WHAT IS A PODIATRIST?
A podiatrist, also called a doctor of podiatric medicine, is a specialist who provides medical diagnosis and treatment of foot and ankle problems, such as bunions, heel pain, spurs, hammertoes, neuromas, ingrown toenails, warts, corns and calluses. A podiatrist also renders care of sprains, fractures, infections, and injuries of the foot, ankle and heel. In addition to undergraduate medical school training, podiatrists also attend graduate school for a doctorate degree in podiatry. Podiatrists are required to take state and national exams, as well as be licensed by the state in which they practice.
According to the American Podiatric Medical Association, there are an estimated 15,000 practicing podiatrists in the United States. Podiatrists are in demand more than ever today because of a rapidly aging population. In addition, according to the association, foot disorders are among the most widespread and neglected health problems affecting people in this country.
- Consult with patients and other physicians on how to prevent foot problems.
- Diagnose and treat tumors, ulcers, fractures, skin and nail diseases, and deformities.
- Perform surgeries to correct or remedy such problems as bunions, clawtoes, fractures, hammertoes, infections, ruptured Achilles, and other ligaments and tendons.
- Prescribe therapies and perform diagnostic procedures such as ultrasound and lab tests.
- Prescribes or fits patients with inserts called orthotics that correct walking patterns.
- Treat conditions such as: bone disorders, bunions, corns, calluses, cysts, heel spurs, infections, ingrown nails, and plantar fasciitis.
WHEN DO I NEED A PODIATRIST?
People call a doctor of podiatry for help diagnosing and treating a wide array of foot and ankle problems. Please contact our office if you experience one of the following:
- Persistent pain in your feet or ankles.
- Changes in the nails or skin on your foot.
- Severe cracking, scaling, or peeling on the heel or foot.
- Blisters on your feet.
There are signs of bacterial infection, including:
- Increased pain, swelling, redness, tenderness, or heat.
- Red streaks extending from the affected area.
- Discharge or pus from an area on the foot.
- Foot or ankle symptoms that do not improve after two weeks of treatment with a nonprescription product.
- Spreading of an infection from one area of the foot to another, such as under the nail bed, skin under the nail, the nail itself, or the surrounding skin.
- Thickening toenails that cause discomfort.
- Heel pain accompanied by a fever, redness (sometimes warmth), or numbness.
- Tingling in the heel; persistent heel pain without putting any weight or pressure on your heel.
- Pain that is not alleviated by ice or over-the-counter painkillers (such as aspirin, ibuprofen or acetaminophen).
- Diabetics with poor circulation who develop Athlete’s Foot.
WHAT ARE THE MOST COMMON FOOT PROBLEMS?
Foot and ankle problems usually fall into the following categories:
- Acquired from improper footwear, physical stress, or small mechanical changes within the foot.
- Arthritic foot problems, which typically involve one or more joint.
- Congenital foot problems, which occur at birth and are generally inherited.
- Infectious foot problems, which are caused by bacterial, viral, or fungal disorders.
- Neoplastic disorders, usually called tumors, which are the result of abnormal growth of tissue and may be benign or malignant.
- Traumatic foot problems, which are associated with foot and ankle injuries.
The top foot problems are:
Bunions – misaligned big toe joints that can become swollen and tender, causing the first joint of the big toe to slant outward, and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. Surgery is frequently performed to correct the problem.
Hammertoe – a condition, usually stemming from muscle imbalance, in which the toe is bent in a claw-like position. It occurs most frequently with the second toe, often when a bunion slants the big toe toward and under it, but any of the other three smaller toes can be affected. Selecting shoes and socks that do not cramp the toes will alleviate aggravation.
Heel spurs – growths of bone on the underside, forepart of the heel bone. Heel spurs occur when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. With proper warm-up and the use of appropriate athletic shoes, strain to the ligament can be reduced.
Ingrown nails – toenails whose corners or sides dig painfully into the skin. Ingrown toenails are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity and poor foot structure. Women are much more likely to have ingrown toenails than men. Ingrown nails can be prevented by trimming toenails straight across, selecting proper shoe style and size – not too tapered or shallow – and paying special attention to foot pain.
Neuromas – enlarged benign growths of nerves, most commonly between the third and fourth toes. They are caused by tissue rubbing against and irritating the nerves. Pressure from ill-fitting shoes or abnormal bone structure can also lead to this condition. Treatments include orthoses (shoe inserts) and/or cortisone injections, but surgical removal of the growth is sometimes necessary.
Plantar fasciitis (heel pain) – usually caused by an inflammation on the bottom of the foot. Our practice can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.
Sesamoiditis – inflammation or rupture of the two small bones (sesamoids) under the first metatarsal bones. Proper shoe selection and orthoses can help.
Shin splints – pain to either side of the leg bone, caused by muscle or tendon inflammation. It is commonly related to excessive foot pronation (collapsing arch), but may be related to a muscle imbalance between opposing muscle groups in the leg. Proper stretching and corrective orthoses (shoe inserts) for pronation can help prevent shin splints.
Stress fractures – incomplete cracks in bone caused by overuse. With complete rest, stress fractures heal quickly. Extra padding in shoes helps prevent the condition. Stress fractures left untreated may become complete fractures, which require casting and immobilization.
WHICH ARE THE DIAGNOSTIC PROCEDURES?
Computed tomography (CT) examination (also known as a CAT scan) is used in podiatry to help diagnose and treat foot or ankle problems. A CT is a kind of X-ray device that takes cross sectional images of a part of the body, giving the physician a three-dimensional image. CT scans are often superior to conventional X-rays because they can more accurately pinpoint a suspected problem. Common foot problems a CT exam can help diagnose include: arthritis, deformities, flat feet, foreign bodies, fractures, infection, and tumors.
