Diabetic Limb Salvage

Achilles tendonitis is irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common injury that tends to occur in recreational athletes. Overuse of the Achilles tendon can cause inflammation that can lead to pain, swelling or rupture.

Achilles tendinosis is a common problem of the Achilles tendon that is not well understood. Unfortunately, many patients and doctors alike confuse the term Achilles tendonitis with Achilles tendinosis. Achilles tendinosis is a chronic problem that is characterized by microscopic tears of the Achilles tendon.

An Achilles tendon tear occurs when the tendon attaching the calf muscle to the heel is completely torn. This is a common injury, most often seen in middle-aged male “weekend warriors.”

Treatment of Achilles tendon problems begins with resting the tendon to allow the acute pain to settle down. In more serious situations, adequate rest, crutches, or immobilization of the ankle may be required. Learn more about different treatments for Achilles tendon problems, including ice, medications, injections, and surgery.

Arch pain is a common foot complaint. Arch pain, also sometimes called a strain, often causes inflammation and a burning sensation under the arch of the foot. Treatment of arch pain often consists of adaptive footwear and inserts.

Often, arch and ball pain is a result of overuse, improper footwear, injury or weight gain. If you experience arch pain or pain the the ball of your foot for more than a few days, see a foot doctor for treatment and prevention options.

Ankle pain is a common complaint with many causes. Determining the cause of your symptoms may be straightforward or it may require special tests to make a diagnosis. Once the cause of your ankle pain can be determined, appropriate treatment can begin.

The calf is the region of the body between the knee and the ankle in the back of the leg. Three major muscles make up the calf, these include the two gastrocnemius muscles and the soleus muscle. Causes of calf pain may include muscle injury, blood clots and cramps.

When it comes to your feet, there are several risk factors that can increase your chances of developing foot problems and diabetic infections in the legs and feet. First of all, poorly fitting shoes are one of the biggest culprits of diabetic foot complications. If you have red spots, sore spots, blisters, corns, calluses or consistent pain associated with wearing shoes, new proper fitted shoes must be obtained immediately. Additionally, if you have common foot abnormalities such as flat feet, bunions or hammertoes, prescription shoes or orthotics from your podiatrist may be necessary to further protect your feet from other damage.

People who have long-standing or poorly controlled diabetes are also at risk for having damage to the nerves in their feet, which is known in the medical community as peripheral neuropathy. If you have nerve damage, you may not be able to feel your feet normally and you may also be unable to sense the position of your feet and toes while walking and balancing, which can cause even more harm to your feet.

Normal nerves allow people to sense if their shoes are too tight or if their shoes are rubbing on the feet too much. With diabetes, you may not be able to properly sense minor injuries, such as cuts, scrapes and blisters-all signs of abnormal wear, tear and foot strain. The following can also compromise the health of your feet:

• Poor circulation
• Trauma to the foot
• Infections
• Smoking

Diabetes can be extremely dangerous to your feet, so take precautions now. You can avoid serious problems such as losing a toe, foot or leg by following proper prevention techniques offered by your podiatrist. Remember, prevention is the key to saving your feet and eliminating pain.

Flat feet are a common condition of the foot structure. In infants and toddlers, prior to walking, the longitudinal arch is not developed and flat feet are normal. Most feet are flexible and an arch appears when children begin standing on their toes. The arch continues to develop throughout childhood and by adulthood most people have developed normal arches.

Flat feet are generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).

Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle or lower leg does occur, especially in children, the feet should be evaluated.

Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.

Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing and orthotics are common treatments for painful progressive flatfoot.

Note: Please consult your physician before taking any medications. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

“Foot Deformity” is a general term for any condition that causes a structural alteration of the foot. Several common deformities are discussed below.

Club Foot

Club foot (known as talipes equinovarus) is a congenital foot deformity that is immediately identifiable at birth or via a prenatal ultrasound. The club foot is pointed downward and rotated inward. The affected foot and calf are usually smaller than the normal foot. Club foot is present in approximately one out of 2,000 live births and affects both feet in approximately 30 percent of cases.

