Podiatry - Dallas/Ft. Worth, TX

Planters Warts

The common wart or planters wart is caused by a virus that invades the skin and makes skin cells grow at an abnormal rate. The result is a growth of small, hard cauliflower shaped lump, usually white or pink in color. Most common warts present no serious health threats and are quite painless. Some, however, can become painful because they are located in areas that are subject to pressure or constant rubbing. The unsightly warts can grow on any part of the body, although the hands, feet and palms are usually the most susceptible. In many cases, home treatment is highly successful. Clean the area and try to keep the wart dry since moisture will encourage it to grow. Apply an over the counter wart medication. If it does not disappear, you may wish to consult your physician. Doctors can surgically remove the wart with extreme heat or cold, or by scraping it away under local anesthetic. If you get a wart and are over the age of 45, or if a wart develops in the genital region, see a doctor immediately for diagnosis and treatment.

Heel Pain

The most common cause of deep pain on the bottom surface of the heel, is plantar fasciitis - inflammation of the plantar fascia. The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, from the heel to the toes. It helps to secure the arch. Long standing inflammation causes deposits of calcium at the point where the inserts into the heel bone. This results in the appearance of a bony heel spur on x-ray. The spur itself is not the source of the pain. Symptoms include sharp pain localized to the bottom and/or inside margin of the heel, often worse in the morning, and after rest, aggravated by prolonged weight bearing and ambulation, may severely limit activities, and is most common in middle-aged and overweight adults. The causes of heel pain may be excessive load on the foot from obesity, excessive flattening of the arch on weight bearing, tight plantar fascia, over pronation of the foot rolling motion including outward rotation of the heel and inward rotation of the ankle. You can do several things to help heel pain, some things are; application of ice to the heel area after prolonged activity, wear supportive shoes with a stiff heal counter and a have a good arch. A well made running or walking shoe is a good example. Stretching exercises for the calf muscles will also help stretch the plantar fascia. This should not be attempted when the heel is sore. Over the counter anti-inflammatory medications containing ibuprofen or aspirin when tolerated. A doctor may also help ease heel pain by prescribing doses of anti-inflammatory medication, inject powerful anti-inflammatory medication to calm inflammation around the painful area, apply taping and padding to relieve strain on the plantar fascia, administer physical therapy such as ultrasound or cold laser, control foot function with an orthotic, prescribe special splints to help stretch the fascia, and surgical removal of the plantar fascia and removal of the heel spur. Some other causes of heel pain may be various types of arthritis, trauma to the heel, inflammation of the tendons around the heel, Heel Neuroma which are benign tumors of the nerves around the heel, abnormality in the shape of the heel bone, foreign body in the heel such as a splinter.

Heel Spurs

A calcaneal spur is a projection of calcium into and around the muscle and ligaments of the foot where they attach to the heel bone. The spur grows on the bone, and within the flesh of the foot. The growth of the spur may take months, or years to become evident. Because of its location, the spur is a source of continuous painful ache in the heel. When you place weight on the heel, the pain can be severe enough to immobilize you. The pain of the heel spur is most evident when first standing on your feet in the morning. Pain caused by a heel spur is not the pressure of weight on the point of the spur, but of the inflammation around muscles where they attach to the heel bone. The pain doesn't increase as you walk on the spur, it decreases. The pain may be localized at first, and there will seem to be one central spot that is the root of the trouble. Continued walking and standing will soon cause the entire heel to become tender and painful. Calcaneal spurs are very painful, and treatment can give immediate relief from the pain. However, if you have problems with painful heel spurs, you should definitely see a professional for treatment.

