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You might think of a bunion as an unsightly annoyance.  But bunions are more than simple (albeit painful) bumps; they are a sign that something is wrong with your feet. Bunions result from years of improper foot motion and stress. Over time, that abnormal motion forces the bone and tissue at the base of the toe out of place, creating a prominent bump and causing foot instability.

Ignoring a bunion almost never works. The pain—and deformity—will almost surely increase unless you take steps to relieve the pressure on the affected joint. The good news is that proper treatment can stop bunion pain and discomfort and increase your quality of life.

What Causes Bunions?

Bunions take time to develop. The most common causes of bunions are:

  • Some feet are particularly susceptible to developing bunions. If either of your parents had bunions, you might develop them also.
  • Ill-fitting shoes. Tight, narrow shoes, such as high heels, can aggravate bunions and contribute to pain. A podiatrist can help with the selection of high heels and other footwear.
  • Foot injuries. A foot injury can alter the position of bones and soft tissue structures in the feet, setting you up for a bunion.
  • Foot deformities. Neurological disorders and arthritis can also cause bunions.

Bunions typically start small. You might notice a bit of redness or skin irritation on the side of your big toe joint. That’s a sign from your body that it’s time to make some changes. If you pad the bunion and switch to better-fitting shoes, you may be able to slow the bunion’s progression as well as minimize pain.

If your bunion is large and causing significant pain, it’s time to see a professional. Today’s podiatrists are highly trained foot doctors who can help you find relief.

Treatment Options

  • Orthotics. Specially designed orthotic inserts can help keep your feet in alignment, relieving pressure on the affected joint. Today’s You don’t have to live with uncomfortable, unattractive bunions. Today’s podiatrist can work with you to develop a treatment plan that will decrease pain and improve the function and appearance of your feet. Small bunions are treated conservatively, while large bunions may require surgery. Consulting a podiatrist while your bunion is still small may eliminate the need for more invasive treatment later.

Common bunion treatments include:

  • Padding & taping. Often the first step in a treatment plan, padding the bunion minimizes pain. Taping helps keep the foot in a normal position and reduces stress and pain.
  • Anti-inflammatory medications. Over-the-counter medications such as ibuprofen can ease the pain and inflammation associated with bunions. Podiatrists can also prescribe special medications and administer cortisone injections to decrease inflammation.
  • Physical therapy. Special foot exercises can relieve pain and increase flexibility and function of the foot.
  • Orthotics. Specially designed orthotic inserts can help keep your feet in alignment, relieving pressure on the affected joint. Today’s podiatrist is an expert on fitting orthotics.
  • Surgery. A variety of surgical techniques are used to treat bunions. The technique used will depend on the severity and location of your bunion. A podiatrist can review your surgical options with you and help you understand what to expect pre- and post-surgery.

(Source of information is from website:  https://www.apma.org/files/ProductPDFs/Bunions2.pdf)

Adults aren’t the only ones who experience foot problems – children have them, too. It’s important to begin foot care at a young age as children’s feet will carry them for their entire life. Children’s feet typically stop growing in their early teen years, but if there’s an issue with their feet before then, it’s essential to get them checked and treated, if necessary.

Depending on your child’s unique feet and what their symptoms are, podiatrists can determine what the problem is and help your child get back to doing the activities they love to do.

 

Children’s Foot & Ankle Conditions

There are many conditions that can affect your child’s feet, but the most common ones we treat are:

  • Warts
  • Flat feet
  • Ingrown toenails
  • Heel pain
  • In-toeing and Out-toeing
  • Foot odor
  • Athlete’s Foot
  • Bunions
  • Corns & Calluses

 

If your child is active in sports, especially soccer or basketball, they may be more prone to a foot problem known as Sever’s Disease. The complaint is usually of pain in the heel during and after a practice or game.

 

Active children are more inclined to have flat feet, which can often cause pain in the feet and lower legs. Pediatricians will often misdiagnose this type of pain as simple growing pains in the feet. It’s a myth that all children will outgrow being flat-footed. Fortunately, most foot and leg soreness from flat feet can be relieved quite easily with custom foot orthotics or custom insoles. If your child has a condition such as flat feet, custom orthotics may be all that’s needed.

 

Foot pain in children is never normal and must be addressed right away.  Many children will not complain of pain so parents must be vigilant and look for signs that their children are experiencing an abnormal foot and ankle condition.  Children limping or suddenly reducing their physical activities and play time can all be signs that they are having foot and ankle problems and an appointment should be made to see a podiatrist.

 

For more information on treatment of pediatric foot pain or deformities please call for an appointment at 1-844-FIX-TOES or complete our online appointment request form.

 

(Source of most information is from website:  https://hollowbrookfoot.com/pediatric-foot-care-in-wappingers-falls-ny/)

What is a Corn? What is a Callus?

