Tag Archives: deformity

Hyperkeratosis – Callus – Hard Skin

Summary

  • Painful thick skin (corns and callous) caused by pressure or friction
  • Usually on the sole of your foot or over bony lumps and joints
  • Can become blistered and form a wound if not treated

How did I get this?

  • Pressure or friction causes the skin to thicken
  • Enlarged joints or bony lumps may increase pressure
  • Tight footwear and high heels will increase pressure
  • Loose footwear will increase friction

What can I do about it?

  • Wear properly fitting shoes
  • Use a foam pads to relieve pressure
  • Use thin fleecy pads or moleskin to reduce friction
  • Gently remove excess skin with a pumice or foot file

What help can I get for this?

  • Podiatrist will help by removing the thick skin
  • Podiatrist may provide a pad to relieve pressure or friction
  • Podiatrist can provide pressure relief insoles for your shoes, and may stretch shoes for bony lumps
  • Careful Shoe fitting to ensure room for your toes and secure fit.
  • Orthopaedic surgeon can operate to reduce bony lumps.

    When will it get better?

    • Removing the thick skin often provides immediate relief
    • Padding and insoles can help prevent recurring problems

Sinus Tarsi Syndrome

Summary

  • The sinus tarsi is a small cavity located on the outside of the ankle. This cavity contains numerous anatomical structures including ligaments and joint capsule. These structures may be injured following an ankle sprain or due to the repetitive strain associated with an excessively pronated (flat) foot. When this occurs, the condition is known as sinus tarsi syndrome. Patients with sinus tarsi syndrome typically experience pain over the outside of the ankle. There may also be swelling and tenderness in the region. Symptoms are typically worse in the morning and may present as pain and stiffness that slowly improves as the patient warms up. Symptoms may also be aggravated during walking or running especially on slopes or uneven surfaces.

How did I get this?

  • Sinus tarsi syndrome usually occurs following an ankle sprain or due to the repetitive strain associated with walking or running on an excessively flat foot.

What can I do about it?

  • Rest sufficiently from any activity that increases your pain.
  • Icing and short term anti-inflammatory medication (e.g. Ibuprofen) may help to significantly reduce inflammation.
  • Elevation of the affected foot to decrease inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe an ankle brace, appropriate footwear, and orthotics, along with strengthening exercises.
  • Your doctor may prescribe a steroid injection.

When will it get better?

  • Most patients with this condition heal well with an appropriate treatment program. This can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early treatment is vital to hasten recovery and ensure an optimal outcome.

Plantar Plate tear/rupture – pain under toes

Summary

  • The plantar plate is a thick ligament on the underside of your foot, running along the first joint of each toe. Its purpose is to act like a support cable and protect the toe joints from pressure and injury, and to prevent the joint from bending upward beyond the normal range of motion. Injury to the plantar plate results to mild to severe pain and swelling under the ball of the foot, extending toward the toes (most commonly the 2nd or 3rd). One or more of your toes may be splayed or clawed. You may also have a sensation of numbness or “burning pain” in your toes, or a feeling like you’re walking on the bones of your foot.

How did I get this?

  • Injury to the plantar plate is usually caused by overuse, such as from running; obesity, which puts too much body weight on the ligament; or wearing high heeled shoes too often which locks the forefoot into a flexed position and requires the plantar plate to carry all of your body weight.

What can I do about it?

  • Icing the injured area.
  • Short term anti inflammatory medications (e.g. ibuprofen) to reduce pain and inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe strapping the toe into a downward position to align it in order to help healing, footwear modifications, orthotics.
  • Podiatrist prescribe special boot or shoe if your case is severe to keep weight completely off the ball of your foot.
  • Foot and ankle surgeon for surgical treatment when non-surgical measures fail to alleviate pain and begin to limit your lifestyle.

When will it get better?

  • Treatment for this acute condition can take time, with most patients pain free with 3-4 months. Initial symptoms improvement allows most people to return to activity within 1 month.

LISFRANC INJURY

Summary

  • Lisfranc injuries occur at the midfoot where a cluster of small bones forms an arch on top of the foot between the ankle and the toes.Lisfranc fracture-dislocations are swollen and painful with some bruising and inability to put any weight on the foot.

How did I get this?

  • Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot.Commonly occur in automobile accident victims, military personnel, runners, horseback riders, football players and participants of other contact sports, or something as simple as missing a step on a staircase.

