Conditions

A World of Advice for The Diabetic Foot

Anyone who has ever had an elevated blood sugar level is at risk for foot complications. It may be as simple as knowing that once in your life, even during pregnancy, you have had an elevated blood sugar level. If so, you are at risk and must monitor your feet.

Diet-controlled diabetics, whether diagnosed as an adult or as a child, have feet at risk for diabetic complications. The simple rule: If you have ever been told that you are at risk of developing diabetes, you need to monitor your feet closely to prevent complications.

Achilles Tendinitis

The Achilles tendon is the largest tendon in the body. It connects the upper calf muscles to the back of the heel bone. Achilles tendinitis is an injury to this tendon that causes pain in the back of the leg. Typically this injury results from inflammation of the surrounding sheath (paratenonitis), degeneration within the tendon (tendinosis), or a combination of the two.

Achilles Tendinosis

The Achilles tendon is the largest tendon in your body. It connects the upper calf muscles to the back of the heel bone. Achilles tendinosis is a condition in which the Achilles tendon degenerates and becomes inflamed. Sometimes, it may also be called Achilles tendinitis. If you have Achilles tendinosis, your tendon can swell and become painful. This condition is common in athletes, runners, and people who have calf tightness.

Acquired Adult Flatfoot Deformity

Acquired adult flatfoot deformity (AAFD) is a progressive flattening of the arch of the foot that occurs as the posterior tibial tendon wears down. It has many other names such as posterior tibial tendon dysfunction, posterior tibial tendon insufficiency and dorsolateral peritalar subluxation. This problem may progress from early stages with pain along the posterior tibial tendon to advanced deformity and arthritis throughout the hindfoot (back of the foot) and ankle.

Ankle Fracture

The ankle is made up of three bones:

  • the tibia (shin bone), which forms the inside, front, and back of the ankle
  • the fibula, which forms the outside of the ankle
  • the talus, a small bone that sits between the tibia and fibula and the heel bone

The ends of these bones are called malleoli. The tibia has a medial (inside) malleoli and a posterior malleoli. The fibula forms the lateral (outside) malleoli.

Ankle Sprain

An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral (outside) part of the ankle. There's a good chance that while playing sports as a child or stepping on an uneven surface as an adult you sprained your ankle—some 25,000 people do it every day. It can happen in the setting of an ankle fracture (i.e., when the bones of the ankle also break). Most commonly, however, it occurs in isolation.

Arthritis of the Foot and Ankle

The pain and stiffness you feel in your feet and ankles as you age could be arthritis. If left untreated, this nagging pain can get worse over time, eventually making it difficult to walk even short distances. Severe arthritis can restrict your mobility, but with proper treatment, you can minimize the pain and maximize your quality of life.

Athlete's Foot

Athlete’s foot (tinea pedis) is caused by several types of fungal organisms. It is quite common and usually easily treated. Two approaches, changing socks and shoes frequently and administering local medications, usually resolve infection.

Bunions (Hallux Rigidus)

If the joint that connects your big toe to your foot has a swollen, sore bump, you may have a bunion. More than one-third of women in America have bunions, a common deformity often blamed on wearing tight, narrow shoes and high heels. Bunions may be hereditary, but many are from wearing tight shoes, and 9 out of 10 bunions occur in women. Too-tight shoes also can cause foot problems such as corns, calluses, and hammertoes.

Charcot Arthropathy

Charcot arthropathy, also known as Charcot foot and ankle, is a syndrome in patients who have peripheral neuropathy, or loss of sensation, in the foot and ankle. Patients may experience fractures and dislocations of bones and joints with minimal or no known trauma.

Chronic Lateral Ankle Pain

Chronic lateral ankle pain is recurring pain on the outer side of the ankle that often develops after an injury such as a sprained ankle. However, several other conditions also may cause chronic ankle pain.

Claw Toe

Claw toe is a common foot deformity in which your toes bend into a claw-like position, digging down into the soles of your shoes and creating painful calluses. People often blame claw toe on wearing shoes that squeeze your toes, such as shoes that are too short or high heels. However, claw toes often are the result of nerve damage caused by diseases like diabetes or alcoholism, which can weaken the muscles in your foot. Claw toes can get worse without treatment and may become a permanent deformity over time. 

Clubfoot

Clubfoot is an abnormal inward curving of the foot. One of the most common nonmajor birth defects, clubfoot affects a child's foot and ankle, twisting the heel and toes inward. The clubfoot, calf and leg are smaller and shorter than normal. Clubfoot is not painful, the deformity is correctable, and your baby is probably otherwise normal. Approximately one in every 1,000 newborns has clubfoot. Of those, one in three have both feet affected. Two out of three clubfoot babies are boys. Clubfoot is twice as likely if the baby’s parents or their other children also have it.

