I Have A Really Large Toe!

Do you have one toe that is much, much larger than all of the others, including your big toe?

What you have is likely localized gigantism, a condition in which a certain part of the body becomes an abnormal size because of excessive growth of the anatomical structures or abnormal accumulation of substances. When it affects the fingers and toes it is called macrodactyl, an uncommon congenital condition.
Macrodactyl more commonly affects the hands than feet. Typically only one foot is affected, with no more than one digit on that foot. Often times macrodactyl coexists with syndactyl, when two toes are fused together. It is a benign condition, but will look displeasing to you and your child.
Congenital causes of the condition include:

• Kippel Trenauary Weber syndrome
• Maffucci syndrome
• macrodystrophia lipomatosa 
• neurofibromatosis
• lipoatrophic diabetes
• Proteus syndrome

In cases of acquired localized gigantism, meaning you were not born with the deformity, causes may include:

• Inflammation
• Tumors, like osteoid osteomas
• Still's disease
• Arteriovenous malformations on a limb
• Elephantiasis
• Amyloidosis
• Acromegaly

Treatment for localized gigantism and macrodactyl depends on the particular condition and may range from antibiotics, other medical therapy, and surgery to correct the anatomical deformity.
If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
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iTCH rECOVERING fROM fOOT sURGERY

Rapper iTCH pulled out a London gig earlier this month to have surgery on his foot after sustaining a gross injury during a performance.
The Bruises hitmaker broke three bones in his heel when he jumped from a balcony during an over the top performance at The Jazz Cafe in London as part of the Camden Rocks Festival.
iTCH, real name Jonathan Fox, was scheduled to appear with American star Action Bronson at the nearby KOKO nightclub, but instead had an operation to fix his broken bones.
The rapper posted a picture of himself hanging from the balcony before the jump on his Facebook page, along with a photo of his bandaged foot, with a caption, "Camden rocks! Hospital sucks!"
He added, "I'm gutted to be missing this gig! If I wasn't knocked out with anesthetic I'd be fighting through doctors to get there in a wheelchair shouting, 'Put your crutches up!'"
Next time no hanging from balconies, iTCH.
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Marcia Gay Harden Recovering From Foot Surgery

Oscar winning actress Marcia Gay Harden is recovering after having foot surgery. 
The 53 year old Harden replaced Rosemarie DeWitt on the television show Newsroom and co-star Jane Fonda revealed that her colleague has been suffering from foot problems during the shoot. 
Fonda has been writing about her time on the set of Newsroom in an online blog and wrote that Harden recently had an operation on her foot. She posted a picture of Harden wearing a classy dress and casual soft shoes. 
Fonda wrote, "My scenes (on the Newsroom) were with Sam Waterson, Marcia Gay Harden, and Chris Messina, who plays my son... Marcia Gay had recent foot surgery so wore slippers when she wasn't shooting."
Reference: Contact Music
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What Questions Should I Ask Before Foot Surgery?

If your podiatrist tells you that you need to have foot or ankle surgery, it is very important to ask questions. When you think of questions that are not included here, make sure you write them down and print out this list to bring with you to your visit. It is extremely important to us that all of your questions are answered and your mind is at ease.
Here are some questions you should ask about the surgical procedure:

1. What is the procedure I will have?
2. Are there any other options besides surgery?
3. What benefits does this surgery have, in terms of pain relief and function?
4. How long will the benefits last?
5. What risks are associated with this surgery?
6. Is there any written or video materials I can read or watch about this surgery?
7. What is the success rate for this surgery?
8. How is the procedure done?
9. Will the surgery need to be repeated after a certain amount of time?
10. How many of these procedures do you do each year?
11. How many patients improve after this surgery?
12. What will happen if I don't have this surgery right away?
13. If I want a second opinion, who should I consult?
14. Will you do the surgery or will someone else?
15. If you won't do the surgery, will I meet the other doctor?
16. Will I need any tests or medical evaluations before the surgery?
17. What kind of anesthesia will be used?
18. Will the anesthesiologist know about my allergies?
19. Will I have pain following the surgery?
20. What pain relievers will I be given?

What do I need to know after the surgery?

1. How long will recovery take?
2. What limitations will I have during recovery?
3. Will I need assistance at home after surgery?
4. What will my discharge instructions be?
5. Will I have any disability following surgery?
6. Will I need physical therapy?
7. When can I return to work?
8. When can I drive my car?