What can I do about it?

  • Refrain from putting weight on the foot.
  • Oral anti-inflammatory medications (ibuprofen) help reduce pain and inflammation.
  • Swelling is reduced by icing the affected area and keeping the foot elevated.

What help can I get for this?

  • Podiatrist will place the affected foot in a cam walker to keep it immobile, and crutches are used to avoid putting weight on the injured foot.
  • Orthopaedic foot surgeon for possible surgical treatment to realign the joints and return the broken (fractured) bone fragments to a normal position.

When will it get better?

  • The majority of the recovery occurs in the first 6 months, but it is often a year or more before patients reach their point of maximal improvement. If the surgical treatment fails or the joint damage from the injury leads to severe arthritis, then a fusion (arthrodesis) of the Lisfranc joints may be necessary. Despite the stiffness of a fused joint most patients with successful fusion of the midfoot joints have good function of the foot.

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HAMMER TOE

Summary

  • Hammertoe is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes when the long muscles originating from the lower leg overpower the smaller muscles in the foot. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop such as pain or irritation of the affected toe when wearing shoes, a buildup of skin (on toe, between two toes, or on the ball of the foot), inflammation, redness, or a burning sensation.

How did I get this?

  • Family history, arthritis, trauma, bunions, tight footwear, and neurological conditions such as stroke or peripheral neuropathy.

What can I do about it?

  • New shoes that have soft, roomy toe boxes (should be 1cm longer than your longest toe).
  • Avoid wearing tight, narrow, high-heeled shoes.
  • Find a shoe with a deep toe box that accommodates the hammer toe.
  • Sandals may help, as long as they do not pinch or rub other areas of the foot.

What help can I get for this?

  • Podiatrist may prescribe pads designed to shield corns and calluses from irritation.
  • Podiatrist may prescribe orthotic devices placed in your shoe to help control the muscle/tendon imbalance.
  • Podiatrist may advise splints or small straps to realign the bent toe.
  • Possible surgery when the hammertoe has become more rigid and painful, or when an open sore has developed.

When will it get better?

  • This is a progressive deformity which can only be corrected with surgery. Treatment for the symptoms and appropriate footwear will help to keep you comfortable.
  • After surgery the length of the recovery period will vary, depending on the procedure or procedures performed.

Accessory Navicular

Summary

  • Accessory Navicular is a condition where the Navicular bone has developed in two pieces.
  • You have a painful lump on the inside of your foot, usually aggravated by shoes rubbing on it.
  • It can be difficult to walk far, or on uneven surfaces, and climbing stairs or ladders is a real pain.
  • Your ski boots or hiking boots are killing you.

How did I get this?

  • The accessory navicular is an extra bone in your foot, of which there can be many in addition to the 26 bones we usually expect to find there. It is thought to develop in teenage years as your skeleton hardens and finishes growing.
  • This can become painful due to irritation from footwear, unusually high levels of activity, or recent weight gain.

What can I do about it?

  • Wearing shoes that do not irritate the area is the first step. You can add padding around the area or inside your shoe. Reduce your activity so that the bone is not irritated. Lose weight to reduce the stress on the bone.

What help can I get for this?

  • A podiatrist can help with footwear advice or padding for the lump. You may also get some relief by using orthotics which are designed to reduce the stress on the bone.
  • A surgeon can remove the bone, but only after all other options have been tried. Surgery can take 9-12 months to recover fully.

When will it get better?

  • After pressure and stress are reduced on the bone you should start to feel relief quickly.
  • Continued use of appropriate footwear and padding or support should result in more prolonged improvement.

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Tarsal Coalition

Summary

  • 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. 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. Symptoms include Pain (mild to severe) when walking or standing, tired or fatigued legs, muscle spasms in the leg causing the foot to turn outward when walking, flatfoot (in one or both feet), walking with a limp, and stiffness of the foot and ankle.

How did I get this?

  • Most often, tarsal coalition occurs during foetal 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.

What can I do about it?

  • Rest from activities that cause the pain.
  • Short term nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be helpful in reducing the pain and inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe orthotic devices for distributing weight away from the joint, limiting motion at the joint and relieving pain. Footwear modification such as a stiff rocker sole may be effective.
  • Podiatrist may consider immobilization to give the affected area a rest. The foot is placed in a cam walker, and crutches may be used to avoid placing weight on the foot.
  • Your doctor may give steroid injections to reduce the inflammation and pain.
  • Foot and ankle surgeon for surgical management if symptoms are not adequately relieved with nonsurgical treatment.

