Common Foot Problems

Common Foot Problems

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Your Foot

• The feet are flexible structures of bones, joints, muscles, and soft tissues that let us stand upright and perform activities like walking, running, and jumping.

The foot contains 26 bones 33 joints 19 muscles 107 ligaments.

• The feet are divided into three sections1. Forefoot

2. Midfoot

3. Hindfoot

Forefoot Contains the five toes (phalanges) and the five longer

bones (metatarsals).

Midfoot Pyramid-like collection of bones that form the arches of

the feet. Include the three cuneiform bones, the cuboid bone, and

the navicular bone.

Hindfoot Forms the heel and ankle. The talus bone supports the leg bones (tibia and fibula),

forming the ankle. The calcaneus (heel bone) is the largest bone in the foot.

Foot arches

Foot has three distinct arches. Two "longitudinal" arches (one on each side)

run from front to back One "transverse arch"

runs across the midfoot from inside to outside.

Foot arches

Functions of foot arches

The structure of an arch is the spread the load out so it can be supported with the least amount of effort and material.

Some shock absorbency, Prevents blood vessels and nerves from being

crushed.

Functions of the foot

Proper functioning of the foot is required for normal gait

Weight Distribution

Weight of the body is supported by the foot, and is transmitted and distributed over 6 areas

Functions of the foot

Common foot complaints

Hammertoes Heel pain Bunions Athlete’s foot Warts Ingrowing nails

Bunions

• Common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe.(abnormal bony bump)

• Big toe pushes up against other toes, forcing big toe joint in the opposite direction

• Causes the big toe to move outward ( hallux valgus deformity)

• Most commonly affect women.

• Bunions may or may not cause symptoms.

• A less common bunion is located at the joint at the base of the smallest (fifth) toe.

Bunions

Bunions

Bunions… Symptoms and Signs• Foot pain in the involved area when walking or

wearing shoes. That is relieved by resting.

• Bulging bump on the outside of the base of big toe

• Swelling, redness or soreness around big toe joint

• Thickening of the skin at the base of big toe

• Restricted movement of big toe

• Positioning of the big toe toward the smaller toes.

Bunions… Causes

• High-heeled or ill-fitting shoes

• Inherited foot type

• Foot injuries

• Deformities present at birth (congenital)

• May be associated with various forms of arthritis and an activities that puts extra stress on the feet (eg. Bunions are common in ballet dancers.)

High Heels

Not your ideal choice

Bunions….Complications

• Bunions are permanent unless surgically corrected, they are a structural deformity.

• If the cushioning sac of fluid (bursa) over the affected joint becomes inflamed (bursitis), a bunion can be very painful and interfere with the normal activities.

• May get larger and more painful, making nonsurgical treatment less effective.

Bunions…TreatmentsConservative treatment

Nonsurgical treatments that may relieve the pain and pressure of a bunion include:

• Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for toes.

• Padding and taping. tape and pad your foot in a normal position to reduce stress on the bunion and alleviate the pain.

• Medications. Anti-inflammation medications/ local injection of steroids to ease inflammation as well as pain

Bunions… Conservative treatment

• Orthotic InsertsGoal of orthotics:

To reestablish the weight bearing parabola across all the metatarsals

Orthotics re-align the foot with the leg for more efficient function. In essence, the foot does not have to work as hard to accomplish the same movements.

For mild to moderate bunions that do not hurt on a daily basis, orthotic therapy can be very effective.

• Others…. Simply resting the foot by avoiding excessive walking Stretching exercises to reduce tension on the inner part of

the joint

–

Bunions…Treatments

Orthotic Inserts

Severe Cases with persisting pain a surgical operation is considered for removal of the bunion.


Bunion surgery is the ultimate correction of the structural deformity. (That does not necessarily mean that it is the best solution for every bunion)

Surgical operation to remove a bunion is referred to as a “Bunionectomy”.

Surgery involves breaking the metatarsal bone and moving it towards the second toe while relocating the big toe straight on the bone.

Some form of fixation is used to hold the metatarsal in place (pin, screw, etc)


Bunions… Surgical treatment

Shoes

Wearing comfortable shoes that fit well can prevent many foot problems.

What qualities make up a well-constructed shoe?

• Lightweight walking shoe

• With breathable upper materials, such as leather or nylon mesh.

• Very firm heel counter, the heel should have reduced cushioning to position the heel closer to the ground for walking stability.