The Diabetic Foot

It is very important to take special care of your feet when you have diabetes. Poor foot care can lead to serious problems, such as amputation. Diabetes affects your feet in two ways; nerve damage and poor blood flow. Nerve damage causes your feet to lose feeling. If this happens, a simple cut or sore can go unnoticed and lead to serious problems. It can also change the shape of your feet causing annoying pressure points resulting in blisters, sores, and foot ulcers. Poor blood flow will cause these injuries and others to heal more slowly than normal. One of the most important things you can do is to keep your blood sugar level as close to normal as possible. Follow these simple foot care steps: Check your feet everyday. Look at the tops and bottoms, use a mirror. Check for scratches cracks, cuts, blisters, ingrown toenails, corns, calluses, sores, changes in color or temperature of the foot. Wash your feet everyday with mild soap and lukewarm water which should be 90 to 95 degrees Fahrenheit. Gently dry your feet and cream tops and bottoms. Take care of your toenails, cut them straight across. If they are too thick, have them cut by a podiatrist. Take care of corns and calluses with a pumice stone. Protect your feet, do not walk barefoot. Keep your blood flowing well to your feet by exercising daily. Don't wear tight socks, garters, or too tight a shoe. Smoking decreases blood flow to the feet, try to quit of you smoke. The greatest complication of diabetes is vascular changes that lead to peripheral gangrene and diabetic peripheral neuropathy.

Arch Pain

Arch pain is a very common problem. When we are born, we inherit from our parents a certain size of foot and a certain shape of the arch. This arch may be really flat at all times or you may have a foot which has an arch when you are not standing, but when you stand on it, the arch collapses. You may also have a very normal arch or a very high arch. Arch pain is actually caused by a foot that does not function properly and it puts a strain on the muscles. This chronic strain can cause pain and fatigue in the arch because these structures are stretched beyond their normal capacity, and the result is pain. We may also get arch pain due to degenerative arthritis from many years of our arch trying to collapse. This type of arch pain is usually seen in people over the age of 30. When we are younger, our muscles in our legs and in our feet have a tendency to try to compensate and hold the foot into a better position. How do we know if our foot functions improperly? Well, some patient's feet will cause their shoes to wear out abnormally and others can see by looking down at their arch and observing that their arch does not stay in a normal position. It is easy to tell when a person with a severe flat foot has a problem because their foot is continually flat. Most patients find out that their arch is not functioning properly because they start to develop arch pain. A new shoe is quite often tried by people with arch pain and they feel comfortable for many months but as soon as the shoe starts to gradually soften up and wear out, their symptoms reappears. Patients often find out that by wearing a slightly elevated heel, that their symptoms are also reduced. If you notice one of your children is wearing their shoes out abnormally, either on the inside or outside with abnormal shoe wear, most likely this child has a foot that is not functioning properly, although they may be a symptomatic without pain. The long term effect of letting a child function in an abnormal position, is that as he/she gets older, his/her foot will have grown up and developed in an abnormal position which predisposes him/her to earlier degenerative arthritis and leg and arch pain. Children who are pronating at the arch level and have a foot that is dropping, should be treated with orthotics to hold the foot in a better position so that these soft bones can develop in a normal adult position to prevent long term problems. Adults with problems of the arch collapsing should also be treated, especially with those who have symptoms and the treatment of choice is wearing proper shoes to begin with and an orthotic device made to hold the foot in a better position to prevent arch strain. When the foot is held in a better position, it can function properly and we can usually walk without pain. Arch pain is a treatable problem and with proper treatment, your foot can be free from pain.

Corns and Calluses

Corns and calluses have two things in common. One, is that the skin around a corn or callus is just thickened normal tissue. Two, is that corns and calluses can be very painful. Corns are usually just a thickened piece of skin over a top of a toe, between toes, or at the end of toes. The main reason we have corn on our toes is that we may be wearing shoes that are too tight or too short, or we may have hammertoe deformities which cause our toes to contract back, rubbing against our shoes excessively. Corns can also be caused by small bone spurs which are causing chronic irritation against the skin as the shoe rubs over the spur, resulting in a thickened piece of skin or corn. Our shoes and socks do play a very large role in deformities of the toes, such as hammertoes, spurs, and corns. This is especially common on women who wear high heeled pointed tight shoes and pantyhose. Some people have hereditary problems in which their toes become contracted and hammered, which predisposes them to chronic irritation, pain, corns, spurs, and ulcerations. Most patients should be aware that if we were wearing more reasonable shoes, we would consistently have less pain and less corn formation on our toes. A patient wearing high heels daily with a very tight pointed toe box area would be much better off wearing a flatter shoe with a more rounded toe. If changing the shoes has done very little, then podiatrists often trim back the corns to give some temporary relief. In some patients, this can even be permanent. For those corn that are persistent, a minor surgical procedure can be performed in the office which will permanently straighten out a hammertoe deformity or remove a spur which may be causing a corn. Calluses, on the other hand, are almost always seen on the ball of the foot and they are also a thickened form of skin caused by chronic irritation from one of two things; either the patient has an abnormal amount of pressure one side of the foot, or a bone in the ball of the foot is somewhat out of place carrying more pounds per square inch than the other bones in a thickening of the skin and a callus. Most calluses can be treated very successfully by having the podiatrist trim them on a regular basis. For those calluses which are persistent, there is a procedure where the bone in the ball of the foot that is out of position, can be re-established to its normal position. This procedure can usually be performed in the office but may require the patient to wear a walking cast for three to four weeks. If you have a corn or callus, your feet can be free from pain with the proper treatment program.