Corns and calluses are areas of thickened skin that develop to protect that area from irritation. They occur when something rubs against the foot repeatedly or causes excess pressure against part of the foot. The term callus commonly is used if the thickening of skin occurs on the bottom of the foot, and if thickening occurs on the top of the foot (or toe), it’s called a corn. However, the location of the thickened skin is less important than the pattern of thickening: flat, widespread skin thickening indicates a callus, and skin lesions that are thicker or deeper indicate a corn.

Corns and calluses are not contagious but may become painful if they get too thick. In people with diabetes or decreased circulation, they can lead to more serious foot problems.

Causes

Corns often occur where a toe rubs against the interior of a shoe. Excessive pressure at the balls of the feet—common in women who regularly wear high heels—may cause calluses to develop on the balls of the feet.

People with certain deformities of the foot, such as hammer toes, are prone to corns and calluses.

Symptoms

Corns and calluses typically have a rough, dull appearance. They may be raised or rounded, and they can be hard to differentiate from warts. Corns or calluses sometimes cause pain.

Home Care

Mild corns and calluses may not require treatment. If the corn or callus isn’t bothering you, it can probably be left alone. It’s a good idea, though, to investigate possible causes of the corn or callus. If your footwear is contributing to the development of a corn or callus, it’s time to look for other shoes.

Over-the-counter treatments can do more harm than good, especially if you have any medical conditions such as diabetes. Some over-the-counter treatments contain harsh chemicals, which can lead to burns or even foot ulcers.

When to Visit a Podiatrist

If corns or calluses are causing pain and discomfort or inhibiting your daily life in any way, see a podiatrist. Also, people with diabetes, poor circulation, or other serious illnesses should have their feet checked.

Diagnosis and Treatment

The podiatrist will conduct a complete examination of your feet. X-rays may be taken; your podiatrist may also want to inspect your shoes and watch you walk. He or she will also take a complete medical history. Corns and calluses are diagnosed based on appearance and history.

If you have mild corns or calluses, your podiatrist may suggest changing your shoes and/or adding padding to your shoes. Larger corns and calluses are most effectively reduced (made smaller) with a surgical blade. A podiatrist can use the blade to carefully shave away the thickened, dead skin—right in the office. The procedure is painless because the skin is already dead. Additional treatments may be needed if the corn or callus recurs.

Cortisone injections into the foot or toe may be given if the corn or callus is causing significant pain. Surgery may be necessary in cases that do not respond to conservative treatment.

Prevention

  • Wear properly fitted shoes. If you have any deformities of the toe or foot, talk to your podiatrist to find out what shoes are best for you.
  • Gel pad inserts may decrease friction points and pressure. Your podiatrist can help you determine where pads might be useful.

 

Source of info:  https://www.apma.org/corns

 

Custom Ankle Foot Orthosis (AFO):

An ankle-foot orthosis is an orthosis or brace that surrounds the ankle and at least part of the foot. AFOs are externally applied and intend to control position and motion of the ankle, compensate for weakness, or correct deformities. AFOs are commonly used in treatment of disorders affecting muscle function and peripheral neuropathy. The following are AFOs casted in our office.

 

Balance Brace:

 Definition – Accidental falls are one of the most common causes of injury among older adults. A balance brace is an ankle-foot orthosis (AFO) designed to help reduce the risk of falls. As a balance brace is prescription-only, it is specially made for a patient. A balance brace is lightweight, easy-to-use, and helps prevents falls in the future. Balance braces are generally a covered benefit under most insurances.

Treatment – Patients who have had a stroke, drop foot, unstable gait, impaired balance, and diabetic peripheral neuropathy, among other diagnoses are candidates for a balance brace.

 

Crow Boot:

Definition – A Charcot Restraint Orthotic Walker (CROW), is a rigid boot designed to accommodate and support a foot with Charcot neuropathy. Patients with Charcot can begin using the CROW boot once swelling has decreased. Patients with mild to moderate Charcot deformities will benefit the most using a CROW boot.

Treatment – The CROW boot is custom-made for each patient’s foot. The outer shell consists of two plastic or fiberglass pieces that are strapped together with Velcro. The boot is sturdy and can be walked on and prevents other bones from breaking. The boot has a custom, removable foam insole that is adjusted to distribute weight equally and support the ankle joint.

Source:  https://www.towerpodiatry.com/custom-ankle-foot-orthosis/

 

Richie Brace:

Definition – The Richie Brace is a custom ankle brace designed to treat chronic conditions of the foot and ankle. It is fabricated from a custom cast taken of a patient’s foot and lower leg. The brace has a contoured balance orthotic footplate articulated to adjustable semi-rigid lower leg uprights. The Richie Brace is ideal to stabilize the midtarsal and subtalar joints. As the Richie Brace has lightweight construction it allows a better shoe fit, freedom of movement, and reduction of pain from injury. All Richie Braces must be fitted and dispensed by a health care provider.

Treatment – Chronic conditions that the Richie Brace treats include but are not limited to Drop foot, ankle sprains, and Posterior Tibial Tendon Dysfunction. Please refer to the source below to learn more about the Richie Brace.

