma.

Treatment options for neuromas include: cortisone injections, sclerosing injections, custom orthotics, shoe modifications, padding, and in severe cases surgical removal.

If you think you have a neuroma come visit one of our doctors at Foot & Ankle Doctors.

Dr. Dardashti

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My Child Has Heel Pain

Severe’s disease AKA calcaneal apophysitis is a growing pain at the back of the heel in young adolescents between the ages of 8 to 14. The heel bone contains a growth plate where the Achilles tendon attaches. Sever’s disease can occur for various reasons such as:

 The heel bones growth quicker than the ligaments that attach to it causing inflammation and pain

 A tight heel cord

 The undeveloped heel bone becomes stressed from repeated forces such as running and pounding on hard surfaces

 Obesity

 Biomechanical problems

Regardless of the etiology, children will often complain of pain at the back of their heel during sports, when they stand for too long or from shoes that rub at the back of their heels.

Diagnosis can be made based on the child’s symptoms and by performing a squeeze test. A positive squeeze test is defined as elicited pain when the child’s heel is squeezed from side to side.

Treatment for Severe’s disease is simple and mainly involves resting. It is advised that children take time off from sports and physical activity, stretch the leg muscles, ice the heel and take anti-inflammatory medications if needed to help reduce the swelling and alleviate pain. Gel inserts and orthotics may be recommended to support the heel. In severe cases a short leg cast may be applied to immobilize the foot and ankle and allow healing to occur.

If your child experiences symptoms of Sever’s disease come see our staff at Foot & Ankle Doctors, Inc.

 

Dr. Nejad

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