Clubfoot is not a painful condition and in most cases is easily corrected by weekly manipulation and long leg casting. A heel cord lengthening is frequently necessary for part of the cast treatment. Children wear special shoes during the day and night after the completion of treatment. In approximately 10 percent of cases, cast treatment is unsuccessful and surgical release is necessary. Most children are able to walk normally, wear regular shoes and lead fully functional lives after successful treatment of club foot.

Metatarsus Adductus

This is a common birth defect in which a child’s feet curve inward from the mid-foot to the toes. The condition usually improves by itself. If the condition does not improve by the time a baby is three-four months old, cast treatment is required. Treatment, which usually involves applying casts or special corrective shoes, has a high rate of success.

Tibial Torsion

This is in-turning of a child’s lower leg. The condition typically improves without treatment, usually before the age of four. Surgery is only considered if the condition hasn’t correct by time the child reaches 8-10 years old.

Femoral Torsion

This is in-turning of a child’s upper leg. It becomes most apparent when a child is five-six years old and usually goes away by the time the child is nine or ten. Surgery is generally only considered if a child is older than nine and the condition is causing problems walking.

Haglund’s Deformity of the Foot

Haglund’s deformity is a bony enlargement on the back of the heel that most often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone). In Haglund’s deformity, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. The deformity is most common in young women who wear pumps.

Symptoms of foot pain cause problems under the ball of the forefoot. Foot pain in this area, often referred to as metatarsalgia, can be debilitating. Treatment of ball of the foot pain can usually be accomplished with footwear and shoe inserts.

Athlete’s foot and fungal nails are the most common fungal problems with feet. A fungus is a common mold that thrives in dark, warm moist areas. On the feet, it can grow on and between toes, as well as on soles and toenails. Fungal problems can be a result of the environment (socks, shoes, heat and humidity) or weakened immunity from such disorders as diabetes.

Chronic fungal infections are most common in adults, while acute fungal infections are seen more often in children.

Heel pain is a common complaint that can be caused by one of several conditions. Patients with heel pain often have symptoms when walking or standing for long periods. Treatment of heel pain consists of rest, shoe inserts and simple exercises to help ease the symptoms.

Pain in the area between the arch and toes, or ball of the foot, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this mid-portion of the foot. Also known as dropped metatarsal heads, metatarsalgia can cause abnormal weight distribution due to over-pronation.

Metatarsalgia occurs when one of the metatarsal joints becomes painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia also can be caused by arthritis, foot injury (from sports, a car accident, or repeated stress), hard surfaces (cement or tile floors) and specific footwear (rigid-soled work boots).

A simple change of shoes may solve the problem. In more severe cases, custom orthotics may be prescribed to alleviate the pain and prevent over-pronation.

Increased media attention has heightened awareness for the spread of infections from shared instruments and unhygienic practices in many salons. One way to avoid any exposure is to do pedicures for yourself at home. However, if you are diabetic, pedicures should be avoided.

Plantar fibromas are benign tissue tumors or growths on the plantar or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band of ligaments called the plantar fascia. The presence of the tumor can cause pain or pressure on other parts of the foot structure that can lead to other foot problems.

Nonsurgical measures used in treating plantar fibromas often fail to provide adequate relief of symptoms. At the same time, surgical correction can lead to further complications such as plantar nerve entrapment or larger and recurrent fibromas that may be worse than the original problem.

A relatively new procedure applies cryosurgery to freeze and shrink the tumors and is gaining in popularity. This short, outpatient treatment causes minimal to no postoperative pain or disability. Patients return to wearing regular shoes within 24 to 48 hours after cryosurgery.

Persistent foot odor can indicate a fungal infection or a severe case of hereditary sweating. In these cases, our practice may prescribe an anti-fungal and/or antiperspirant for the feet. Subsequently, a nail and/or skin biopsy may be necessary to rule out a fungal infection.