“Doctor, the ball of my foot really hurts when I walk…it is like I am stepping on a pebble.” Does this sound like something you have experienced recently? Do you sometimes feel as if you have pain in between your toes and they go numb or tingle? If so, you could have a condition known as Morton’s Neuroma.
What is Morton’s Neuroma?
Neuromas are nerve thickenings and can develop in different parts of the body. This thickening is often painful and can potentially interrupt daily living or make simple tasks difficult. Morton’s Neuroma is a typical foot neuroma occurring between the toes, most commonly between the 3rd and 4th toes, but can also occur between other toes. With Morton’s neuroma, the thickened tissue around the nerve causes much discomfort around the ball of your foot, and may sometimes feel numb. This condition is also sometimes referred to as an “entrapment neuropathy” due to the possibility of the nerve becoming compressed with daily activities.
What Causes the Neuroma to Form? Who is at Risk?
Although the exact cause remains unclear, one of the most common causes of neuroma formation is due to continually irritation, compression, or entrapment of the nerves between your toes. Individuals who wear narrow shoes, high heels, or any shoe that causes the toes to squeeze together can lead to neuroma formation. Repeated trauma or stress from certain occupations or activities can potentially lead to neuroma formation (i.e. working with ladders, running, or standing for long periods of time).
Morton’s neuroma can occur in both genders and at nearly any age. However, women are much more at risk for developing Morton’s neuroma than men. People with certain foot types and/or deformities are also more susceptible to neuroma formation. Pre-existing conditions such as bunions, hammertoes, or flat feet tend to be more at risk for developing a neuroma; this is due mainly to the changes in stability around the toe joints.
Typical Signs and Symptoms
Symptoms vary from patient to patient and can be unpredictable. However, the most common complaint given by patients with neuromas is pain in the ball of the foot and between the toes. However, the following are additional signs to watch for if you suspect Morton’s neuroma:
- Tingling and/or numbness in the ball of your foot
- Swelling in between the toes
- Feelings of stepping on a marble or pebble when walking (may or may not be painful)
- Pain when squeezing your foot and pressing in between your toes (Known as a Mulder’s sign)
When to See Your Podiatrist
If you suspect a neuroma in your feet, then it is important you see your podiatrist to get a definitive diagnosis, and begin treatment as soon as possible. Finding the correct treatment can sometimes be difficult due to the possibility of recurrence. There are several treatment options available to you depending on the severity of your pain and overall goals. The following are recommendations to help minimize or alleviate the pain felt from the neuroma:
- Make sure to wear shoes with adequate room for your toes to move – this will help minimize compression of the space between the toes and decrease entrapment of the nerves
- Wear shoes with shock-absorbing soles to help decrease the amount of pressure applied to the ball of your foot
- Rest your foot when you can to take the pressure off your foot and ice it to help dull the pain
- Non-steroidal anti-inflammatory medications may also help provide temporary relief.
If the above treatments have not been successful, more aggressive treatment may be needed to help provide pain relief and may include: orthotics, cortisone or alcohol injection therapy or surgical excision.
If you are experiencing pain between your toes and suspect a neuroma, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you to ensure you continue to maintain healthy feet.
It can be shocking news for parents when their newborn child is born with more toes than normal. When a child is born with more than 10 fingers or toes, it is known as polydactyly. Polydactyly literally means having many digits. This condition is not very common and it occurs in roughly 2 out of 1000 lives along with many patients having a positive family history of others with polydactyly. Polydactyly has been linked to having a genetic cause and has a dominant inheritance pattern, and can be recessive when associated with other conditions.
Types of Polydactyly
This condition can present in different forms ranging from a fully-functional toe (bones, nerves, and blood supply) or be a non-functioning skin tag type of toe (no bones). A classification system has been established for the different types of polydactyly based on where they are located and/or the shape of the underlying bones. The two main types of polydactyly are: preaxial and postaxial.