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
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No Dancing In the Moonlight For Singer Jessie J

There will be no dirty dancing in the moonlight for singer Jessie J, as she continues to struggle with

complications from a broken foot she sustained in June 2011. 
The singer will undergo surgery later this year to remove a metal plate which was inserted in her broken foot in 2011. The "Domino" singer recently reinjured her foot during a gig rehearsal in London and has spent weeks getting around on crutches. 
At the time of the original injury in 2011, Jessie J underwent extensive reconstructive surgery, getting a bone transplant and fusion, as well as metal fittings and plate in her foot. After the surgery she sat on a gilded throne at the Glastonbury Festival while her foot was in a surgical boot. She went against doctor's orders to stay out of high heels, saying "Come on foot. I believe in you. Pop back in and behave! Ouch!" 
Jessie J recently revealed that she visited a physical therapist to pop the bone in her foot back in place.
She told England's Daily Mirror, "I'm getting some time off at Christmas and I'm having surgery to have the plate removed. It is flicking against my bone and causing a lot of pain. I hurt my ankle about two years ago and it's still causing me a lot of discomfort.
"The foot is still bruised and swells up because it won't heal, so I'm having the metal taken out. It sets off the security systems at airports and when I sit down it gets cold... I'm hoping it will be sorted at Christmas then it will be done and dusted and I can have some down time."
Reference: Star Pulse and The Podiatry Center.
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Mark Harper On Why Table Dancing Is Not A Good Idea

Sometimes you would think supposedly intelligent people would know better. Then you think to yourself,

"Nah. They're just as lame as the rest of us."
British Tory minister Mark Harper broke his foot after he took a tumble while table dancing. Yes, that's right. The Tory minister was table dancing. There's a joke in here somewhere, we know it. The Minister for Immigration was out celebrating with his wife, Margaret, when he lost his footing on the table and crashed to the floor (can we say toasted?...) 
The 43 year old told England's Evening Star newspaper that "I honestly cannot remember what the tune was. It's not very painful and I'm 'cracking on' with my job as MP and a minister. I'm just going to the fracture clinic now to have it X-rayed. It is in an air boot, not a cast, so it's not too bad."
The embarrassed MP added, "My wife Margaret was with me but thankfully she's a far better dancer so didn't fall off." Perhaps she has more experience dancing on tables?...
Harper's fall was the talk of Westminister as he walked around on crutches. Fellow Conservative and Forest of Dean councilor Len Lawton said of his colleague, "We found it hilarious and gave him plenty of stick. The imagination runs wild when you hear it was when he was dancing on a table at a bar in SoHo. He said it happened at his wife's leaving do and he alighted from the table very inelegantly.
"I know dozens of people who would just sit back but it's good he's getting on with it- although his staff are getting the rough end as they have to drive him everywhere."
Harper is still planning on taking part in the Lydney relay in support of Cancer Research UK this weekend, but concedes that he'll be moving "a bit more slowly than usual."
Lynne Gardner, organizer of the event, said of Harper, "Mark definitely has a fun side. Obviously we're sad to hear he had broken his foot, but we will be giving him some stick about how he did it. We'll have to try and get him a buggy or wheelchair so he can do his usual tour of everything."
And no more dancing on tables, Mr. MP.
Reference: The Mirror
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Can I Have Carpal Tunnel In My Foot?

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel- arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.
Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.
Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.

Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:

• A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with fallen arches can produce strain and compression on the nerve.
• An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
• An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
• Systemic disease such as diabetes or arthritis can cause swelling, thus compressing the nerve.

Patients with tarsal tunnel syndrome experience one or more of the following symptoms:

• Tingling, burning, or a sensation similar to an electrical shock.
• Numbness.
• Pain, including shooting pain.

Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.
Sometimes the symptoms of the syndrome appear suddenly. Often they are brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.
It is very important to seek early treatment if any of the symptoms of tarsal tunnel occur. If left untreated, the condition progresses and may result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated.
The foot and ankle surgeon will examine the foot to arrive at a diagnosis and determine if there is any loss of feeling. During this examination, the surgeon will position the foot and tap on the nerve to see if the symptoms can be reproduced. He or she will also press on the area to help determine if a small mass is present.
Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Studies used to evaluate nerve problems- electromyography and nerve conduction velocity (EMG/NCV)- may be ordered if the condition shows no improvement with non-surgical treatment.
A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:

• Rest. Staying off the foot prevents further injury and encourages healing.
• Ice. Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
• Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
• Physical therapy. Ultrasound therapy, exercises, and other physical therapy modalities may be prescribed to reduce symptoms.
• Injection therapy. Injections of a local anesthetic provide pain relief, and an injection corticosteroid may be useful in treating the inflammation. 
• Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
• Shoes. Supportive shoes may be recommended.
• Bracing. Patients with flat foot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount pressure on the foot.

