Taming Tarsal Tunnel Syndrome

Ever experience a combination of numbness and sharp, burning pain around your ankle? Did it feel similar to that crazy sensation you get when your feet fall asleep, yet more intense? If this sounds familiar, you could have been experiencing compression of either your posterior tibial or deep peroneal nerves which caused tarsal tunnel syndrome.

Tarsal tunnel syndrome is very similar to carpal tunnel syndrome. The only difference is that tarsal tunnel syndrome involves the ankle and sometimes pervades into adjacent parts of the foot. The posterior tibial nerve running along the medial aspect of the ankle is more frequently affected since it rests in a narrow canal, bundled together with an artery and vein. The neurovascular bundle is surrounded by tendons that all run behind the medial malleolus as they traverse from the lower leg down into the foot. Excessive pronation causes more pressure along this canal, and entrapment of the nerve can result. Trauma suffered from an ankle sprain may also cause compression.

Conservative treatment measures are primarily taken to relieve the pressure surrounding the nerve. An orthotic is often prescribed to relieve the pressure that may be caused by excessive pronation. Shoe gear is assessed to ensure it isn’t too tight, and consults with a neurologist may be necessary to rule out other causes of the symptoms. Surgical treatment is explorative in nature, and involves releasing the tissue surrounding the nerve.

Numbness, tingling and burning pain in your feet can also be caused by a variety of other conditions such as diabetic peripheral neuropathy, peripheral arterial disease, charcot-marie-tooth disease, hypothyroidism, chronic kidney disease, HIV, vitamin deficiency anemia, and alcoholism. While your foot-jerk reaction may be to self-diagnose the problem, it’s important to allow your podiatrist to investigate the sensations instead. We’ll go the extra mile to ensure the true underlying cause is treated!

Don't Sing the Blister Blues

Whether your feet have suffered in the past from shoes that are too tight or from increasing your running mileage, we’ve all suffered from blisters at one time or another. Bothersome and often painful, they can set you on the sidelines if not treated properly. The dilemma as Shakespeare would describe it becomes to pop, or not to pop - that is the question.

Blisters on the feet may be caused by wet friction, sunburn, frostbite, and viral or fungal infections. Most frequently caused by wet friction, they are often the result of socks or shoes rubbing against an excessively moist foot. The areas most commonly affected are the ball of the foot, sides of the heel, and tips of the toes. Blisters are easily preventable by breaking in new shoes and wearing shoes that fit. Taking precautions such as wearing sweat wicking socks and breathable shoes while engaging in sports will keep blisters at bay as well. If prone to hyperhidrosis of the feet, use of an antiperspirant such as Neat Feat will help minimize friction by keeping them dry.

Ideally, treatment of a blister is best achieved by eliminating the cause. Blisters should not be intentionally popped if it can be helped, and measures to offload the pressure by surrounding them with moleskin may alleviate some of the discomfort. Popping a blister with an unsterile object may lead to infection, and there have been cases where infected blisters have led to cellulitis. The best thing to do is to leave it alone, especially if it is a blood-filled blister since these are even more prone to infection. Should a blister burst on its own and the underlying skin is not yet healed, protect the area with some antibiotic cream and a bandage.

If you find yourself with multiple blisters on your feet with no obvious cause, it’s important to refrain from commencing a "popping palooza." Podiatrists are trained to differentiate between friction blisters and vesicles caused by fungal infections. They will nail down the cause in no time. Ultimately when it comes to blisters, the best offense is a good defense.

Tackle Troublesome Big Toe Pain

New year equals new you! This is a very general resolution. A lot of people make them, and 2010 is unique since we’ve just begun a new decade. Resolving to change our behavior in one of the areas that will improve our health in the pursuit of increased vitality and longevity is universal. Have you ever made goals in the past to lose weight, walk more, or run a certain number of races and been hindered by a big pain in the toe?

Big toe (hallux) pain can be attributed to many things such as gout, bunions, stress fractures and ingrown toenails; however, one of the most frequent causes is a condition called hallux limitus. Essentially, it is limited range of motion of the hallux characterized by pain, stiffness, an enlarged toe joint in later stages, and occasionally swelling with heightened activity levels. It’s caused by biomechanical and structural abnormalities such as a dorsiflexed first metatarsal secondary to excessive pronation and hypermobility of the first ray or a long first metatarsal relative to the second metatarsal. Muscle imbalances including a weak peroneus longus, overpowering of the tibialis anterior, and contracture of plantar fascia and intrinsic foot muscles may also contribute to decreased hallux range of motion.