- Preaxial – with this type of polydactyly, there is an extra toe on the side of the big toe. Additionally, there are different types of polydactyly that involve the medial ray and include the following:
- A duplicate of the 1st digit/toe
- The big toe having three phalange bones rather than two (known as polydactyly of a triphalangeal first digit)
- Polydactyly of the 2nd digit/toe
- Polysyndactyly – this is an extra toe that is fused with another toe by skin
- Postaxial – this type is the most common and refers to the extra toe being on the side next to the little toe (or 5th digit). This type of polydactyly has additional types that include:
- Duplicated 5th metatarsal
- Having a T- or Y-shaped metatarsal bone
- Vestigial digit – this is an extra digit that does not have any bones and acts as a skin tag
How will this affect my child’s life?
In many cases, having polydactyly does not cause health problems, and many people with the extra toe can live their lives with it. However, depending on the type of polydactyly, it can be difficult to find appropriately sized shoes to fit your child, and some shoes may cause pain. There are several conservative treatment options available and include: padding, wider shoe types, and wearing shoes with extra depth. If the extra toe needs to be removed surgery can be done early in childhood.
If your child was born with an extra toe or you know someone with an extra toe that has been causing them pain, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you and learn more about your child’s condition to ensure you and your child continue to maintain healthy feet.
When going out to purchase new shoes, the color, and design of the shoe tend to be biggest factors considered before deciding to buy them. As a result, people tend to overlook the importance of shoe’s stability. Each person has unique feet and some shoe types are more appropriate for their feet than others. Choosing the appropriate shoe type with proper stability is a very important decision for your foot health and can help improve the quality of your walking ability.
Basic Types of Shoes
There are basic shoe types categorized for the type of foot they are meant to help. The following list are the basic categories:
Neutral Shoes – These shoes are primarily intended for people who have high arch feet and/or have lack of shock absorption when they walk
Stability Shoes – These shoes are used for people with normal arch feet and have mild pronation when walking depending on the patient’s weight. These shoes control small amounts of pronation and are not intended for individuals with severe flat feet
Stability Plus Shoes – These shoes are primarily used for people who have normal arch feet as well as a lower arch with a moderate level of foot pronation
Motion Control Shoes – This shoe type is intended for people who have normal and lower arch feet and is used to help maintain maximum control over people who over-pronate when they walk (flat foot).
Quickly Assessing Shoe Stability
After your podiatrist recommends the appropriate shoe type for you, having knowledge in assessing shoe stability before purchasing them is beneficial for your foot health. The following are basic rules to help you quickly and properly assess their stability:
Take note at where your shoe bends – The bend should be at the ball of the foot
Check the firmness of the heel counter – The heel counter is the back of the shoe where the back of your heel rests and the level of firmness determines its stability. If the heel counter is not firm, it acts more like a cushion, rather than stable heel counter.
How much torque the shoe has – By twisting the shoe, you can check the torque of the shoe. A decrease in the torque increases how much stability it has and an increase in the shoe torque will reduce the shoe stability
Shank Rigidity – The shank of a shoe is part of the midsole and serves to provide cushion and stability for the shoe under the arch. The shank provides shoe stability by making the middle portion of the shoe more resistant to flexion and torque. Even though the different shanks add weight to the shoe, it is helps the shoe bend at the toes, rather than the arch.
If you do not know your foot type or what shoes are best recommended for your feet, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your options presented to you and ensure you are walking in the shoes best for your foot health.
Summer is approaching fast, children will soon be out of school, and ready to engage in summer sports, and other fun activities. These young, active individuals are prone to minor injuries, but can sometimes develop more painful conditions, and is important for parents/guardians to watch for in their kids. One such condition is known as Sever’s disease and causes pain or discomfort in the heel of the foot.
What is Sever’s Disease?