• The front or forefoot area of the shoe should have adequate support and flexibility.

well-constructed shoe

Well-constructed shoe

Brannock Device

Shoes…. Tips for choosing right shoes for you

• The size of your feet changes as you grow older so always have your feet measured before buying shoes.

• Most of us have one foot that is larger than the other, so fit your shoe to your larger foot.

• Don't select shoes by the size marked inside the shoe but by how the shoe fits your foot.

• Select a shoe that is shaped like your foot.

• Make sure there is enough space (3/8" to 1/2") for your longest toe at the end of each shoe when you are standing up.

• Make sure the ball of your foot fits comfortably into the widest part of the shoe.

• Don't buy shoes that feel too tight and expect them to stretch to fit.

• Your heel should fit comfortably in the shoe with a minimum amount of slipping

• Walk in the shoes to make sure they fit and feel right.

Shoes…. Tips for choosing right shoes

Hammertoes

A hammer toe or contracted toe is a deformity of the proximal interphalangeal joint of the second, third, or fourth toe causing it to be permanently bent, resembling a hammer.

Hammertoes.... Causes

Wearing poorly fitting shoes that can force the toe into a bent position (eg. High heels)

Muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke or diabetes

Often found in conjunction with bunions or other foot problems

Hammertoes

Hammertoes....Symptomes/Signs

Pain with walking Difficulty moving the toe Corns and calluses resulting from the toe

rubbing against the inside of footwear

Hammertoes....Treatment

Conservative treatment Physical therapy New shoes with soft, spacious toe box Wear shoe inserts (orthotics) or pads to reposition

the toe and relieve pressure and pain. Surgical treatment

If the toe has become tight and inflexible

Hammertoes… Conservative Treatment

Hammertoes… Surgical Treatment

Heel pain

“pain usually occurs underneath your heel (plantar fasciitis) or just behind it”

Heel pain….Causes Achilles tendinitis Achilles tendon rupture Bone bruise Bone cyst Bone spurs Bursitis Fracture Gout Heel pad wear and tear Neuroma

• Osteomyelitis

• Peripheral neuropathy

• Pinched nerve

• Plantar fasciitis

• Problems with your gait

• Rheumatoid arthritis

• Stress fractures

• Tarsal tunnel syndrome

• Tendinitis

Heel pain... Treatment Treatment of heel pain depends entirely on the

cause of the problem. Therefore, it is of utmost importance that you

understand the cause of your symptoms before embarking on a treatment program.

Some general measures Rest Apply Ice Packs Exercises and Stretches Anti-Inflammatory Medications Shoe Inserts-Orthotics

Heel pain... KT taping

Heel pain... Treatment

Heel pain... Treatment

Orthotic Inserts

Neuroma

“Neuroma is a growth or tumour of nerve tissue”.

Morton's Neuroma

• Morton's neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes.

• Involves a thickening of the tissue around one of the nerves leading to your toes.

• May occur in response to irritation, injury or pressure.

Morton's Neuroma

• A feeling as if you're standing on a pebble in your shoe

• A burning pain in the ball of your foot that may radiate into your toes

• Tingling or numbness in your toes

Morton's Neuroma…. Symptoms

• Non Surgical Treatment Arch supports and foot pads fit inside your shoe and

help reduce pressure on the nerve An “Arch Cookie” pad can help to spread the

metatarsals and give the nerve more space Injection of steroids into the painful area Injections of medications to desensitize the nerve

Morton's Neuroma…. Treatments

• Surgical Treatment Cryogenic neuroablation• This minimally invasive procedure

• Exposes the nerve to very cold temperatures

• It interferes the transmission of pain signals

• Results are not permanent. Decompression surgery.• In some cases, surgeons can relieve the pressure on the

nerve by cutting nearby structures


Removal of the nerve• Surgical removal of the growth may be necessary if

other treatments fail to provide pain relief.

• As a last resort, because the procedure removes both the neuroma and the nerve, which can leave permanent numbness in the affected toes.


Athlete’s foot

• Very common skin condition that affects the sole of the foot and the skin between the toes.

• Usually a scaly, red, itchy eruption( occasionally may be weepy and oozing.)

• Athlete's foot, also called tinea pedis, is the most common type of fungal infection.

Athlete’s foot

Athlete's foot is contagious and can be spread by contact with an infected person or with contact with contaminated surfaces, such as towels, floors and shoes.

