Hallux rigidus is arthritis at the base of the big toe, at the metatarsophalangeal joint. The articular cartilage covering the ends of the bone can erode due to wear and tear or trauma, resulting in stiff and painful motion at the joint. A bony spur may develop at the tops of the bone, preventing full range of motion at the joint during ambulation. The consequence is a stiff big toe, or hallux rigidus.

Hallux rigidus commonly develops in adults between the ages of 30 to 60 years. Risk factors for developing hallux rigidus include history of trauma to the area such as a fracture or hyperextension/hyperflexion injuries at the joint leading to articular damage. Other risk factors include, history or osteoarthritis, rheumatoid arthritis, or gout. Hallux rigidus may also develop due to variances in anatomy that intensify stress on the joint. Symptoms of hallux rigidus include pain with activity especially during push off. People may also experience swelling around the joint, along with a bump that may develop at the top of the joint. Stiffness may develop at the big toe joint, limiting upward and downward motion of the toe.

Your podiatrist will test the range and quality of motion at the joint and also obtain X-rays. Treatment for the condition depends on the extent of joint damage and pain. Your podiatrist may recommend NSAIDs to help reduce inflammation and control pain. Shoegear changes would include getting a stiff soled shoe with a rocker bottom. Other treatments include foot orthoses such as a carbon fiber plate or a Morton’s extension to limit movement at the joint. Your podiatrist may also offer injections at the joint for pain relief.

Depending on the extent of the damage, different surgical procedures may be discussed. A cheilectomy, is a surgery that is usually recommended when the damage is mild to moderate. A cheilectomy involves removing the bone spurs and parts of the bone to allow for joint decompression. Other surgeries that may be recommended including joint fusion or joint replacement with an implant. Call your podiatrist today if you have questions or concerns about big toe joint pain.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

A plantar fibroma may present as a small mass on the sole of the foot. Plantar fibromas are benign tumors that are found in the plantar fascial ligament of the foot. The plantar fascia is a ligament that supports the arch of your foot and connects the heel bone to the toes. Plantar fibromas may occur as a single lesion or multiple nodules. The medial and central band of the plantar fascia are frequently affected. Patients usually present with this issue in the 2^nd to 6^th decade of life. The fibromas are typically slow growing and do not grow larger than an inch in size. Most fibromas are typically asymptomatic, some may grow large enough to be painful with weightbearing and ambulation.

The cause of plantar fibromas is relatively unknown but there may be a genetic association. Fibromas are more prevalent in males. Those with systemic conditions such as, epilepsy, hypothyroidism, alcoholism, and diabetes may also have an increased incidence of plantar fibromas.

A clinical exam and X-ray would be sufficient for diagnosis, biopsies are usually not necessary. An ultrasound may also be ordered to further investigate the nodule. Your healthcare provider may order further imaging such as an MRI if they are suspicious of a more serious soft tissue mass that is possibly malignant or as a part of surgical planning. Asymptomatic fibromas may just be observed. If fibromas are painful, your podiatrist may suggest accommodative padding or insoles. The insole may have a cut out where the nodules exist to offload pressure to the area. Corticosteroid injections may also be offered to help alleviate pain and to attempt to reduce the size of the nodules. Surgery would involve removing the masses with surrounding portions of the plantar fascia. Risks of surgery include recurrence, wound complications and damage to local structures. Call your podiatrist today if you have questions or concerns about your plantar fibroma.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

A neuroma is a result of a persistent benign fibrotic enlargement of a nerve. This may occur to digital nerves, between the toes. The most common neuroma occurs at the 3^rdinterspace, known as Morton’s neuroma.  The thickening of the nerve develops as a consequence of repetitive trauma or entrapment of the nerve.

The pain from neuromas may be nonspecific including a variety of symptoms such as burning, tingling, numbness, or the sensation of a foreign object.  Pain may be elicited by shoe gear that has a narrow toe box. The pain or neuralgia is commonly unilateral. Pain may worsen to the point where a person is unable to tolerate closed toe shoes. Patients may describe feeling like they are walking on a pebble or that their sock feels bunched up under the ball of their foot.

Upon physical examination, your podiatrist may try to reproduce pain by palpating the interdigital spaces or by squeezing the foot. They also may order imaging to rule out other lesions or arthritis as a cause of pain. Treatment for the neuromas includes shoe gear changes, such as a wider toe box to prevent compression. Your podiatrist may recommend orthotics with metatarsal pads or bars to provide more space between metatarsal heads. A local anesthetic or corticosteroid injections may be offered to help reduce symptoms. Alcohol injections may be offered to chemically ablate the nerve. If conservative treatment fails, surgical excision of the neuroma may be an option. Call your podiatrist today if you have questions or concerns about neuromas.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Similar to carpal tunnel there is a lower extremity analog known as tarsal tunnel syndrome. The posterior tibial nerve courses behind the calf, through a fibrous canal known as the tarsal tunnel, near the heel, behind the medial malleolus. If inflammation occurs in the tissues adjacent to the tarsal tunnel, swelling can cause compression of the nerve, resulting in pain. Any conditions that may affect ankle swelling may cause or contribute to tarsal tunnel syndrome.  Such disorders may include, hypothyroidism, rheumatoid arthritis, heart failure and kidney failure. There are biomechanical factors involved that may contribute, such as the ankle rolling inward, stressing the nerve in the tunnel.

