Sesamoiditis
The sesamoid is a small bone under the ball of the foot. It can become strained in repetitive activities that place pressure on the ball of the foot or involve repeated upward flexion of the big toe. Sesamoiditis is inflammation and pain as a result of this.
Diagnosis
The diagnosis of sesamoiditis is made based on the location of the pain and on the type of activities that make it worse. There is also pain when pressure is applied to the sesamoid, especially on the inside part of the ball of the foot.
Treatment
Treatment involves primarily rest. Special footwear with a rigid sole that minimizes movement of the joint at the base of the big toe may also be prescribed. In some cases a steroid injection along the sesamoid is given.
Without Treatment
Pain may increase. In some cases the sesamoid can become fractured. In severe problems that involve the seasamoid the bone itself can be surgically removed.
Foot Ulcers
Patients with diabetes are prone to the development of foot ulcers. After years of elevated blood sugar, both nerves and small blood vessels in the feet are damaged. Patients therefore do not feel small injuries occur, and damage to the circulation predisposes people to the development of wounds that may not heal. Diabetes also affects the immune system, leading to an increase chance of infection of foot ulcers.
Diagnosis
At Chiropody Center, Dr. Sami and George are specialized in Diabetic Foot Care. Dr. Sami even travels to Al Ain (Thursdays) and Abu Dhabi (Tuesdays) to see Diabetic patients at the London Imperial College, as he is facing mostly Arab speaking patients and can explain the very serious subject in his own language. Ulcers can form on the feet of people with diabetes, usually after an injury or in places that receive constant pressure, such as the ball of the foot. Further testing can be done to assess the circulation of the foot, and to determine the extent of the loss of sensation.
Treatment
Because pain from infection or enlarging of an ulcer might not be felt, diabetic foot ulcers need to be closely monitored for progression or infection. Calluses on the foot or around the wound should also be monitored regularly and treated when necessary. In some cases, alterations can be made to footwear to promote healing. Topical medications can be applied to encourage wound healing. George Stobel is well known for his alternative ways to treat diabetic foot ulcers and many patients are still walking on both feet due to his expertise.
Without Treatment
Diabetic ulcers may become deep or infected. In cases of bone infection, long courses of intravenous antibiotics may be required. In some cases amputation of the affected toe/foot/lower leg may be necessary.
Charcot Foot
Charcot foot is a chronic foot condition that is found in conditions that cause loss of sensation in the foot, most commonly diabetes. As a result of the loss of sensation, the foot is unable to maintain its normal structure, and the bones of the foot and ankle collapse. The result is pain and inflammation. Over time, the bones and joints of the ankle can become damaged, and lead to chronic pain and ulcers on the feet.
Diagnosis
The diagnosis of Charcot foot can be made on the basis of loss of normal shape and structure of the foot and ankle. This can be seen on physical exam, and demonstrated by X-ray or MRI.
Treatment
Ideally, the treatment of Charcot foot includes treatment of the underlying condition causing the loss of sensation. During acute pain, the foot can be immobilized and anti-inflammatory medication can be taken. Measures are taken to maintain the proper shape and weight bearing of the foot and ankle.
Without Treatment
As Charcot foot progresses, chronic ulcers can develop. These are painful and can lead to infection.
Gout
Gout is painful inflammation of a joint as a result of built up of crystals within the joint. The crystals are made of uric acid, a substance that is found in many foods and usually excreted by the kidneys. People who produce too much uric acid, or whose kidneys do not excrete it enough, are predisposed to the development of gout. When the levels of uric acid in the blood are high enough, it begins to collect as crystals in joints which leads to pain and swelling. Gout most often affects the base of the big toe, but can affect any joint. It tends to recur in repeated attacks of acute inflammation.
Diagnosis
The diagnosis of gout is often suggested on the basis of the history and physical exam. A sample of joint fluid can be obtained with a needle and examined under a microscope. The urate crystals can then be seen. This is also the best way to make sure the joint is not infected, or inflamed due to another condition. A very close cooperation with an internal specialist for monitoring the uric acid levels is mandatory.