Ingrown and Fungal Nails

The two most common forms of nail problems are ingrown toenails and thick fungal nails. An ingrown nail is a nail deformity in which the edges of the nail start to pinch down into the skin located on the sides of the nail causing pain and in some patients infection. The nail can simply be painful, but is considered an ingrown once it has this deformity, but does not have to be red or infected. Some nails with this deformity look red and swollen and very tender to the touch, and quite often patients have to trim out the edges of the nail every month to reduce any symptoms they may have. Most ingrown toenails are caused by our shoes and sock which we wear from a very early age, while some ingrown toenails are caused by having injured our toenail and eventually loosing the nail after this injury. As the new nail tries to grow back, it will quite often grow back at least as deformed as it's predecessor and usually takes on a more severe shape. As a child, our nails are quite soft and supple, but once we begin to wear shoes and socks, we change this soft flat nail into one which begins to curve on the sides digging into the skin at a very early age. Once we start to have sensitivity at the edges of our nails, we start cutting back at a rather sharp angle which just compounds the problem allowing the skin edges to shrink further and further up on the nail requiring that every month we begin much more aggressive with our treatment. Some patients believe that cutting a notch in the middle of the nail or by filing the nail down in the middle will give some relief, but this usually does very little to change to nail permanently. The treatment of an ingrown toenail is relatively simple today using modern chemicals and laser surgery. After the edges of the nails have been removed, a chemical is placed into the root structure of the nail to destroy it or laser is used to prevent any recurrence of this ingrown nail deformity. There is usually no pain following this treatment of ingrown nails since the skin is not actually cut and the nail is not sensitive following surgery. Most people can return to their normal activities the following day of the surgery. Fungal nails come in many sizes, shapes, and colors. A fungal nail may be slightly discolored, white to yellow, while others can be green or black. The nail can be rather thin or it can be up to one-fourth inch thick with these fungal characteristics. Fungus is found in almost all parts of the world and in all conditions, but it thrives where moisture is present. Our feet happen to sweat more than our hands and for most people this increase in moisture allows the barrier to be broken down in and the fungus thrives once it is established in our skin underneath our nails. Patients who have fungal nails should work at trying to keep their feet from sweating to cut back on the amount of moisture in the area and to treat any fungal disease of the skin to prevent contamination from the skin to the nails. The treatment of fungal nails has been improving over the last ten years because of better medication both topically and orally. Most fungal nail deformities can be treated today using modern laser techniques and new oral and topical medications. A patient with an ingrown nail deformity can be free from pain with proper treatment.

