Foot and Ankle Doctor Blog Space

Category: Foot Conditions

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Melanoma of the Foot

Melanoma is a serious skin cancer that can affect people of all ages.  Exposure to UV radiation from the sun or tanning beds can increase your risk of developing melanoma. However, melanoma can occur anywhere on the body, even on less sun-exposed areas such as the soles of your feet.

Signs and Symptoms

  • Change in an existing mole

  • Development of a new pigmentation that grows over time  – predominately brown, black or blue in color and in some cases red

 

To help identify characteristics of unusual moles or spots on the body use the mnemonic ABCDE:

  • Asymmetry – Melanoma is asymmetric

  • Border – Melanoma is will have an irregular border or edge that is typically ragged

  • Color – Melanoma is typically a mix or colors rather than one solid color

  • Diameter – Melanoma grows in diameter where benign moles remain the same size. A mole larger than 5mm, the size of a pencil eraser should be seen by a physician

  • Evolving over time – change in color, size, shape or symptoms (itching tenderness or bleeding)

 

Diagnosing Melanoma

To accurately diagnose melanoma a biopsy should be taken and analyzed by a pathologist

  • Punch biopsy – a tool with a circular blade is pressed into the skin around the suspicious mole or pigmented area to remove a round piece of skin

  • Excisional biopsy – the entire mole or pigmented area is removed

  • Incisional biopsy – only parts of the irregular mole or pigmented area is taken for analysis

 

Prevention

  • Use adequate sunscreen on areas of the body not covered by clothes or shoes

  • Wear a wide brimmed hat and sunglasses

  • Wear water shoes that provide protection

  • Inspect your feet daily

  • Remove nail polish to inspect the toenails

 

Early detection of malignant melanoma is key. If you notice any changes in size of a mole on your foot or new pigmentations/discolorations come see us at Foot& Ankle Doctors, Inc.

 

Dr. Nejad

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Extensor Hallucis Longus Tendon Injury

We all have our clumsy moments where we accidentally drop something on our foot. The top of the foot lacks a lot of fat or padding to protect vital structures such as arteries, nerves and tendons which makes dropping a piece of glass, metal or plastic worrisome. Pain, swelling, bruising and bleeding are common symptoms of injury to the foot. If you notice the inability to move your big toe up towards the ceiling you may have severed your extensor hallucis longus (EHL) tendon and should come to see one of our physicians at Foot& Ankle Doctors, Inc.

 

Severing the EHL can be treated conservatively or surgically depending on the severity of the injury. If the EHL tendon ends are close enough to each other conservative care would include a non-weight bearing cast for 6 weeks. This would allow the two torn tendon ends to heal together.

 

If the tendon ends are far apart surgery will be required to sew the two ends together or a tendon graft may be necessary to bridge the gap and restore tendon alignment and function.

 

Dr. Dardashti

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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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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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