Source: Richie Brace, www.richiebrace.com

 

Arizona Brace:

 Definition – The Arizona Brace is prescribed to stabilize the ankle, talocalcaneal, subtalar and midtarsal joints.  It is the only brace tested to be 90% effective at treating Posterior Tibial Tendon Dysfunction (PTTD).

Treatment – This brace is used to treat ankle arthritis, Charcot foot, chronic achilles tendonitis, severe pronation, anterior/posterior tibial tendonitis, talocalcaneal varus or valgus, and posterior tibial tendon dysfunction.

Source:  https://www.arizonaafo.com/resources/how-the-arizona-brace-works.html

The effects of diabetes extend to your entire body, impacting your eyes, vital organs, feet, and more. Because diabetes can cause very serious foot complications, a podiatrist is a critical member of your care team. Podiatrists work to prevent complications, detect problems as early as possible, and intervene if complications do arise. For expert diabetic foot care, schedule your appointment with the experts at Westchester Foot Care today, serving patients in their three Westchester County offices located in Yonkers, New Rochelle, and White Plains.

How does diabetes affect my feet?

If you manage your blood sugar efficiently, you’re at lower risk of foot complications from diabetes, but there will always be some level of risk. Brittle diabetics and those with uncontrolled sugar are at highest risk of foot problems, including:

  • Sores, ulcers, and wounds that don’t heal on their own
  • Loss of feeling in your feet, which can cause trips, falls, and sores that go unnoticed
  • Neuralgia, a condition that affects the nerves in your feet and causes chronic pain, tingling, and numbness

When sores go unnoticed or intervention is too late, people with diabetes commonly experience serious consequences, including amputation of toes, feet, or even the lower leg.

What signs and symptoms should I watch for?

It’s essential to involve a podiatrist in your care before you ever experience signs and symptoms of foot problems because the podiatrist is as engaged in prevention as treatment. However, you should contact a podiatrist immediately if:

  • You notice a loss of sensation in your feet
  • You experience frequent trips and falls
  • You have a sore on your foot that isn’t healing
  • You need help with foot care
  • You have foot pain

The doctors at Westchester Foot Care have extensive experience in diabetic foot care.

What is a podiatrist’s role in my diabetic care plan?

The podiatrist plays a critical role. They inspect your feet to identify issues early, while treatment is still effective. They can also assist with routine foot and nail care to prevent complications and provide both surgical and nonsurgical treatment when problems do arise.

Is there anything I can do to prevent diabetic foot problems?

Although you may not be able to prevent problems completely, you can significantly reduce your risk by taking these preventive measures:

  • Involve a podiatrist in your care early (as soon as you know you have diabetes)
  • Wear socks and shoes at all times to protect your feet from injury; special shoes designed for diabetics are recommended
  • Keep your blood sugar under control by following your doctor’s recommendations for diet and medication
  • Examine your own feet daily if you can, and ask your primary care doctor to check your feet at every appointment
  • Schedule routine foot care to maintain healthy feet and toenails

 

Source of info: https://www.starrettpodiatry.com/services/diabetic-foot-care

Diabetics are at greater risk for developing ulcers, infections, and amputations due to damaged nerves and blood vessels secondary to prolonged elevated levels of blood sugar.  Wearing specific proper fitting shoes and comfortable insoles can prevent future complications.

Westchester Foot Care participates in the Diabetic Shoe Program that is recognized by most insurances, including Medicare, as preventative medicine. We will prescribe & order your diabetic insoles, custom made arch supports and diabetic orthopedic shoes.  We are also happy to fill your doctor’s prescriptions.

We have access to a complete collection of men’s and women’s fashionable and comfortable shoes and sneakers in a variety of widths and sizes that can accommodate swelling & foot deformities, such as bunions & hammertoes, as well as most custom-made braces.

The following is a list of some of our most popular brands:

  • Propet
  • Dr. Comfort
  • New Balance
  • Orthofeet
  • Drew
  • Mt. Emey
  • Brooks
  • SAS
  • Hush Puppies
  • Rockport
  • Anodyne
  • Pure Stride

COME IN AND SEE HOW GOOD YOUR FEET CAN FEEL!

Over time high blood sugar levels in Diabetics cause damage to nerves and blood vessels.

Nerve damage in the feet increases risk of injury because of a decrease or loss of pain sensation. A diabetic may not be aware that an injury has occurred as they may not have any feeling to alert them that something is wrong.

Damaged blood vessels cause circulation problems which prevent continuous blood flow to toes and feet and can result in cuts, blisters, or wounds that are slow to heal or that do not heal at all.

Diabetic socks are designed to reduce the risk of injury, keep skin dry, and increase circulation to the feet.  They are an important part of foot care and help prevent infections and amputation of toes and feet.