Sometimes surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate proceudre or procedures based on the cause of the condition.
If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
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My Second Toe Hurts!

Ligaments surrounding the joint at the base of the second toe form a capsule, which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed.
Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort, and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis- also referred to as predislocation syndrome- is a common condition that can occur at any age.
It is generally believed that capsulitis of the second toe is a result of abnormal foot mechanics, where the ball of the foot beneath the toe joint takes an excessive amount of weight-bearing pressure.

Certain conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of the foot. These most commonly include a severe bunion deformity, a second toe longer than the big toe, an arch that is structurally unstable, and a tight calf muscle.
Because capsulitis of the second toe is a progressive disorder and usually worsens if left untreated, early recognition and treatment are important. In the earlier stages- the best time to see treatment- the symptoms may include:

• Pain, particularly on the ball of the foot. It can feel like there's a marble in the shoe or a sock is bunched up.
• Swelling in the area of pain, including the base of the toe.
• Difficultly wearing shoes.
• Pain when walking barefoot.

In more advanced stages, the supportive ligaments weaken leading to failure of the joint to stabilize the toe. The unstable toe drifts toward the big toe and eventually crosses over and lies on top of the big toe- resulting in crossover toe, the end stage of capsulitis. The symptoms of crossover toe are the same as those experienced during earlier stages. Although the crossing over of the toe usually occurs over a period of time, it can appear more quickly if caused by injury or overuse.
An accurate diagnosis is essential because the symptoms of capsulitis can be similar to those of a condition called Morton's neuroma, which is treated differently from capsulitis.
In arriving at a diagnosis, the foot and ankle surgeon will examine the foot, press on it, and maneuver it to reproduce the symptoms. The podiatrist will also look for potential causes and test the stability of the joint. X-rays are usually ordered, and other imaging studies are sometimes needed.
The best time to treat capsulitis of the second toe is during the early stages, before the toe starts to drift toward the big toe. At that time, non-surgical approaches can be used to stabilize the joint, reduce the symptoms, and address the underlying cause of the condition.
The podiatrist may select one or more of the following options for early treatment of capsulitis:

• Rest and ice. Staying off the foot and applying ice packs helps reduce the swelling and pain. Apply an ice pack, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
• Taping/splinting. It may be necessary to tape the toe so that it will stay in the correct position. This helps relieve the pain and prevent further drifting of the toe.
• Stretching. Stretching exercise may be prescribed for patients who have tight calf muscles.
• Shoe modifications. Supportive shoes with stiff soles are recommended because they control the motion and lessen the amount of pressure on the ball of the foot.
• Orthotic devices. Custom shoe inserts are often very beneficial. These include arch supports or a metatarsal pad that distributes the weight away from the joint.

Once the second toe starts moving toward the big toe, it will never go back to its normal position unless surgery is performed. The podiatrist will select the procedure or combination of procedures best suited to the individual patient.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
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Bone Spurs In the Foot

A bone spur is a bony growth formed on normal bone. Most people think of something sharp when they think of a spur, but a bone spur is just extra bone. It's usually smooth, but it can cause wear and tear or pain if it presses or rubs on other bones or soft tissues such as ligaments, tendons, or nerves in the body.
A bone spur forms as the body tries to repair itself by building extra bone. It typically forms in response to pressure, rubbing, or stress that continues over a long period of time.
Some bone spurs form as part of the aging process. As we age, the slippery tissue called cartilage that covers the end of the bones within the joint breaks down and eventually wears away. Over time, this leads to pain and swelling, and in some cases, bone spurs forming along the edge of the joint. Bone spurs due to aging are especially common in the feet.