Children and Foot Problems

Fortunately, very few children are actually born with any type of severe foot disability, with the club foot deformity being the most common. While rare, club foot is an easily recognizable foot problem and with modern techniques, is correctable today. One thing to be aware of is that children inherit their parents feet. In the first three to four years, the most common complaint in children is that their legs hurt after they've been playing all day. This is caused by a foot that does not function properly, which puts a strain on the muscles in the leg which are trying to make this foot function better. After playing all day, the muscles at night can go into spasm or feel extremely fatigued and the child often wakes up at night complaining of leg pain. By simply putting this child in a special orthotic to hold it in a better position, these symptoms will improve. As the child gets older, they start to develop other symptoms, and one of the most common one in children is heel pain. This heel pain usually is seen following strenuous activities, such as soccer, football, baseball, and goes away after 12 to 14 hours of rest. The number one factor is the foot doesn't function properly. The second factor is the growth center for the heel is being strained by the activity plus the fact that the foot does not function properly. This problem is also easily treatable and controlled and will give a considerable amount of relief with a simple orthotic device. In early adolescent years, we start to see more young people with arch pain especially those that have a foot which is very flexible and seems to be flattening out or in those children who are showing a lot of unusual shoe wear. You can have a foot that does not function properly in a child and the foot can have a rather high arch. or a normal arch, or a foot that has no arch. Putting an orthotic device underneath the arch and holding the foot up will not only reduce their symptoms, but reduce the abnormal shoe wear that their shoes are showing. Children who have an arch that is abnormally flat or it looks as though it is collapsing on the inside, should be treated. The treatment is simply an orthotic device to hold the foot in a better position and allow the soft bones of the child to grow up in a better alignment to each other which will prevent severe degenerative changes in the adult. These feet should be treated even if the patient has no symptoms. Another problem seen in children not related to foot function, is one in which they start to develop warts at a very early age. By going around barefooted, they allow small viruses to penetrate the skin through thorns and cuts which slowly develop into a thickened callus type tissue. Treatment of planter warts today is highly effective and should be done to prevent enlargement of the wart of development of other warts on the foot.

Warts

Warts on the foot are almost always caused by a virus that is able to penetrate our skin, and after penetration, develops into a very sensitive thickened skin lesion. Most of the warts are actually seen on the bottom of the foot, although, we do see some on the top of the foot. The reason there are much fewer warts on the top of the foot is because we do have a tendency to go around barefoot at times. It is very easy to step on a small thorn, bark dust, a piece of glass, or a nail, which allows the entrance of this virus into our skin. It is much more difficult to get these same type pf skin penetration on the top of the foot. Sometimes warts are very difficult to diagnose since they can look like corns or calluses. It takes a trained physician to tell the difference on the bottom of the foot. Those warts that are on the bottom of the foot appear to be flat, enlarged, thickened pieces of skin which are very tender to the touch or very sensitive to being pinched. Those on the top of the foot seem to be more elevated and thickened like some skin moles and have the same appearance as the warts that we see on our fingers. Most warts are seen on either the foot or the hand and we will rarely see warts on our chest, back, or face. After we get a wart, several things can happen. The wart can start to grow in size becoming more sensitive or remaining relatively pain free. Sometimes we start to develop satellite warts around the main wart and instead of having just one wart, after four to five months, you can have 10 to 15 warts within one inch of the original wart. Warts can also spread in other ways. Occasionally, patients will have warts between the toes and by the toe with the wart on it rubbing against the next toe, over a period of months it will actually spread over to the other toe. Generally speaking, warts are not contagious to other people, but it is somewhat contagious to the patient with the wart. How do we treat warts? The warts on the bottom of the foot are probably the hardest to get rid of. The skin on the bottom of the foot is very thick which allows the wart to be very thick and protected by this heavier skin barrier. There are probably a hundred ways to treat warts including freezing of the wart, applying different types of acids to the wart, surgically removing the wart, injections of various chemicals around the base of the wart, and in the last few years, laser surgery on warts. The problem with treatment of warts is there is no sure cure for warts and there is no pill that can be taken or medicine that can be applied that will guarantee this will go away with treatment. Our feeling is that warts should be treated conservatively initially with different types of acids. Probably 50 to 70 percent of these will go away with proper treatment. For those warts that are resistant to treatment, our preference is laser surgery because it does not leave as much scar tissue on the bottom of the foot as other surgical procedures. Many physicians like to surgically remove wart tissue, but once we have made an incision on the bottom of the foot, we not only leave scar tissue from removing the wart, but there is still 20 to 30 percent chance that the wart can come back in the scar tissue. The problem is much more serious and complicated if we do have recurrence of the wart in the scar tissue. There are several over the counter products for warts which are very mild acids which when applied can remove some warts. The initial treatment with these are successful in some patients. If this fails, our recommendations are stronger chemical acids to peel off the wart and if this fails, laser surgery is the most satisfactory treatment. Treatment of warts with the proper methods can make your foot free from pain.

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