 

CHARACTERISTICS OF DIABETIC SOCKS:

  • Moisture wicking material draws moisture away from the skin keeping feet dry and preventing formation of blisters and wounds.
  • Antifungal and antimicrobial properties from copper or silver infused yarn to help prevent infections.
  • White color of socks allows for increased awareness of bleeding or draining cuts or wounds.
  • Padding at the heels, toes, or under the balls of the feet prevent blisters and injury.
  • Seamless feature along the toe reduces the risk of rubbing and formation of blisters and ulcers.
  • Non-elastic binding prevents restriction of blood flow and improves circulation which keeps feet warm and promotes healing.

 

If you have any concerns call Westchester Foot Care to schedule an evaluation today.

The purpose of arches in the feet is to add springiness and flexibility to the midfoot. Arches in the feet 
help to generate the strength to push off with movement, distribute body weight, absorb the shock of contacting the ground, and assist with balance. In addition to these functions, the arch of each foot acts as an energy store to support activities like walking, running, or jumping.

One of the most common and well-known deformities of the lower extremities is flat feet.
 They occur when the arches of the feet (the insteps) are either partially or completely collapsed. This deformity puts the soles of the feet, the plantar surface, in complete or near complete contact with the ground. When flat feet, which are also known as fallen arches, are present, the alignment of the legs may also be slightly altered. In some cases this can lead to pain and other problems in the feet, ankles, legs, knees, hips, and the lower back.

If you or your child has foot pain, it is a good idea to see our podiatrist for a thorough evaluation and treatment. This is the best way to prevent any additional and potentially debilitating complications from developing. Our podiatrist can provide the most suitable and therapeutic treatment options to stabilize the causes of flat feet, help restore and improve foot function, and alleviate any associated symptoms.

Many foot and ankle injuries occur during sports. Football players are particularly vulnerable to sprains and fractures. Basketball players are prone to ankle sprains, and runners may develop stress fractures of the ankle or foot. Gymnasts and dancers may also develop stress fractures.

Tripping or stumbling on uneven ground is another common cause of sprains and fractures.

Symptoms 

Pain, swelling, bruising, and difficulty walking on the affected foot or ankle are the most common.

Home Care  

If you’ve hurt your foot or ankle, it’s best to err on the side of caution. The acronym RICE can help you remember what to do:

Rest—Rest the affected area. Stay off the injured foot or ankle until it can be fully evaluated. Walking, running, or playing sports on an injured foot or ankle may make the injury worse.

Ice—Apply ice to the affected area as soon as possible, and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.

Compression—Wrap an elastic bandage (such as an Ace® wrap) around the affected foot or ankle. The wrapping should be snug, but not so tight as to cut off circulation.

Elevation—Elevate the affected extremity on a couple of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

When to Visit a Podiatrist 

Podiatrists are doctors who specialize in the care and treatment of the lower extremities. If you’ve injured your foot or ankle, see a podiatrist. He or she can determine the extent of the injury and develop a plan of care to get you back in the game (or back to your everyday life) as soon as possible.

Increased pain, swelling, bruising, redness, or difficulty walking after an injury are definite signs that it’s time to see a podiatrist.

Diagnosis and Treatment

A podiatrist will carefully examine your feet and ankles and take a complete medical history. He or she will also order tests, including an X-ray, ultrasound, or MRI, to determine the extent of your injury. If you have a fracture that’s clearly visible on X-ray, you may not need additional testing. Ultrasounds and MRIs are useful for finding soft issue injuries (including torn ligaments) and stress fractures.

Treatment will depend on your injury.  Stress fractures are treated with rest and immobilization. You will be instructed to stay off the affected area until healing is complete. Crutches and/or a special “boot” or cast may be used to immobilize the area.

Sprains are also treated with a period of immobilization. Depending on the extent of your sprain, you may be able to resume activity fairly quickly, or you may need to wear a soft cast or special “boot” and use crutches for a period of weeks.

Professional athletes may undergo surgery to repair torn ligaments.

Oral anti-inflammatory medication, such as ibuprofen, can be used to decrease pain, swelling, and inflammation.

Prevention

Warming up prior to physical activity can prevent ankle sprains and fractures. So can wearing proper shoes.  Athletic shoes should be replaced yearly; running shoes should be replaced every 300–400 miles or so.

Avoid running or walking on uneven surfaces.

Source: https://www.apma.org/SprainsStrainsFractures

FUNGAL TOENAILS

Onychomycosis (toenail fungus) is an infection of the nail and sometimes surrounding tissue. It is extremely common with 20 percent of the general population and 75 percent of people over 60 years old affected. Frequently the problem causes cosmetic concerns, but many patients also experience pain. Sometimes toenail fungus can allow more serious infections to develop.

Symptoms:

Most patients see yellowing and thickening of the nail. Sometimes the area around the nail itches. With time the nail may become brittle with jagged edges, deformed or detached from the nail bed. Trimming your thickening nail can become difficult. If the nail gets too thick, wearing shoes can become uncomfortable.

Causes:

Multiple fungi species can infect the nail. Fungus grows well in warm, moist environments such as showers. Fungus infection is one of the few foot problems that affect more men than women, perhaps because more men walk barefoot in locker rooms. Age is a factor, too. Half the sufferers are people older than 70. Other risk factors include having certain medical conditions such as diabetes, vascular insufficiency and malnutrition.