Bone spurs form in the feet in response to tight ligaments, to activities such as dancing and running that put stress on the feet, and to pressure from being overweight or from poorly fitting shoes. For example, the long ligament on the bottom of the foot, the plantar fascia, can become stressed or tight and pull on the heel, causing the ligament to become inflamed. As the bone tries to mend itself, a bone spur can form on the bottom of the heel, known as a heel spur. Pressure on the back of the heel from frequently wearing shoes that are too tight can cause a bone spur. This is sometimes called pump bump, or Haglund's Deformity, because it is seen in women who wear high heels.
Many people have a bone spur without ever knowing, because most bone spurs cause no symptoms. But if the bone spurs are pressing on the bones or tissues or are causing a muscle or tendon to rub, they can break that tissue down over time, causing pain, swelling, and tearing. Bone spurs in the foot can also cause corns and calluses when tissue builds up to provide added padding over the bone spur.
A bone spur is usually visible on an X-ray. But since most bone spurs do not cause problems, it would be unusual to take an X-ray just to see if you have a bone spur. If you had an X-ray to evaluate one of the problems associated with bone spurs, such as arthritis, bone spurs would be visible on that X-ray.
Bone spurs do not require treatment unless they are causing pain or damaging other tissues. When needed, treatment may be directed at the causes, symptoms, or the bone spurs themselves.
Treatment directed at the cause of bone spurs may include weight loss to take some pressure off the joints (especially when osteoarthritis or plantar fasciitis is the cause) and stretching the affected area, such as the heel cord and bottom of the foot. Seeing a physical therapist for ultrasound or deep tissue massage may be helpful for plantar fasciitis.
Treatment directed at the symptoms could include rest, ice, stretching and non-steroidal anti-inflammatory drugs, such as ibuprofen. Education in how to protect your joints is helpful if you have osteoarthritis. When the spur is in the foot, changing footwear or adding an orthotic may help. If the spur is causing corns or calluses, padding the area or wearing different shoes can help. A podiatrist is the best trained in helping your bone spur and may also recommend a cortisone injection to reduce pain and inflammation of the tissues near the spur.
Bone spurs can be surgically removed or treated as part of a surgery to repair or replace a joint when osteoarthritis has caused considerable damage and deformity. Examples might include repair of a bunion or heel spur in the foot.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
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My Foot Is Collapsing! Help!

Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.
Charcot foot is a very serious condition that can lead to severe deformity, disability, and even amputation. Because of its seriousness, it is important that patients with diabetes- a disease often associated with neuropathy- take preventive measures and seek immediate care if signs or symptoms appear.

Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain, or trauma. Because of diminished sensation, the patient may continue to walk- making the injury worse.
People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot.
The symptoms of Charcot foot may include:

• Warmth to the touch (the affected foot feels warmer than the other).
• Redness in the foot.
• Swelling in the area.
• Pain or soreness.

Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays and other imaging studies and tests may be ordered.
Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.
It is extremely important to follow the surgeon's treatment plan for Charcot foot. Failure to do so can lead to the loss of a toe, foot, leg, or life.
Non-surgical treatment for Charcot foot consists of:

• Immobilization. Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the weakened bones can repair themselves. Complete non-weightbearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the surgeon determines it is safe to do so. During this period, the patient may be fitted with a cast, removable boot, or brace, and may be required to use crutches or a wheelchair. It may take the bones several months to heal, although it can take considerably longer in some patients.
• Custom shoes and bracing. Shoes with special inserts may be needed after the bones have healed to enable the patient to return to daily activities- as well as help prevent recurrence of Charcot foot, development of ulcers, and possibly amputation. In cases with significant deformity, bracing is also required.
• Activity modification. A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet.

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Why Do My Toes Turn Outward?

The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.
PTTD is often called "adult acquired flatfoot" because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn't treated early.

Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change.
For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen.
Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward.
As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.
Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested.
In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases of PTTD, treatment can begin with non-surgical approaches that may include:

• Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe. 
• Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while. 
• Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
• Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support.

In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
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My Feet Are Flat. Is This Normal?

Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability.

There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.
Other characteristics shared by most types of flatfoot include: 

• "Toe drift", in which the toes and front part of the foot point outward.
• The heel tilts toward the outside and the ankle appears to turn in.
• A tight Achilles tendon, which causes the heel to lift off the ground earlier when walking and may make the problem worse.
• Bunions and hammertoes may develop as a result of a flatfoot. 

Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and progresses in severity through the adult years. As the deformity worsens, the soft tissues (tendon and ligaments) of the arch may stretch or tear and can become inflamed.
The term "flexible" means that while the foot is flat when standing (weight-bearing), the arch returns when not standing.
Symptoms, which may occur in some persons with flexible flatfoot include:

• Pain in the heel, arch, ankle, or along the outside of the foot.
• "Rolled-in" ankle (over-pronation).
• Pain along the shin bone (shin splint).
• General aching or fatigue in the foot or leg.
• Low back, hip, or knee pain.