Conservative treatment ranges from casting the feet for orthotics in order to minimize some of the excess of pronation to prescribing a plate fitted for shoes that may not be rigid enough to counter the hallux hypermobility. Hallux limitus left untreated may eventually progress to hallux rigidus. Hallux rigidus is characterized by an even greater restriction of motion in the hallux and is a sign of degenerative arthritis in the big toe joint. Surgical treatment to decrease the pain is often necessary when the big toe deformity has progressed to hallux rigidus. Surgical treatment options include cleaning out the joint space, implanting a joint, and fusing the first metatarsalphalangeal joint.

Runners are generally are more susceptible to developing hallux limitus since the foot endures stronger forces when pronating during running as opposed to walking. Therefore, it’s important to see your podiatrist sooner rather than later so that conservative measures can be taken to preserve the joint. Don’t let a pain in the big toe prevent you from achieving your resolutions!

Athlete's Foot Awareness

Whether you’ve added swimming to your winter cross-training routine, made a New Year resolution to start going to the gym or simply have been wearing socks more often due to the cooler weather, it is important to take measures to keep your feet from picking up this uncomfortable fungal infection.

Athlete’s foot, otherwise know as tinea pedis, is a superficial fungal infection of the skin. It most occurs more frequently in adults, targeting the web spaces between the toes and soles of the feet. The fungi thrive in warm, moist environments that may be present in socks, old running shoes, around indoor pools and in fitness center showers. Symptoms of tinea pedis include itching, redness, scaling and occasionally blisters. There are many different types of fungi that cause athlete’s foot, and superficial bacterial infections of the skin can present with identical symptoms. Therefore, it’s important to distinguish a bacterial from a fungal organism causing the skin infection prior to commencement of treatment. Below are some tips provided by the American Podiatric Medical Association for avoiding superficial skin infections of the feet.

Avoid walking barefoot; use shower shoes.
Reduce perspiration by using talcum powder.
Wear light and airy shoes.
Wear socks that keep your feet dry, and change them frequently if you perspire heavily.

Whether you describe yourself as an athlete or not, we’re all susceptible to an attack of athlete’s foot if we don’t take proper measures to keep our feet dry. If the above tips fail to prevent this fungal infection from attacking your feet, don’t hesitate to schedule an appointment with your podiatrist. They have the training to differentiate between bacterial and fungal infections with noninvasive tests and will get you on the road to recovery in no time.

The Truth About Bunions

One day as you slip on your favorite pair of dress shoes, you notice a bit of discomfort. You’ve had the shoes for years and they’ve always fit properly in the past, so you continue to wear them. Over time, as you continue to wear those shoes, the discomfort gradually turns into pain. All of a sudden you notice a bump on the side of your big toe, and the pain has become so unbearable you cannot wear your dress shoes anymore. The painful bump is a bunion.

A bunion is a deformity of the foot otherwise known as hallux abducto valgus. It presents as a bump on either the medial side of the big toe (hallux) at the first metatarsal phalangeal joint or the lateral side of the fifth toe at the fifth metatarsal phalangeal joint. The metatarsal head is subluxed medially at the joint while the big toe is deviated laterally. Retrograde forces from muscles that attach to the metatarsal and proximal phalanx in the hallux then cause the first metatarsal to drift medially.

Contrary to common belief, shoes do not cause bunions. They merely exacerbate symptoms, and it’s been suggested that those with narrow toe boxes may accelerate the bunion formation process. Bunions are primarily caused by abnormal biomechanics at the first or fifth metatarsal phalangeal joints, abnormal pronation with a hypermobile first ray. They may also occur secondarily to trauma, arthritic diseases, amputation of the second toe, neuromuscular disorders, and congenital disorders.

Treatment for correction of bunions requires outpatient surgery that may involve immobilization of the foot anywhere from four to six weeks depending on the procedure performed. At your pre-operative appointment your podiatrist will either take radiographs of your foot have you get them in advance. The results from the information obtained from the radiographs combined with a thorough biomechanical analysis of the foot, will then dictate the types of procedures best suited for correction of your bunion. You can expect your podiatrist to discuss all the treatment options with you, and together, you will develop the best treatment plan to achieve an optimal outcome.