Diagnosis:

Diagnosis is made based on clinical exam and can be confirmed by viewing scrapings of the nail under a microscope, or growing the fungus in a culture medium. This is not an easy condition to cure, so rather than trying home treatment with over-the-counter medications, it’s best to see your doctor. As with many conditions, nail fungus infections are easier to treat if you catch them early.

Treatment:

Your doctor will trim your nail and scale away the dead layers. You may also be prescribed a topical medication. If the infection is very far advanced, topical medication won’t be able to penetrate the thickened nail. In these cases, you can take prescription oral medication. These are very effective but must be taken for several months.

Treatment regimens vary and can last between six weeks and one year. Side effects of systemic treatment include gastrointestinal disorders, liver toxicity, skin rash and other hypersensitivities. These medications should not be taken during pregnancy or if there is a chance you will become pregnant because of effects on the fetus.

Recovery:

Healing time depends on the type of treatment used. Prevention of a new infection is important. Podiatrists recommend good foot hygiene with frequent changing of stockings and rotating pairs of shoes to allow them to completely dry between uses. Also, avoid going barefoot in locker rooms and around swimming pools. If you have a pedicure, make sure the nail salon uses sterilized instruments.

Potential Complications:

More significant infection is uncommon, but in patients with a compromised immune system the thickened nail can be an entry site for bacterial infection that may become limb threatening.

Nail Salon Safety:

Professional pedicures can transmit infections if not done properly. Make sure the salon you visit meets the following standards:

  • Maintains clean, sanitary conditions
  • Is licensed and displays the licenses–with photo ID–of each operator
  • Uses cleaned or single-use implements for each customer
  • Uses small brushes to prevent nail polish and other products from coming in contact with the skin

 

(Source of information from website:  https://www.hudsonpodiatryassociates.com/fungal-toenails/)

One of the most common toe deformities seen by our office is a hammertoe. Most often attributed to wearing ill-fitting, tight footwear or high-heeled shoes that squish the toes into a bent position, a hammertoe can also be influenced by genetic factors, the result of a bunion, or caused by arthritis in the toe joint.

What a hammertoe looks like

Just as the name implies, a hammertoe resembles a “hammer” with the toe bending at the middle joint into a claw-like deformity. While hammertoes usually affect women, men can develop them as well.

Hammertoes can cause discomfort while walking as well as when you simply try to move or stretch your toes. You may also develop corns or calluses on the top of the toe, and the ball of the foot and have difficulty fitting into your shoes. While in its early stages of development, the involved joint still feels flexible, left untreated, your hammertoe will become more rigid and less responsive to conservative modes of treatment.

Treatment options

Our podiatrist will develop an appropriate plan to treat your hammertoe. When designing an approach to care, we’ll consider the severity of your toe deformity, level of toe flexibility, existing medical conditions, along with any other factors that may influence treatment. In the case of mild deformities or for individuals with complex medical histories, conservative treatment may be recommended. A non-surgical plan may include strategically placed foot padding, wearing shoes with a roomy toe box, custom orthotics, splinting, or taking anti-inflammatory medication as needed to reduce pain and inflammation. However, severe toe deformities and joint rigidity warrant surgery. And, a combination of procedures may be recommended when a hammertoe is accompanied by other foot deformities.

Corrective hammertoe surgery

The goals of surgery to correct hammertoes are to restore normal anatomy, comfort, and function. During a surgical procedure, the toe is straightened, and the joint between the involved bones stabilized. While healing, the newly realigned bones fuse, thereby permanently maintaining the toe in a straighter and healthier position.

As experts in foot anatomy, health, and function, we use the most advanced surgical techniques to achieve outstanding results of care. The success rate of hammertoe surgery is quite high, while the risk of complications is low. While hammertoe surgery is often performed as an outpatient procedure, we customize treatment and the delivery of care to address the unique requirements of each patient.

Sometimes hammertoes and a bunion go hand-in-hand. When that’s the case, both deformities can be addressed during one surgical procedure.

The best “steps” in care

Whether it’s the treatment of hammertoes, or any other issue affecting foot health and function, you can rely on our office for skilled and experienced care. We’re dedicated to the care and comfort of our patients and are always on hand to address all questions and concerns.

For more information on the treatment or surgical correction of hammertoes and the many other services we provide, give us a call today.

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.

Causes

Heel pain has many causes. Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear (such as flimsy flip-flops); or being overweight.

Common causes of heel pain include:

Heel Spurs:

A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.” Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Plantar Fasciitis:

Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.

Excessive Pronation:

Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.

As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

Achilles Tendinitis:

Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.

Other possible causes of heel pain include:

  • rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint;
  • an inflamed bursa (bursitis), a small, irritated sac of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur;
  • Haglund’s deformity (“pump bump”), a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe;
  • bone bruise or contusion, which is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

When to Visit a Podiatrist

If pain and other symptoms of inflammation—redness, swelling, heat—persist, limit normal daily activities and contact a doctor of podiatric medicine.