Athlete’s foot

• a man ?

• Frequently wear damp socks or tight fitting shoes

• Share mats, rugs, bed linens, clothes or shoes with someone who has a fungal infection

• Walk barefoot in public areas where the infection can spread, such as locker rooms, saunas, swimming pools, communal baths and showers

• Have a weakened immune system

Athlete’s foot... Risk factors

Athlete’s foot.... Causes

Caused by a fungus (group of mold-like fungi called dermatophytes ).

Can be contracted in many locations, including gyms, locker rooms, swimming pools, nail salons, airport security lines, and from contaminated socks and clothing

Athlete's foot is closely related to other fungal infections, including ringworm and jock itch- change the towel when drying off!

Athlete’s foot.... Causes

Athlete’s foot... Symptoms

Itching, stinging and burning Cracked and peeling skin

between your toes

on the soles of the feet Excessive dryness of the skin on the bottoms or

sides of the feet Toenails that are thick, crumbly, ragged,

discolored or pulling away from the nail bed

Athlete’s foot… Treatment

• Make the infected area less suitable for the athlete's foot fungus to grow

Keeping the area clean and dry. Absorbent socks like cotton that wick water away

• Antifungal creams and washes Tea tree oil Lamisil cream Ertazco

Athlete’s foot… Treatment

Plantar Warts

• Warts are local growths in the skin that are caused by Human Papilloma Virus (HPV) infection

• Plantar warts are noncancerous skin growths on the soles of your feet

• Virus enters the body through tiny cuts or breaks

Plantar Warts

• Often develop beneath pressure points in the feet, such as the heels or balls of the feet

• Pressure also may cause a plantar wart to grow inward beneath a hard, thick layer of skin (callus).

Plantar Warts

Callus

Plantar Warts…..Signs & Symptoms

• Small, fleshy, grainy lesions, or growths on feet

• Hard, thickened skin (callus) where a wart has grown inwards

• Black pinpoints- "wart seeds" ( actually small, clotted blood vessels)

• Lesions that interrupt the normal lines and ridges in the skin of your feet

• Pain or tenderness when walking or standing

Plantar Warts…..

Plantar Warts….. Complications

• Plantar warts cause pain

• May alter your normal posture or gait — perhaps without realizing the change

• Contagious

Plantar Warts…..Treatments

• Plantar warts may resolve on their own without treatment within a couple of years.

• If they are causing pain or spreading, they should be treated. Freezing (cryotherapy) Cantharidin. Minor surgery Laser treatment- can leave scarring

Cryotherapy for warts

Plantar Warts…..Treatments

In Growing Toenails(Onychocryptosis)

• Common condition in which the corner or side of one of your toenails grows into the soft flesh of that toe.

• Usually affects your big toe.

• Result is pain, redness, swelling and, sometimes, an infection.

In Growing Toenails

• Wearing shoes that crowd your toenails

• Cutting your toenails too short or not straight across

• Injury to your toenail

• Unusually curved toenails

In Growing Toenails…Causes

• Pain and tenderness in your toe along one or both sides of the nail

• Redness around your toenail

• Swelling of your toe around the nail

• Infection of the tissue around your toenail

In Growing Toenails… Symptomes /Signs

In Growing Toenails

• Bacteria and fungi can easily infect the skin of the feet and nails. (Staphylococcus,Pseudomonas, Candida and Trichophyton)

• May cause deeper bacterial tissue infection (Cellulitis), localized infection of the nail fold (Paronychia), and scarringg of the nail fold and skin.

In Growing Toenails… Complications

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In Growing Toenails

Often mild cases be treated through lifestyle Applying an antibiotic cream Soaking the foot regularly in Epson Salt warm water

Medical interventions Lifting the nail Partially removing the nail/Removing nail and tissue

In Growing Toenails… Treatment

• Wear shoes that fit properly. Shoes that you wear every day should have

plenty of room around your toes. But not be too loose.

• When trimming your toenails: Considering briefly soaking your foot in warm

water to soften the nail Use a clean, sharp nail trimmer

In Growing Toenails… Prevention

• When trimming your toenails: Trim toenails straight across the top. Do not taper

or round the corners or trim too short Do not pick or tear at the nails Keep the feet clean and dry

In growing Toenails… Prevention

In Growing Toenails… Prevention

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Common Foot Problems

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