Feel Footloose with Comfy Boots

As autumn officially comes to a close and winter creeps ever so closer, you’re probably dusting off your boots from last season if you haven’t already. Or perhaps you are pondering over whether it will be necessary to invest in some boots before an upcoming vacation over the holidays. Boots come in such a variety of styles that it may often be tricky to get a good, comfortable fit. Whether it is riding boots, snow boots, or cowboy boots that tickle your toes, there are some general guidelines you can follow to maximize the comfort of your feet.

UGG Boots. The nonconforming shape combined with lack of ample arch support can make these tough to fit. Use over-the-counter inserts to add cushioning or a Powerstep Slim Tech orthotic for arch support to customize the inside of the boot for the best fit.

Cowboy Boots. Narrowed toe boxes can often cause blisters or cramped toes. The best remedy is to avoid wearing these for long periods of time. For extra shock absorption and additional support, Superfeet inserts are designed for both men’s dress shoes and women’s dress shoes.

Snow Boots. Snow boots with good rubber soles with plenty of traction are recommended to minimize slipping on slick surfaces. To help keep your feet warm, Superfeet Wintergreen arch supports are specifically designed to trap the heat generated in the boot and release it gradually.

Riding Boots. Synthetic materials tend to trap heat and moisture. Leather is the best choice for material since it will allow airflow and help to keep the feet the dry.

As with fitting any type of shoe, it’s important to ensure each foot is measured for its correct size, and to always fit for the largest foot if their sizes differ. Boot shopping in the afternoon or evening is best since feet typically swell during the day. It’s also a good idea to wear the same type of socks you’re planning to wear with the boot when you try them on to ensure there will be enough wiggle room for your toes. Boots should not have a “break-in” period like athletic shoes; rather, they should feel comfortable when you’re walking around in the store. Whether you’re dressing up the inside of boots you currently own or are in the market for some new ones, follow the above tips and your feet will feel footloose in no time.

Information Provided by the American Podiatric Medical Association

Treat Your Feet

It’s that time of year when you should be spreading cheer, yet all you can think about is your aching feet. Your feet may ache because you choose trendy shoes over more comfortable ones, or perhaps, because you don’t give them a little rest and relaxation every now and then. Pampering your feet is not only important for overall foot health, but it can be a great stress reliever as well. Below are some pointers for your next pedicure.

Safety at the salon. Bring your own pedicure set to the salon. There’s no way to be sure they are using proper sterilization techniques between clients. We recommend the SOS Safe Salon Pedicure Kit.

~ Schedule your pedicure first thing in the morning. Foot baths are the cleanest.

~ Don’t shave your legs prior to getting a pedicure.

Smooth calluses. Soak feet in warm water for 5 minutes. When eliminating the build-up of dead skin on the heel and ball of the foot, ensure you or the pedicurist uses a pumice stone or foot file. Do not use a razor!

Trimming toenails. Use TOEnail clippers with a straight edge. Ensure the nail is cut straight across. Using other tools can increase your chances of getting ingrown toenails.

Ingrown toenails. Attempting to remove ones that are not infected can increase your chances of infection. See your podiatrist for care.

File for style. Emery boards work best for smoothing the edges of the nails. Ensure you bring your own to the salon since emery boards are porous and can carry germs.

Clean beneath the nails. Run a wooden or rubber manicure stick underneath them to remove hidden crud.

Moisturize your soles. Apply emollient-enriched lotion to maintain the proper moisture balance of your feet, or a one-step exfoliating/moisturizing cream.

Cuticle care. Use a rubber cuticle stick to push back cuticles. Do not cut them since cuticles are barriers that protect against infection.

Polish Up. Use nail polish if toenails are healthy, and remove it regularly with a non-acetone based remover. If your nails are discolored at all, this indicates a fungal infection. Do not apply nail polish if you suspect you have a fungal infection, it will seal in moisture facilitating growth of the infection.

A good foot hygiene regimen should involve regular pedicures to prevent the build up of dry skin and painful calluses. As the holidays approach and you participate in Secret Santa exchanges, why not give someone the gift of a pedicure? Or better yet, a pedicure set to take with them the next time they treat their feet!

Information Provided by the American Podiatric Medical Association