Diagnosis and Treatment

The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone.

Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.

Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

A variety of steps can be taken to avoid heel pain and accompanying afflictions:

    • Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid shanks, and supportive heel counters
    • Wear the proper shoes for each activity
    • Do not wear shoes with excessive wear on heels or soles
    • Prepare properly before exercising. Warm up and do stretching exercises before and after running.
    • Pace yourself when you participate in athletic activities
    • Don’t underestimate your body’s need for rest and good nutrition
    • If obese, lose weight

 

Source of info:   https://www.apma.org/heelpain

If you trim your toenails too short, particularly on the sides of your big toes, you may set the stage for an ingrown toenail, a common disorder. Like many people, when you trim your toenails, you may taper the corners so that the nail curves with the shape of your toe. But this technique may encourage your toenail to grow into the skin of your toe. The sides of the nail curl down and dig into your skin. An ingrown toenail may also happen if you wear shoes that are too tight or too short. Any of your toenails can get ingrown, but it’s most likely with your big toes.

When you first have an ingrown toenail, it may be hard, swollen and tender. Later, it may get red and infected, and feel very sore. You may see pus drain from it. Finally, your skin may start to grow over the ingrown toenail.

Treatment:

To treat an infected ingrown toenail, soak your foot in warm, soapy water several times each day. You may need to gently lift the edge of the ingrown toenail from its embedded position and insert some cotton or waxed dental floss between the nail and your skin. Change this packing every day. If your infection is severe, your doctor may prescribe a course of antibiotics. Learn how to trim your toenails properly. Wear clean socks and open-toed shoes, such as sandals.

If you are in a lot of pain and/or the infection keeps coming back, your doctor may remove part of your ingrown toenail (partial nail plate avulsion). Your toe is injected with an anesthetic and your doctor uses scissors to cut away the ingrown part of the toenail, taking care not to disturb the nail bed. An exposed nail bed may be very painful. Removing your whole ingrown toenail (complete nail plate avulsion) increases the likelihood your toenail will come back deformed. It may take 3-4 months for your nail to re-grow.

Ingrown toenails often recur. If you have a chronic problem with an ingrown toenail, your doctor may recommend another surgical procedure in which the toenail’s formative part is permanently removed.

Prevention:

You can lower your risk of developing an ingrown toenail by trimming your toenails straight across with no rounded corners. The length of your toenail should extend out past your skin. The top of each nail should form a straight line across, level with the top of your toe. Some additional guidelines for preventing ingrown toenails include:

  • Don’t pick at your toenails or tear them off.
  • Make sure your shoes and socks are not too tight.
  • Keep your feet clean at all times.

(Source of information from the website:  https://www.hudsonpodiatryassociates.com/ingrown-nails/)

Do you experience the sensation of a pinched nerve — burning, tingling pain — near your third and fourth toes, or second and third toes, while walking? It’s possible you’ve developed a neuroma, a benign nerve tissue growth that causes pain while walking.

Neuromas are best treated by a podiatrist, who can provide necessary medical intervention. For neuroma diagnosis and treatment, contact the doctors at Westchester Foot Care today at one of their three office located in Yonkers, New Rochelle, or White Plains in Westchester County.

What is a neuroma?

A neuroma is a benign growth that most commonly occurs between your third and fourth toes.

It feels similar to a pinched nerve in that area and causes the most pain when you’re walking. Neuromas aren’t dangerous but can make it hard to get around and cause severe discomfort when left untreated.

What causes neuromas?

The causes of neuromas are unknown, but several factors can increase your risk of developing a neuroma:

  • Repeated stress due to repetitive work
  • Trauma to the nerve and subsequent inflammation
  • Ill-fitting footwear including high heels
  • Flat foot, high arches, and other deformities

What are the signs and symptoms of neuromas?

The only visible sign of a neuroma is swelling between your third and fourth or second and third toes. Symptoms — which you can feel but not see — include pain toward the front of your foot, near the toes, numbness or tingling in the ball of your foot in the same area, and pain that worsens when your foot is bearing weight.

Is there anything I can do myself to relieve the pain?

Wear a low-heeled shoe with plenty of room for your toes. Choose shoes with appropriate support to ensure your foot is positioned well. Stop walking and massage the area of pain when it occurs, and apply ice three times a day.

These measures can help manage the pain but won’t address the underlying neuroma or prevent future problems. Schedule an appointment if you believe you have a neuroma. When left untreated, neuromas can worsen.

How are neuromas treated?

Your treatment options will depend on the stage of development of your neuroma and may include:

  • Appropriate diagnosis using examination, medical history review, and X-rays if necessary
  • Alleviation of pressure on the neuroma through the use of padding the ball of the foot and taping
  • Custom orthotics designed to align the foot properly and correct functional problems
  • Oral anti-inflammatory medications or cortisone injections to reduce inflammation and swelling
  • Surgical removal of the neuroma when other options fail to alleviate pain and discomfort

Source of info: https://www.starrettpodiatry.com/services/neuroma

Custom orthotics are specially-made devices designed to support and comfort your feet. Prescription orthotics are crafted for you and no one else. They match the contours of your feet precisely and are designed for the way you move. Orthotics are only manufactured after a podiatrist has conducted a complete evaluation of your feet, ankles, and legs, so the orthotic can accommodate your unique foot structure and pathology.