Tarsal tunnel syndrome can cause pain in the foot and ankle. Pain may be accompanied by tingling and burning that usually occurs to the bottom of the heel and may extend to the toes. The burning and tingling may be exacerbated or elicited with certain shoe gear, standing, or walking. Pain is usually relieved by rest, but as the condition worsens, pain may also be present even with rest.

When examining your foot, the health care provider may tap over the area of compression, eliciting possible tingling in the heel, arch, or toes. Your podiatrist may also order nerve conduction studies to determine the source or magnitude of the injury. Treatment for tarsal tunnel syndrome may include corticosteroid injections into the area for pain relief. Other treatments include strapping the foot and the use of orthotics to better position the foot to relieve pressure to the nerve. If pain persists even with treatment, surgical decompression may be necessary. Call your podiatrist today if you have questions or concerns about tarsal tunnel syndrome.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Verrucae, also known as plantar warts, are common, benign, skin lesions that are caused by Human papillomavirus (HPV) infection. They may commonly appear on the bottom of feet or around the toes. Plantar warts vary in size and shape but most commonly appear like a cauliflower growth with minute black dots. Warts may appear in a solitary fashion or in clusters.  Callused skin may grow over the warts, intensifying pain for lesions on weightbearing surfaces. These lesions are especially painful when squeezed.

The virus responsible for verrucae is thought to thrive in damp, moist settings. People may contract verrucae by walking barefoot in communal areas with warm, moist environments such as gym showers, changing rooms, or swimming pools.  There are different strains of the virus and some may develop at varying speeds.  Warts may resolve or appear spontaneously, recurring at the same or different areas. A contributing factor to the appearance of verrucae is the state of a person’s immune system.

There are many treatments for plantar warts, consult your podiatrist to inquire about the best options for you.

Treatment may include:

• Regular trimming of the callus overlying the lesion and then applying an acid-based treatment, such as salicylic acid.
• Cryotherapy- freezing the lesion with liquid nitrogen
• Needling- the extent of the verruca is pierced with a needle in an attempt to stimulate the body’s immune system
• Excisional surgery
• Laser surgery

Call your podiatrist today if you have questions or concerns about your plantar wart.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Fungal toenails, also known as onychomycosis, is the most common infection of the nail. When infected, nails become thickened, have a yellowed or whitened discoloration and may be difficult to cut. Nails may become so thickened that they are unable to be cut with traditional nail clippers. Fungal nails may be so dystrophic that they can become ingrown and become infected.

Onychomycosis is an issue more commonly seen in older individuals. Men are more likely to present with fungal nails than women, and diabetics also tend to be more susceptible to this problem. About 30-60% of fungal nails may originate from Tinea Pedis from the surrounding skin. Repeated nail trauma is a also a risk factor because trauma can lead to keratin accumulating underneath the nail, creating a moist, warm environment for the fungus to grow. Humidity and exposure also play a role in fungal infections.

There are many treatments for the care of fungal nails.  If only one or two nails are involved, nail avulsions may be appropriate to try and eradicate the infection and allow for a new healthy nail to grow back. There are multiple topical anti-fungal medications that come in cream, solution, or lacquer forms. Topical treatment is indicated for mild cases, usually when less than half the nails are affected. Depending on the severity of the condition and patient’s overall health, oral medication is also available as a form of treatment. With oral antifungals, liver tests usually must be ordered before and during the medication regiment. Your podiatrist may want to take a sample of affected nails to determine what kind of infection the nail is undergoing. Call your podiatrist today if you have questions or concerns about fungal nails and the treatment options available.

Please visit our websitefor more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

When you overuse a set of muscles, you’re likely to strain the tendons, which are soft tissue structures that connect muscle to bone.  The strain may cause a tendon’s sheath to swell or the fibers to separate and pull apart. At the beginning, pain and swelling may be intermittent and resolve quickly. If the muscle group continues to be stressed without time to recover, damage to the tendons accumulates leading to the development of tendonitis and ultimately tendonosis. Over time, the pain and swelling may limit physical activity. At first you may feel pain only during or after a workout, but eventually, as the damage accumulates, your feet may hurt when just simply walking or standing.

A common area of tendonitis is at the back of the heel, where the Achilles tendon of the calf muscle inserts into the heel. With Achilles tendonitis, pain may occur when your foot hits the ground or when the heel lifts off the ground. With insertional Achilles tendonitis, first steps may elicit an achy pain, pain may be worse when going up an incline and there may be irritation where the back of the heel makes contact with a shoe.