Treatment
Acute attacks of gout are treated with anti-inflammatory medications. Sometimes a steroid injection is given directly into the joint to relieve pain and swelling, or steroids are taken orally. Colchicine is a medication that can help an attack of gout resolve faster. Some patients then take a daily medication to decrease the level of uric acid in their blood to prevent attacks of gout.
Without Treatment
Repeated attacks of gout tend to last longer, and the pain may not go away entirely. Eventually the bones of the joint can be damaged, and large collections of urate crystals can accumulate under the skin and cause nodules.
Plantar Fasciitis
Plantar fasciitis is one of the most common orthopedic conditions relating to the foot. It is when the thick tissue on the bottom of the foot (the plantar fascia) becomes inflamed and irritated, making it difficult to walk. This is most often the result of repeated episodes of minor but recurring injury, such as with frequent running or long periods of standing. The pain can be located in the heel area of the foot or in the arch. It is often worse in the morning due to stiffness of the tissue, and also becomes worse after long periods of walking. The pain often decreases with rest.
Diagnosis
Your podiatrist will exam your foot for swelling, redness and tenderness of the area. X-rays may be taken.
Treatment
Initial treatment usually involves heel stretching exercises, night splints or shoe inserts. Anti-inflammatory medications may also be given. Treatment can span several months to two years before symptoms improve. Most patients will see an improvement within one year. Further treatment may include steroid injections into the sole of the foot, or in certain situations a surgical procedure that releases the plantar fascia.
Without Treatment
Foot pain can continue, and progress into a severe condition that affects the ability to walk. Eventually, permanent damage to the plantar fascia or surrounding nerves may occur.
Heel Spur
A heel spur is an extension of the heel bone that extends into the tissue directly in front of the heel. It is most often a result of chronic plantar fasciitis.
Diagnosis
A heel spur can be seen on an X-ray as an extension of bone in front of the heel.
Treatment
Treatment of a heel spur involves treatment of plantar fasciitis. It includes stretching exercises, possibly the use of a splint, or anti-inflammatory medications. In some cases a steroid injection is given directly in front of the heel. At Chiropody Center we are providing custom made orthotics to distribute the weight from the heal to the entire foot are to reduce friction casing addition inflammation.
Without Treatment
The pain due to the plantar fasciitis that causes the heel spur can become progressively more severe, in some cases damaging the tissue.
Sprains and Fractures
The foot and ankle contains a total of 26 bones. Any one of the bones can become fractured as a result of injury. Tendons are the connective tissue that connects bones to each other and holds them together. When these become strained or torn, often as a result of being hit or twisted, the result is a sprain. If a ligament is completely torn, sometime a pop is heard or felt.
Diagnosis
Fractures can be diagnosed with the use of an X-ray, or other imaging such as a CAT scan or MRI. Sprains are often diagnosed on the basis of the type of injury and where the pain and tenderness is. Sometimes an MRI can help diagnose a specific sprain.
Treatment
The initial treatment of either a sprain or a fracture includes rest, elevation and ice. It is important to keep weight off of the affected foot or ankle. In some cases a cast or splint is applied to minimize motion so that the foot or ankle can heal properly. In other cases surgery may be needed to repair a ligament or to stabilize a fracture.
Without Treatment
If the support of the foot is compromised, then permanent damage may result. If the tissues do not heal properly then pain may progress and not go away.
Shin Splints
Shin splints refers to pain along the shins, or the front of the leg between the knee and ankle. The pain is typically worse along the lower one-third of the leg. The muscle in this area controls upward movement of the foot, and the pain is caused by overuse and strain of this muscle. The most common cause of shin splints is athletic activity that involves running.
Diagnosis
Shin splints are diagnosed on the basis of the typical area involved and the type of movement that increases the pain.
Treatment
The treatment of shin splints primarily involves rest. Medications can also be used to help control pain and inflammation. Activities may need to be modified to prevent shin splints from recurring.
Without Treatment
Shin splints may become more severe and cause pain with normal walking. Progressive damage to involved muscle can occur, especially if there is swelling. Damage to the bone to which the muscle is attached, a stress fracture, can also occur