Prescription orthotics are divided into two categories:

  • Functional orthotics are designed to control abnormal motion. They may be used to treat foot pain caused by abnormal motion; they can also be used to treat injuries such as shin splints or tendinitis. Functional orthotics are usually crafted of a semi-rigid material such as plastic or graphite.
  • Accommodative orthotics are softer and meant to provide additional cushioning and support. They can be used to treat diabetic foot ulcers, painful calluses on the bottom of the foot, and other uncomfortable conditions.

Podiatrists use orthotics to treat foot problems such as plantar fasciitis, bursitis, tendinitis, diabetic foot ulcers, and foot, ankle, and heel pain. Clinical research studies have shown that podiatrist-prescribed foot orthotics decrease foot pain and improve function.

Orthotics typically cost more than shoe inserts purchased in a retail store, but the additional cost is usually well worth it. Unlike shoe inserts, orthotics are molded to fit each individual foot, so you can be sure that your orthotics fit and do what they’re supposed to do. Prescription orthotics are also made of top-notch materials and last many years when cared for properly. Insurance often helps pay for prescription orthotics.

What are Shoe Inserts? 

You’ve seen them at the grocery store and at the mall. You’ve probably even seen them on TV and online. Shoe inserts are any kind of non-prescription foot support designed to be worn inside a shoe. Pre-packaged, mass produced, arch supports are shoe inserts. So are the “custom-made” insoles and foot supports that you can order online or at retail stores. Unless the device has been prescribed by a doctor and crafted for your specific foot, it’s a shoe insert, not a custom orthotic device—despite what the ads might say.

Shoe inserts can be very helpful for a variety of foot ailments, including flat arches and foot and leg pain. They can cushion your feet, provide comfort, and support your arches, but they can’t correct biomechanical foot problems or cure long-standing foot issues.

When to Visit a Podiatrist

If you are simply looking for extra cushioning or support, you may wish to try an over-the-counter shoe insert first. If you have serious pain or discomfort, however, schedule an appointment with a podiatrist. He or she will assess your overall health and look for any other contributing factors. Today’s podiatrists are specially trained to evaluate the biomechanics of the lower extremity.

Your podiatrist will examine your feet and how you walk. He or she will listen carefully to your complaints and concerns and assess the movement and function of your lower extremities. Some also use advanced technology to see how your feet function when walking or running.

The information gathered during the exam will help your podiatrist determine if shoe inserts might be helpful or if you need prescription orthotics. If orthotics are needed, your podiatrist will capture a three-dimensional image of each foot. Those images, as well as any measurements obtained by your podiatrist, are used to create a set of unique foot supports that will improve your foot movement and lead to more comfort and mobility. Your podiatrist might also suggest additional treatments to improve the comfort and function of your feet.

 

(Source of information is from the following website: https://www.apma.org/orthotics)

WHAT IS PERIPHERAL NEUROPATHY

Peripheral neuropathy is a condition in which the small nerve fibers of the body that innervate the skin and organs are damaged.  The condition is initially seen in the feet, but may later progress and affect the hands, face, and torso.

SYMPTOMS

Symptoms of Small Fiber Peripheral Neuropathy include:

  • Burning
  • Shooting
  • Pins & Needles
  • Aching
  • Tingling
  • Restless Leg Syndrome
  • Coldness/Freezing
  • Electric Shock
  • Numbness
  • Tearing

Other signs may be abnormal sweating, dryness of the skin, or hair loss in the legs.  Symptoms generally get worse at night when lying in bed with the feet elevated.

RISK FACTORS

Certain conditions may predispose a person to developing small fiber peripheral neuropathy.  These risk factors include glucose intolerance (prediabetes or diabetes), anyone over the age of 65, thyroid disease, B12 deficiency, Sjogren’s disease, HIV, Lupus, and some medications.  The condition is also more common in men than women.

WHAT IS EPIDERMAL NERVE FIBER DENISTY TESTING

The Epidermal Nerve Fiber Density test (ENFD) is a highly sensitive and specific tool used in the diagnosis and monitoring of Small Fiber Peripheral Neuropathy.  This is a minimally invasive simple procedure performed in the office.

A small skin biopsy is performed on the lower part of the leg which is then analyzed by a trained pathologist.  The entire procedure is relatively painless, takes about 5-10 minutes with little post procedural care.

 

If you think you could be suffering from Peripheral Neuropathy, call our office to schedule an appointment and see if the Epidermal Nerve Fiber Density test is right for you.

Whirlpool therapy offers soothing and effective treatment to help reduce pain in the foot and ankle area. It provides significant relief from pain and pressure while easing tenderness and muscle tension.