Treating tendonitis begins with controlling the pain and swelling. Ice and rest would be first line treatment as ice prevents swelling and reduces pain and rest allows time for tissues to heal.  If left untreated, tendonitis may predispose you to further injury such as a tendon rupture. Your podiatrist may prescribe anti-inflammatory medications, steroids or topical anti-inflammatories. Orthotics or bracing may be recommended to immobilize the area or reduce stress to the area. Your podiatrist may recommend a stretching regimen or physical therapy to help relieve tension on the tendon. If tendonitis symptoms persist, injections may be offered to reduce pain. Surgical treatment is reserved for only chronic cases but may involve debridement of the tendon itself, release of adhesions, or removal of bony spurs. Call your podiatrist today if you have questions or concerns about tendonitis.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Cramping is a common issue, yet the origins of muscle cramps are relatively unknown. Sometimes cramping is sign of somewhat benign issues such as the lack or hydration or electrolytes. Other times, cramping can be a symptom of more serious problems.

If walking leads to cramping and is accompanied by painful, aching or tired feelings in the legs and is relieved by rest, it may not be just be a simple case of cramping. Instead, it could be an instance of intermittent claudication. Intermittent claudication usually occurs in the calves but may also affect the feet, thighs, hips or buttocks. Intermittent claudication is caused by Peripheral Arterial Disease or PAD. Claudication is a manifestation of reversible ischemia induced by exercise.

As PAD develops, the distance a person can walk without experiencing symptoms may decrease. People with severe PAD may experience pain at rest.  Rest pain is usually experienced at night and intensified by leg elevation and may be reduced with positioning the leg below the heart.

There are several risk factors for PAD including diabetes, high blood pressure, high cholesterol, and tobacco usage. Additional risk factors include older age, male sex and obesity. People with mild PAD may be asymptomatic.

If you are at risk for PAD, your podiatrist may do a Doppler exam of the distal pulses, like those of your feet, if those pulses cannot be palpated. Your healthcare provider may also do some additional testing such as an ankle-brachial blood pressure index. Depending on the severity of your PAD, your podiatrist may refer you to a vascular specialist for further tests. Call your podiatrist today if you have questions or concerns about cramping or exercise induced pain of your legs and feet.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

If you are experiencing skin changes such as scaling or peeling on the bottom of your feet or in between your toes along with burning or itching sensations, you may have a form of tinea pedis. Tinea pedis, also more commonly known as “athlete’s foot,” is a fungal infection of the foot.

There are 4 forms of tinea pedis that are common and present in different patterns.

• Chronic hyperkeratotic – manifests as scaling and thickening of the soles of the feet and sides of the feet, usually not present on the tops of the feet. May be described as a moccasin type pattern and this form is most typically known as “athlete’s foot.”
• Chronic intertriginous – may present as scaling, redness or erosions of the interdigital spaces or the skin at the bottom of the toes.
• Vesiculobullous – small vesicles develop at the bottom of the feet and may combine to form a large blister or bullae.
• Acute ulcerative- is typically present in the 3^rd and 4^th interdigital spaces as macerations with scaling borders and may spread to the outside of the foot or the bottom of the arch.

Since fungus prefers warm, dark, moist environments, moisture reduction and control is key for preventing recurrence of fungal infections. Open-toed shoes and frequent sock changes are important, especially during the warmer seasons. One should be thorough when drying interdigital spaces, as moisture can get trapped in those areas and allow for the proliferation of fungi. Drying agents such as antifungal powders can be used in shoes and socks to help with humidity control.

Visit your podiatrist for a clinical evaluation if you are worried about fungal infection. Your podiatrist may recommend or prescribe topical and oral antifungals. Call your podiatrist today if you have questions or concerns about your possible tinea pedis.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

As temperatures rise, the shoes come off, and with that people may be more invested in the state of their feet. You may notice a bump on the top of your foot that you don’t remember being there before. Or, you may be noticing that a bump is increasing in size. If the lump is soft and round and located over a joint, it may be a ganglion cyst.  Ganglion cysts are benign, fluid-filled sacs that ordinarily develop over a tendon on a joint. These cysts can develop quickly or over a span of years and fluctuate in size and may or may not be painful.  People may have trouble finding shoes that are comfortable with this condition as the friction from the shoes can irritate the cyst.  If the cyst is overlying a nerve, it can cause burning, tingling, numbness sensations, or pain.

The exact cause of a ganglion cyst is unknown, but there are theories regarding their origin. One such theory is repetitive trauma to a joint or tendon. Trauma may cause the joint tissues to break down, creating small cysts that conglomerate into a larger mass.  Or, a defect in the joint capsule or tendon sheath may allow the tissue to expand outwards.

Conservative treatments for ganglion cysts include observation, shoe gear changes to accommodate the mass, and immobilization. If the mass is not painful and not affecting activity, your health care provider may ask you to monitor the size.  By immobilization with a splint or brace, limiting movement to the area may help cause a reduction in the volume of the cyst.  If the cyst is painful or the size is bothering you, your podiatrist may offer to drain it. Your doctor will numb the area with a local anesthetic and then aspirate the fluid with a needle. Aspiration may be followed up with a steroid injection for pain alleviation. This process may need to be repeated if the mass reoccurs. Surgery may be an option if the drainage is unsuccessful or if the cyst is large to point where it limits activity. The appearance of a new or growing mass may be unnerving. Call your podiatrist today if you have questions or concerns about your ganglion cyst.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office