Sever’s disease, also known as calcaneal apophysitis, is a condition resulting from inflammation of the growth plate in the heel bone (calcaneus). This condition is commonly seen in children because they are still growing, the growth plates are not closed, and can be susceptible to inflammation and injury when used excessively. Since bones tend to grow faster than its attached muscles, these muscles can tighten up. This is mainly due to the Achilles tendon since it attaches to the back of heel near the growth plate. As a result, it makes the heel bone less flexible than it should be. So, when your children engage in activities such as sports or other weight-bearing activities, it can put an increased amount of pressure on the back of the heel bone, and cause injury to the growth plates.
Common Signs and Symptoms seen in Sever’s Disease
· Complaints of pain in one or both heel bones – it may be painful when standing or painful to the touch
· Swelling and redness around the heel
· Painful when walking or when heel is squeezed
· Unusual limping or walking on tiptoes
Who is at Risk?
Sever’s disease commonly affects children who are between 8-14 year of age and typically occurs during the growth spurt of adolescence. This condition is rarely seen in older teens or adults because the heel bone is done growing in the teenage years, and the growth plate eventually hardens, and becomes bone.
Other conditions can also increase the risk Sever’s disease. These can include:
· Obesity – This puts additional pressure on the growth plate, causing heel pain
· Having high or flat arches – Either of these types of arches alter the angle of the heel bone and will cause tightness of the Achilles tendon, resulting in heel pain
· Flat Feet – When standing or walking on a flat foot, the ankle rolls in an undesired manner, and causes tightness of the Achilles tendon, which results in heel pain.
How do I Treat it?
The first goal in treatment is to relieve the pain since the pain usually worsens with an increase in activity. So, making sure your child receives rest is important in reducing the pressure on the heel. It is also important to minimize the amount of activities or change the activity type (swimming, music, art, etc.) performed by the child to help reduce the pain and pressure on the heel. Performing leg and foot stretches will also help strengthen the leg muscles and minimize the heel pain. If there is any additional swelling, then icing the foot, and wrapping it can help decrease the swelling.
If your child is consistently complaining of heel pain, it could be a case of Sever’s disease. Please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you and your child to ensure they continue to happily engage in their recreational activities without pain.
You are walking down the street one day and feel as if you are stepping on a pebble. However, when you go to remove your shoe, you notice there are no rocks in there. You keep walking and still feel as if you are walking pebbles. Finally, you decide to take off your sock and notice what look like several calluses on the bottom of your foot, but with black dots – you could have a case of plantar warts.
About Plantar Warts
Plantar warts (verruca plantaris) are skin lesions occurring on the bottom of your feet and are caused by specific strains of the human papilloma virus (HPV) from viral entry through small cuts, or other breaks in your feet. These particular warts considered to be an epidermal lesion (only of the superficial later of skin) and are common to find in areas of the foot where pressure and friction are increased (i.e. heel, ball of the foot). As a result, these warts can become tender and painful to walk on. Plantar warts have unique features to help distinguish it from other foot ailments such as:
Tiny black dots (commonly called “wart seeds”), indicating a small, clotted blood supply – these could cause a small amount of bleeding
Well-defined edges around the wart – your normal skin lines will not appear on the wart, but instead be moved aside
More than one wart in the same region of your foot or in multiple areas
The wart(s) may have the appearance of a cauliflower vegetable or present as a mosaic pattern
The wart(s) could be more tender when you push it on the sides rather than directly on the top
At-Risk Groups and Treatment Options
People of all age groups can develop plantar warts but are most commonly seen in children and teenagers, people who have previously had plantar warts, and people with weakened immune systems.
Finding the right treatment for your plantar warts can be a challenge due to chance of recurrence of the warts. However, there are a large number of treatments options available to those who have plantar warts, ranging from at-home treatments to laser or surgical excision depending on the needs of the patient.
When to See Your Podiatrist
When you or your family members have warts and desire to have them removed
It becomes painful to walk or you notice bleeding, redness, and swelling
The warts reappear after previous treatments have not worked
If you or your family members think you might have plantar warts, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all of your treatment options presented to you to ensure you continue to maintain happy, healthy feet.
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