Whirlpool therapy also improves blood flow in the foot and ankle, bringing oxygen to damaged tissues and promoting the healing process.

Ultrasound

Ultrasound technology is useful for the diagnosis of podiatric problems and the delivery of therapeutic care.

  • In therapeutic applications, ultrasound technology can be used to help break up scar tissue, improve blood flow, encourage a healing response from the body, and reduce painful inflammation in the feet and heels.
  • As a diagnostic tool, ultrasound imaging offers a safe and comfortable way to detect soft tissue conditions like Achilles tendinitis, plantar fasciitis, tumors, foreign bodies, torn tendons, and stress fractures. This technology is also useful when guiding needles for the precise injection of medications to reduce pain and inflammation.

Electrical Stimulation Therapy

A non-invasive and comfortable mode of care, electrical stimulation therapy improves muscle function in the foot and ankle. It offers an effective way to activate contraction with the intent of strengthening weak muscles, encouraging blood circulation, managing inflammation, controlling pain, and restoring function.

A plantar wart is an epithelial growth that occurs on the sole or toes of the foot that is caused by a strain of the human papillomavirus (HPV). The most common area for a plantar wart to occur is on the ball of the foot or on the heel. Standing and walking, which both put direct pressure on these areas, push the wart inward, causing discomfort and pain.

While plantar warts are contagious, not everybody gets them. Some individuals are more susceptible than others and they are most common in children and young adults. The virus can be picked up anywhere, but warm moist places like shower floors, locker rooms, and public swimming pools are popular breeding grounds for the virus.

Plantar warts can appear flat rather than raised because they are covered by the top layer of tough skin on the sole of your foot. However, they can also have a rough, grainy surface texture and can occur singly, or in clusters. The little black dots that are seen near the center of the wart represent the blood supply to the wart. While plantar warts exhibit certain distinguishing features, they sometimes resemble other skin conditions and lesions of the foot.

Our podiatrist will be able to determine if what you are suffering from is actually a plantar wart and not a corn, a callous, or a more serious problem. It is of the utmost importance that individuals who have diabetes, circulatory problems, or are immune compromised get an appropriate diagnosis and prompt care.

As far as treating plantar warts is concerned, the ultimate goal is to completely eradicate the wart so that it will not recur. Depending on the response to treatment, the successful elimination of a plantar wart may involve topical applications of medications, cryotherapy, immune therapy, surgical procedures, or laser surgery.

What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.

Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable.

Causes

Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem. Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also slow healing.

Symptoms

Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage on your socks. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.

When to Visit a Podiatrist

Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce health-care costs.

Diagnosis and Treatment

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

  • Prevention of infection
  • Taking the pressure off the area, called “off-loading”
  • Removing dead skin and tissue, called “debridement”
  • Applying medication or dressings to the ulcer
  • Managing blood glucose and other health problems

Not all ulcers are infected; however, if your podiatrist diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

To keep an ulcer from becoming infected, it is important to:

  • keep blood glucose levels under tight control;
  • keep the ulcer clean and bandaged;
  • cleanse the wound daily, using a wound dressing or bandage; and
  • avoid walking barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.”  You may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches.  These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist.

Appropriate wound management includes the use of dressings and topically-applied medications. For a wound to heal, there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.

Surgical Options: A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”

Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

Prevention

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. Your podiatrist can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you have or do the following:

  • Neuropathy
  • Poor circulation
  • A foot deformity (e.g., bunion, hammer toe)
  • Wear inappropriate shoes
  • Uncontrolled blood sugar
  • History of a previous foot ulceration

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose, are important in prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatrist can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial so that you can find a potential problem as early as possible. Inspect your feet every day—especially the sole and between the toes—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health-care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible; no matter how simple they may seem to you.

The key to successful wound healing is regular podiatric medical care to ensure the following “gold standard” of care:

  • Lowering blood sugar
  • Appropriate debridement of wounds
  • Treating any infection
  • Reducing friction and pressure
  • Restoring adequate blood flow

Additional information is available from the American Diabetes Association.

At Westchester Foot Care we use the latest imaging techniques in diagnosing and planning treatment of foot and ankle pathologies.  Digital x-rays are a new technology offered at all our offices that provide safer, better quality, and more detailed images than traditional x-rays.  This technology can also display x-rays in just a few seconds allowing patients to obtain their results immediately.  In addition, images can be copied on a CD and given to patients at their request.

Why Digital X-Rays May Be Ordered:

  • Suspect a fracture or break in the bone
  • Evaluate structural deformities
  • Locate foreign objects, such as glass or metal
  • Planning of surgical procedures and monitor postoperative healing
  • Look for signs of osteomyelitis, or bone infection
  • Assess for arthritic changes, including gout
  • Monitor healing of fractures and growth of bone in children
  • Rule out a variety of pathologies

At Westchester Foot Care we use the most cutting-edge tools to provide outstanding podiatric care and are committed to earning the trust of our patients.  Contact us today!