A Schwannoma is a benign tumor arising for the covering of nerve sheath. These tumors do not invade the nerve, but rather simply lie on top of the nerve sheath. The cause of it is unknown and can elicit a variety of symptoms. Some patients experience no symptoms at all, and only notice a lump on the bottom of their foot. Other patients experience shooting pain and numbness to the area, and symptoms worsen as the tumor grows.

Imaging modalities can be used to help identify the lesion. MRI will reveal cystic fluid collection in the affected area.

The lesion must be surgically excised and sent to pathology for evaluation. After surgery symptoms should subside. Early diagnosis of this lesion is important in preventing long-term nerve damage.

If you questions or concerns about an abnormal lump or bump on your feet come see us at Foot & Ankle Doctors, Inc

Dr. Dardashti

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

At Foot & Ankle Doctors, Inc we understand that sweaty feet can be an embarrassing and stressful problem, and worrying about it makes the sweating worse. Hyperhydrosis is the term for excessive sweating of the feet and is more common in men than women. The cause of hyperhydrosis is unknown, some believe it is an inherited problem.

Hyperhydrosis can cause the feet to turn a whitish color. The excess sweat can break down the skin and increase risk of infection. Odor and fungal infection are commonly associated with hyperhydrosis.

Treatment options are tailored towards the severity of the symptoms. Various treatments include:

• Antiperspirants: plug sweat glands and prevent the body from producing excess sweat
• Iontophoresis: a low electrical current is used to temporarily “shut off” sweat glands
• Botulinum toxin: works by blocking a chemical that stimulates sweat glands
• Prescription medication: prevent sweat glands from working
• Surgery
  • Surgical removal of sweat glands
  • Sympathectomy: destroying nerves that send signals stimulating sweat glands

Good hygiene is essential. Washing your feet and between your toes daily with antibacterial soap will help prevent infections. Dry your feet well after showering and apply a foot powder or antifungal powder. Change your socks daily or multiple times during the day. It is best to wear socks made with acrylic fiber, which will help wick away moisture and keep your feet dry.

At Foot & Ankle Doctors, Inc we can help ease your anxiety about hyperhydrosis and help control the problem.

Toe walking in children is always a concern for parents. Children who walk normally for a period of time and then start to toe walk should be evaluated. A medical history, family history, gait evaluation, musculoskeletal examinations are necessary to determine the cause of toe walking. Toe walking can be attributed to:

• Equinus (tight calf muscle)
• Muscular dystrophies
• Peripheral neuropathy
• Spinal cord pathology
• Acquired contractures
• Cerebral palsy

If your child began toe walking from the first time they started walking you can try placing your child in high top shoes/boots with stiff soles. This prevents your child from being able to walk on their toes and their heel won’t slip out from the back. If toe walking persists, come see one of our physicians at Foot & Ankle Doctors, Inc. An ankle foot orthosis (AFO) may need to be custom fitted for your child. This device is a rigid plastic that runs from the foot all the way up to the back of the calf muscle. This prevents motion at the ankle and again, limits the child’s ability to walk on their toes. If the calf muscle is tight and is contributing to your child’s toe walking, physical therapy can be prescribed as a modality that will help stretch and strengthen the calf muscle.

If you notice your child toe walking come see us for a full evaluation of your child. It is important to rule out more serious causes of toe walking other than a tight calf muscle. It is helpful if you videotape your child toe walking to evaluate their gait pattern.

Dr. Dardashti

Toenail fungus is an embarrassing problem and many patients are willing to try something new to cure their yellow discolored nails. JUBLIA is a new topical solution that has successfully made a splash in the media and has many patients requesting it.

When talking about curing fungal nails, there are two types of cures, a clinical cure and mycological cure. Clinical cure means that the nail looks clear of fungus, however if a sample of the nail were taken it would reveal the presence of a fungal infection. Mycological cure means that the nail is no longer infected with fungus. Ideally you want both a clinical and mycological cure, however many patients are satisfied with just a clinical cure.

JUBLIA has to be applied every day for 48 weeks and in two separate clinical studies JUBLIA only had a 18%-26% clinical cure rate. It can also cost up to $400 for a 4ml bottle if not covered by insurance, and you would need to buy more than one bottle during the 48 weeks.

There are fewer side effects to using JUBLIA than an oral medication, however the price and cure rates are not impressive and nothing to boast about.

Other treatment options for fungal nails include:

• Oral antifungal medications
• Laser and light therapies
• Nail removal
• Medicated nail polish
• Medicated nail cream
• Natural or home remedies: Vicks VapoRub, snakeroot extract, tea tree oil

If you are concerned about your fungal nails come visit us at Foot & Ankle Doctors, Inc.

Dr. Nejad

Individuals under the age of 20 who complain of pain, and swelling in long bones for less than 3 months should be evaluated for an aneurysmal bone cyst (ABC). ABC is a benign bone tumor commonly found in long bones. It is more frequently present in younger individuals between the ages of 10 to 20. ABCs are blood filled expansile lesions that cause pain as the cavity fills with fluid.

An ABC is generally induced by major or minor trauma that results in a vascular anomaly in the long bone. In a small percent of cases it is associated with a pathological fracture.

Radiographic images will reveal an eccentric “blow-out” or “soap bubble” lesion in the metaphysis of long bone. It is often difficult to differentiate an ABC from malignant bone tumors, and MRI imaging is needed to confirm findings on x-ray.

Treatment involves curetting the cavity and filling the defect with a bone graft. Patients will be immobilized in a below-knee cast for 6 weeks followed by physical therapy. If you or a loved one is experiencing pain and swelling and don’t recall any recent trauma, come visit one of our physicians at Foot & Ankle Doctors, Inc.

Dr. Dardashti

The second toe is the most common toe to dislocate in the forefoot. The plantar plate at the second metatarsophalngeal joint can become unstable and rupture causing pain, swelling and subluxation or dislocation of the toe. The plantar plate attaches the bottom of the metatarsal (long bone in the foot) to the base of the proximal phalanx (toe bone) and prevents motion in the sagittal plane and absorbs shock while ambulating. It is a major stabilizing structure and when damaged can lead to a crossover toe.

Plantar plate tears are caused by trauma, inflammatory arthropathy, and repetitive hyperextension commonly caused by excessive wear of high heels.

Patients often complain of pain and swelling on the bottom of the toe. Without treatment the deformity can progress and the second toe can cross over the big toe making it difficult to wear shoes.

Our physicians at

will perform an anterior draw test, which is pathognomonic for an unstable metatarsal phalangeal joint. Ultrasound, x-ray and MRI are other diagnostic tests that may be ordered to determine the severity. Conservative treatment includes:

-Rest

-Ice

-NSAIDs

-Taping the toe in a plantarflexed position

-Accommodative padding to reduce pressure under the affected toe

-Stiff-soled shoe or rocker-bottom shoe

-Custom orthotics

In severe cases the plantar plate may need to be surgically repaired. The plate itself may need to be sutured or a metatarsal osteotomy performed to shorten the second metatarsal.

If you are having pain in your toes, come see us at