Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. Although the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.
If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence. However, early diagnosis and proper medical care can limit or slow the damage.
Symptoms of arthritis in the foot and ankle include:
- Early morning stiffness.
- Limitation in motion of joint.
- Recurring pain or tenderness in any joint.
- Redness or heat in a joint.
- Skin changes, including rashes and growths.
- Swelling in one or more joints.
Forms of Arthritis
Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or wear and tear arthritis. Aging usually brings on a breakdown in cartilage, and pain gets progressively more severe. Dull, throbbing nighttime pain is characteristic, and may be accompanied by muscle weakness or deterioration. Many of these symptoms can be relieved with rest. Overweight people are particularly susceptible to osteoarthritis. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.
Rheumatoid arthritis is a major crippling disorder and the most serious form of arthritis. It is a complex, chronic inflammatory group of diseases, often affecting more than a dozen smaller joints during its course. In the foot, it frequently affects both ankles and toes.
Arthritis of the foot and ankle can be treated in many ways, including:
- Physical therapy and exercise.
- Anti-inflammatory medication and/or steroid injections into the affected joint. Note: Please consult your physician before taking any medications.
- Orthotics or specially prescribed shoes.
There are many kinds of cancers of the foot. Some take the form of cysts and lesions, while others are more widespread.
Malignant melanoma is a skin cancer that is curable if caught early. Although it makes up only one percent of skin cancers, malignant melanoma accounts for over 60 percent of skin cancer deaths. It is estimated that approximately 30 percent of melanomas occur in the lower extremities, and that 3 percent occur in the feet.
Neoplastic disorders, usually called tumors, are the result of abnormal growth of tissue. Both benign or malignant tumors occur in the foot.
Osteochondromas are benign bone tumors under the toenail. Osteochrondromas account for about half of all benign bone tumors in the foot, occurring mostly in children and young adults. Unless they cause irritation to the surrounding tissue, they are generally not very painful. Sometimes, they can deform the toenail and cause an ingrown toenail. In rare cases, they are removed surgically.
A plantar fibroma is a benign tissue tumor or growth on the plantar, or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. There are a number of nonsurgical measures for treating plantar fibromas, such as orthotics. When these conservative measures fail to provide adequate relief of symptoms, surgical removal is a reasonable option.
Giant cell tumors are benign tumors of the tendon sheath. These masses are generally found on the toes, top of the foot, or sides of the foot. They can also occur deep inside the foot. They are firm irregular masses that are typically painful.
Gout (also known as gouty arthritis) is a condition caused by a buildup of the salts of uric acid (a normal byproduct of the diet) in the joints. A single big toe joint is the most commonly affected area, possibly because it is subject to so much pressure in walking. Attacks of gouty arthritis are extremely painful. Men are more likely to be afflicted than women. Diets heavy in red meat, rich sauces, shellfish, and brandy have been linked to gout. However, other protein compounds in foods, such as lentils and beans, may play a role.
The main symptom of gout is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen. The pain lasts for around three or four hours and then subsides. However, pain in the same toe usually returns within a few months.
Gout can be controlled by with prescription medications and diet. Note: Please consult with your physician before taking any medications. The application of ice or cooling lotions helps alleviate pain and swelling during an acute phase. In some cases, specially-made shoes are prescribed to relieve the pain associated with gout.
Common Fungal Problems
Athlete’s foot and fungal nails are the most common fungal problems with feet. A fungus is a common mold that thrives in dark, warm moist areas. On the feet, it can grow on and between toes, as well as on soles and toenails. Fungal problems can be a result of the environment (socks, shoes, heat and humidity) or weakened immunity from such disorders as diabetes.
Chronic fungal infections are most common in adults, while acute fungal infections are seen more often in children.
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.
Since fungal nails are usually more resistant and more difficult to treat than Athlete’s foot, topical or oral antifungal medications may be prescribed. Permanent nail removal is another possible form of treatment for fungal nails.
After a fungal nail infection has cleared up, you can take steps to prevent the infection from coming back.
Keeping the fungus under control will help prevent a fungal infection of the skin from reinfecting the nail. Before bed, thoroughly wash and dry your feet, and apply a non-prescription anti-fungal cream to the entire foot from the ankle down. Use the cream every night, then gradually apply it less often. Keep your feet dry. Dry feet are less likely to become infected. Apply powder to your dry feet after you take a shower or bath.
- Don’t share nail clippers or nail files with others.
- Don’t share shoes or socks with others.
- Try not to injure your nail, such as by cutting it too short (trauma to the nail may lead to infections).