In diagnosing flatfoot, the foot and ankle surgeon examines the foot and observes how it looks when you stand and sit. X-rays are usually taken to determine the severity of the disorder. If you are diagnosed with flexible flatfoot but you don't have any symptoms, your surgeon will explain what you might expect in the future.
If you experience symptoms with flexible flatfoot, the surgeon may recommend non-surgical treatment options, including:

• Activity modification. Cut down on activities that bring you pain and avoid prolonged walking or
  
  standing to give your arches a rest.
• Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches may aggravate your symptoms. 
• Orthotic devices. Your foot and ankle surgeon can provide you with custom orthotic devices for your shoes to give more support to the arches. 
• Immobilization. In some cases, it may be necessary to use a walking cast or to completely avoid weight-bearing.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
• Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief. 
• Shoe modification. Wearing shoes that support the arches is important for anyone who has flatfoot.

In some patients whose pain is not adequately relieved by other treatments, surgery may be considered. A variety of surgical techniques is available to correct flexible flatfoot, and one or a combination of procedures may be required to relieve the symptoms and improve foot function.
In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of recovery period will vary, depending on the procedure or procedures performed.
If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
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I Have A Stiff Big Toe!

Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. "Hallux" refers to the big toe, while "rigidus" indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis.
This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Many patient confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.

Because hallux rigidus is a progressive condition, the toe's motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called "hallux limitus". But as the problem advances, the toe's range of motion gradually decreases until it potentially reaches the end stage of "rigidus", in which the big toe becomes stiff, or what is sometimes called a "frozen joint".

Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis- the kind that results from "wear and tear"- often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.

In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse- especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury, such as stubbing your toe. Or it may be caused by inflammatory diseases such as rheumatoid arthritis or gout. Your foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment.
Early signs and symptoms include:

• Pain and stiffness in the big toe during use (walking, standing, bending, etc.).
• Pain and stiffness aggravated by cold, damp weather.
• Difficulty with certain activities (running, squatting).
• Swelling and inflammation around the joint.

As the disorder gets more serious, additional symptoms may develop, including:

• Pain, even during rest.
• Difficulty wearing shoes because bone spurs (overgrowths) develop.
• Dull pain in the hip, knee, or lower back due to changes in the way you walk.
• Limping (in severe cases).

The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle is when you first notice symptoms. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.
In diagnosing hallux rigidus, the surgeon will examine your feet and move the toe to determine its range of motion. X-rays help determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.
In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may include:

• Shoe modifications. Shoes with a large toe box put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended.
• Orthotic devices. Custom orthotic devices may improve foot function.
• Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
• Injection therapy. Injections of corticosteroids may reduce inflammation and pain. 
• Physical therapy. Ultrasound therapy or other physical modalities may be undertaken to provide temporary relief.

In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus. In selecting the procedure or combination or procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT
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Why Won't My Foot Move?

A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage, or fibrous tissue, may lead to limited motion and pain in one or both feet.
The tarsal bones include the calcaneus (heel bone), talus, navicular, cuboid, and cuneiform bones. These bones work together to provide the motion necessary for normal foot function.
Most often, tarsal coalition occurs during fetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or a previous injury to the area.

While many people who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature, usually around ages 9 to 16. Sometimes there are no symptoms during childhood. However, pain and symptoms may develop later in life.
The symptoms of tarsal coalition may include one or more of the following:

• Pain (mild to severe) when walking or standing.
• Tired or fatigued legs.
• Muscles spasms in the leg, causing the foot to turn outward when walking.
• Flatfoot (in one or both feet).
• Walking with a limp.
• Stiffness of the foot and ankle.

A tarsal coalition is difficult to identify until a child's bones begin to mature. It is sometimes not discovered until adulthood. Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot and ankle. The findings of this examination will differ according to the severity and location of the coalition.
In addition to examining the foot, the surgeon will order x-rays. Advanced imaging studies may also be required to fully evaluate the condition.
The goal of non-surgical treatment of tarsal coalition is to relieve the symptoms and reduce the motion at the affected joint. One or more of the following options may be used, depending on the severity of the condition and the response to treatment:

• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
• Physical therapy. Physical therapy may include massage, range-of-motion exercises, and ultrasound therapy.
• Steroid injections. An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary. 
• Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint, and relieving pain.
• Immobilization. Sometimes the foot is immobilized to give the affected area a rest. The foot is placed in a cast or cast boot, and crutches are used to avoid placing weight on the foot.
• Injection of an anesthetics. Injection of an anesthetic into the leg may be used to relax spasms and is often performed prior to immobilization. 

If the patient's symptoms are not adequately relieved with nonsurgical treatment, surgery is an option. The foot and ankle surgeon will determine the best surgical approach based on the patient's age, condition, arthritic changers, and activity level.
If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT
Visit our website, like our page on Facebook, and follow our tweets on Twitter.