When will it get better?

  • Treatment by a podiatrist may result in symptom relief within 6-8 weeks.
  • Depending upon the type and location of your surgery, a cast will be required for a period of time to protect the surgical site and prevent you from putting weight on the foot. Although it may take several months to fully recover, most patients have pain relief and improved motion after surgery.

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Stress Fracture

Summary

  • Stress Fracture occurs when excessive repetitive force is applied to a localized area of bone. Activities such as walking, running, and repeated jumping can subject the bones of the foot to large forces that often lead to microscopic cracks in the bone.

How did I get this?

  • Generally, it is repetitive stress (i.e. running, marching, sport etc.) although some bone diseases can pre-dispose to thin bones which therefore fracture more easily. In people with osteoporosis (thinning of the bone) there is an increased risk of stress fracture.

What can I do about it?

  • Rest the area and stop sporting activity.
  • Wear good fitting shoes with adequate support and cushioning.
  • Avoid high heels.
  • You can try a protective pad.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist may advise appropriate shoes, consider prescribing orthotics, consider immobilisation, and advise on surgery.

When will it get better?

  • In the majority of cases, conservative care allows the bone to heal and normal activity can then be resumed. Surgery is sometimes necessary to stabilise the fracture site which allows longer time to resume activity.

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Posterior tibial tendon dysfunction

Summary

  • Posterior tibial tendon dysfunction (PTTD) is an injury involving overstretching or rupturing of the posterior tibial tendon, leading to tendon inflammation, weakness, foot deformity and arthritis. The posterior tibial tendon extends from the deep layer of muscle at the back of your leg. It runs along the inside of your ankle and down the inside of your foot to underneath your arch. This tendon, along with some strong stabilising ligaments, is one of the major supporting structures of the foot. In PTTD, the tendon’s ability to perform that job is impaired, often resulting in a collapsed arch or ‘flat foot’. PTTD is the most common type of flat foot developed during adulthood, and is also known as adult-acquired flat foot.
  • Symptoms include pain and swelling on the inside of your ankle which grows worse with increasing activity, tenderness over the midfoot especially during activity, weakness or an inability to stand on your toes, a collapsed arch and development of a flat foot, and gradually developing pain on the outer side of your ankle.

How did I get this?

  • Often occurs in women over 50 years of age and may be due to an inherent abnormality of the tendon. But there are several other risk factors which include obesity, diabetes, hypertension, previous surgery or trauma, inflammatory diseases, and arthritis. The tendon may also become inflamed if excessive force is placed on the foot, such as when running on a banked track or road.

What can I do about it?

 

  • Rest.
  • Short term nonsteroidal anti-inflammatory drugs such as ibuprofen.

What help can I get for this?

  • Podiatrist may advise immobilization of the foot for six to eight weeks with a removable boot to prevent overuse.
  • Podiatrist may prescribe shoe inserts such as a heel wedge or arch support.
  • Podiatrist may recommend that you use a custom-made orthotic or support.
  • Foot and ankle surgeon for surgical management such as tendon repair or ankle joint fusion if conservative treatments don’t work.
  • A program of exercises and therapy to help rehabilitate the tendon and muscle following immobilization.

When will it get better?

  • The success of nonoperative treatment first requires the assessment of the flexibility of the flatfoot deformity. It is common for a patient to take 4-6 months to achieve much of their recovery and 12-18 months before they reach their point of maximal improvement after surgery.

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Posterior Heel Spur

Summary

  • Posterior heel spur occurs where the achilles tendon inserts into the back of the heel bone. If there is excessive pull at the attachment, the area can become painful. In some instances a bone spur can form at the back of the heel. There is pain directly over the bone at the back of the heel.

How did I get this?

  • Overuse particularly in sport. However, bone spurs can take many years to form without being painful.

What can I do about it?

  • Rest.
  • Ice.
  • Heel raises can help.
  • An Achilles heel protector can be of benefit.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist may advise appropriate shoes, stretching, heel raise , and possible guided injection for symptoms control.
  • Orthopaedic surgeon for surgical removal of bone spur.

When will it get better?

  • This can be a very difficult condition to treat and can take several months to settle. Whilst the treatment options can be of benefit, they will not reduce any bone spur. With surgery, it often involves a long recovery (6-12 months).

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