- Wear dry cotton socks, and change them two or three times a day if necessary.
- Wear dry shoes that allow air to circulate around your feet (tight, enclosed, moist shoes contribute to fungal toenail infections).
- Wear shower sandals or shower shoes when you are at a public pool or shower.
Follow basic foot care guidelines and you more than likely can head off most common foot fungus problems.
Plantar Fasciitis (heel spur)
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.
Ingrown toenails, also known as onychocryptosis, is usually caused by trimming toenails too short, particularly on the sides of the big toes. They may also be caused by shoe pressure (from shoes that are too tight or short), injury, fungus infection, heredity, or poor foot structure. Ingrown toenails occur when the corners or sides of the toenail dig into the skin, often causing infection. A common ailment, ingrown toenails can be painful. Ingrown toenails start out hard, swollen, and tender. Left untreated, they may become sore, red, and infected and the skin may start to grow over the ingrown toenail.
In most cases, treating ingrown toenails is simple: soak the foot in warm, soapy water several times each day. Avoid wearing tight shoes or socks. Antibiotics are sometimes prescribed if an infection is present. Note: Please consult your physician before taking any medications. In severe cases, if an acute infection occurs, surgical removal of part of the ingrown toenail may be needed. Known as partial nail plate avulsion, the procedure involves injecting the toe with an anesthetic and cutting out the ingrown part of the toenail.
Ingrown toenails can be prevented by:
- Trimming toenails straight across with no rounded corners.
- Ensuring that shoes and socks are not too tight.
- Keeping feet clean at all times.
Two kinds of skin allergies, or dermatitis, are caused by substances coming in contact with the skin: primary irritant dermatitis and allergic contact dermatitis. Primary irritant dermatitis is a non-allergic reaction of the skin resulting from exposure to an irritating substance. Allergic contact dermatitis is an allergic sensitization to various substances.
People who work in areas where their feet are exposed to repeated or prolonged contact to hot water, chemicals, oils, or wet cement can develop primary irritant dermatitis. Some solutions are safe if used properly. However, improper use can lead to a serious contact dermatitis. This is particularly dangerous for diabetics. For primary irritant dermatitis, soaking feet in solutions, such as bleach, vinegar, salt water, or Betadine, can be beneficial as long as excessive amounts are not used.
Allergic contact dermatitis is the result of exposure to substances that sensitize the skin. Each time the foot is exposed to the substance, an inflammatory reaction occurs. Some people are allergic to the substances in sock dyes or certain shoe materials. Adhesive tapes can cause an allergic reaction with blisters or a rash developing beneath the tape. Because of the heat and the accumulation of moisture beneath the tape, an acute Athlete’s Foot infection can also be caused by an allergic reaction to the adhesive. Treatments include the use of cool compresses, topical steroid compounds (like hydrocortisone creams), and antifungal creams.
Most foot warts are harmless, even though they may be painful. They are often mistaken for corns or calluses, which are layers of dead skin that build up to protect an area which is being continuously irritated. A wart, however, is caused by a viral infection which invades the skin through small or invisible cuts and abrasions. Foot warts are generally raised and fleshy and can appear anywhere on the foot or toes. Occasionally, warts can spontaneously disappear after a short time, and then, just as frequently, they recur in the same location. If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of warts. Children, especially teenagers, tend to be more susceptible to warts than adults.
Plantar warts, also known as verrucas, appear on the soles of the feet and are one of several soft tissue conditions that can be quite painful. Unlike other foot warts, plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries. They are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. Plantar warts are often contracted by walking barefoot on dirty surfaces or littered ground. The virus that causes plantar warts thrives in warm, moist environments, making infection a common occurrence in public pools and locker rooms.
Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading. Plantar warts that develop on the weight-bearing areas of the foot (the ball or heel of the foot) can cause a sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.
To prevent the spread of warts, follow these tips:
- Avoid direct contact with warts, both from other persons or from other parts of the body.
- Avoid walking barefoot, except on sandy beaches.
- Change your shoes and socks daily.
- Check your children’s feet periodically.
- Keep your feet clean and dry.
It is important to note that warts can be very resistant to treatment and have a tendency to reoccur. Over-the-counter foot wart treatments are usually ineffective because their use can inadvertently destroy surrounding healthy tissue. Please contact our office for help in effectively treating warts. Our practice is expert in recommending the best treatment for each patient, ranging from prescription ointments or medications to, in the most severe cases, laser cautery.
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 Varus). 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.