Pregnant women, especially those in their first trimester, are advised against having a CT exam or any X-ray examination because the radiation may harm the unborn child.
X-rays help determine whether a bone has been fractured or damaged by conditions such as an infection, arthritis, or other disease.
Other reasons for conventional X-rays on your feet are to:
- Evaluate changes in the bones from infections, arthritis, or other bone disease.
- Assess whether a child’s bones are growing normally.
- Locate foreign objects (such as pieces of glass or metal) in a wound.
- Determine whether bones are properly set after treating a fracture.
- Pregnant women, especially those in their first trimester, are advised against having X-rays because the radiation may harm the unborn child.
Magnetic resonance imaging (MRI) is sophisticated diagnostic equipment used to diagnose an array of health problems or conditions, including:
- Injuries of the tendons, ligaments, or cartilage
MRIs use no radiation like conventional X-rays or CT scans. They employ large magnet and radio waves to produce three-dimensional images. MRIs are very good at portraying soft tissues and bones in your feet and ankles.
People with the following conditions may not be good candidates for a MRI:
- Conditions that requires a heart pacemaker
- Artificial heart valves
- Electronic inner ear implants
- Electronic stimulators
- Implanted pumps
- Metal fragments in eyes
- Surgical clips in the head (particularly aneurysm clips)
- Individuals with dental fillings or bridges, a replacement hip or knee, or tubal ligation clips are generally safe to have a MRI
In most cases, a full exam of the foot and ankle via MRI lasts between 60 and 90 minutes.
Ultrasound is a very effective tool for diagnosing a wide variety of foot and ankle problems, particularly soft tissue problems. Ultrasound uses sound waves on the body in a way much like radar uses sound waves. The waves hit a targeted area and are bounced back to a recording device, which produces an image. Ultrasound is a completely safe, noninvasive, and painless diagnostic procedure.
Common problems for which ultrasound may be prescribed include:
- Heel spurs or plantar fasciitis
- Injuries of the ligaments, tendons, or cartilage
- Morton’s neuroma
- Presence of foreign bodies
- Soft tissue masses
- Tarsal tunnel syndrome
- Tendonitis or tears in a tendon
WHAT ARE ORTHOTICS?
Orthotics, also known as orthoses, refers to any device inserted into a shoe, ranging from felt pads to custom-made shoe inserts that correct an abnormal or irregular, walking pattern. Sometimes called arch supports, orthotics allows people to stand, walk, and run more efficiently and comfortably. While over-the-counter orthotic are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual’s unique foot structure.
Orthotic devices come in many shapes, sizes, and materials and fall into three main categories: those designed to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.
Rigid orthotic devices are designed to control function and are used primarily for walking or dress shoes. They are often composed of a firm material, such as plastic or carbon fiber. Rigid orthotics are made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot. Rigid orthotics control motion in the two major foot joints that lie directly below the ankle joint and may improve or eliminate strains, aches, and pains in the legs, thighs, and lower back.
Soft orthotics are generally used to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. They are usually effective for diabetic, arthritic, and deformed feet. Soft orthotics are typically made up of soft, cushioned materials so that they can be worn against the sole of the foot, extending from the heel past the ball of the foot, including the toes. Like rigid orthotics, soft orthotics are also made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot.
Semi-rigid orthotics provide foot balance for walking or participating in sports. The typical semi-rigid orthotic is made up of layers of soft material, reinforced with more rigid materials. Semi-rigid orthotics are often prescribed for children to treat flatfoot and in-toeing or out-toeing disorders. These orthotics are also used to help athletes mitigate pain while they train and compete.
HOW IMPORTANT ARE SHOES?
Shoe are extreme import to avoid foot problems. Here are some things to consider:
- Avoid shoes that have seams over areas of pain, such as a bunion.
- Avoid shoes with heavy rubber soles that curl over the top of the toe area (such as seen on some running shoes), because they can catch on carpets and cause an accidental fall.
- Flat shoes (with a heel height of one inch or less) are the healthiest shoes for your feet. If you must wear a high heel, keep to a heel height of two inches or less, limit their wear to three hours at a time, and take them off coming to and from an activity.
- Laced, rather than slip-on shoes, provide a more secure fit and can better accommodate insoles, orthotic devices, and braces.
- Look for soles that are shock absorbing and skid resistant, such as rubber, rather than smooth leather.
- Shoes should be made of a soft material that has some give.
Understanding the basic construction of shoes will help you make more informed decisions and select shoes that fit your foot and needs.
Shoes are made up of five major components:
- The toe box is the tip of the shoe that provides space for the toes. Toe boxes are generally rounded, pointed, or squared and will determine the amount of space provided for the toes.
- The vamp is the upper middle part of the shoe where the laces are commonly placed. Sometimes Velcro is used instead of laces.
- The sole consists of an insole and an outsole. The insole is inside the shoe; the outsole contacts the ground. The softer the sole, the greater the shoe’s ability to absorb shock.
- The heel is the bottom part of the rear of the shoe that provides elevation. The higher the heel, the greater the pressure on the front of the foot.
- The last is the part of the shoe that curves in slightly near the arch of the foot to conform to the average foot shape. This curve enables you to tell the right shoe from the left.
The material from which a shoe is made can affect fit and comfort. Softer materials decrease the amount of pressure the shoe places on the foot. Stiff materials can cause blisters. A counter may be used to stiffen the material around the heel and give added support to the foot.