Corns and Calluses

Every day, the average person spends several hours on their feet and takes several thousand steps. Walking puts pressure on your feet that's equivalent to one-and-a-half times your body weight. No wonder your feet hurt!

Custom Shoes for Diabetics

Since people with diabetes are at risk for foot problems that can lead to more serious issues, having the proper footwear is important. While some people in the early stages of the disease may be able to find their own footwear, others need shoes prescribed by a foot and ankle specialist. Click the button below to find out more about custom orthotics (shoe inserts) and other beneficial prescription footwear that a doctor can offer.

Diabetic Foot Overview

About 30 million people in the US have diabetes, according to the American Diabetes Association. A possible complication of the disease is nervous system impairment (neuropathy), which may cause you to lose feeling in your feet or hands. This means you won't know right away if there is a problem. Diabetic neuropathy affects about 60 to 70 percent of people with diabetes.

Diabetic Foot Problems

Diabetes can cause serious foot problems. These conditions include the loss of nerve function (diabetic neuropathy) and loss of circulation (peripheral vascular disease). These two conditions can lead to: 

Foot Ulcers and the Total Contact Cast

Patients with diabetes are prone to major foot problems. This is because the foot expresses many of the underlying effects of diabetes, including neuropathy, vascular disease, and diminished response to infection.

Hammertoe

A hammertoe is a deformity of the second, third, or fourth toe. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Hammertoes typically start as a flexible deformity but if left untreated could potentially develop into a fixed/rigid deformity that may require more aggressive surgery to correct.

Heel Pain

Every mile you walk puts tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop heel pain, the most common problem affecting the foot and ankle.

High Ankle Sprain

The high ankle ligaments are located above the ankle, as opposed to the more commonly injured ligaments on the outside of the ankle. These high ankle ligaments connect the tibia to the fibula. It is important to have stability between the tibia and fibula at this level because walking and running place a tremendous amount of force at this junction.

A high ankle sprain occurs when there is tearing and damage to the high ankle ligaments. These injuries are much less common than a traditional ankle sprain. 

How to Care for Your Diabetic Feet

People with diabetes are at risk for foot problems. However, building regular healthy habits, practicing proper daily care, and carefully protecting the feet can go a long way towards avoiding more serious issues, like gangrene, infection, deformity, and amputation. Click the button below for a list of important care recommendations for people with diabetes.

Ingrown Toenail

An ingrown toenail (onychocryptosis) is a common condition, usually of the big toe, where the nail cuts into the surrounding nail bed causing an infection and pain. 

Insertional Achilles Tendinitis

Insertional Achilles tendinitis is a degeneration of the fibers of the Achilles tendon directly at its insertion into the heel bone. It may be associated with inflammation of a bursa or tendon sheath in the same area. 

Intoeing

Intoeing means that the feet curve inward instead of pointing straight ahead when walking or running. If your young child has intoeing, he or she probably will outgrow the condition naturally. You don't need special shoes, stretching exercises or other treatments. By age two most children walk with their feet pointing in the direction they are heading.

Lisfranc Injury

A Lisfranc injury involves the joints and/or the ligaments of the middle of the foot. The Lisfranc ligament is a ligament of the foot that runs between two bones called the medial cuneiform and the second metatarsal. The name comes from French surgeon Jacques Lisfranc de St. Martin (1790-1847), who was the first physician to describe injuries to this ligament.

Metatarsalgia (Forefoot Pain)

Pain in the ball of your foot, the area between your arch and the toes, is called metatarsalgia (MET-ah-tar-SAL-gee-ah). The pain usually centers on one or more of the five bones (metatarsals) in this area under the toes.

Morton's Neuroma

Morton's neuroma is a thickening of the tissue that surrounds the small nerve leading to the toes. It occurs as the nerve passes under the ligament connecting metatarsal bones in the forefoot. 

Morton's neuroma most frequently develops between the third and fourth toes. It often occurs in response to irritation, trauma, or excessive pressure, and is more common in women.

Osteochondral Lesion

Osteochondral lesions, sometimes called osteochondritis dessicans or osteochondral fractures, are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. These injuries may include softening of the cartilage layers, cyst-like lesions within the bone below the cartilage, or fracture of the cartilage and bone layers. Throughout this article, these injuries will be referred to as osteochondral lesions of the talus (OLT).

Peroneal Tendinosis

The peroneal tendons run on the outside of the ankle just behind the bone called the fibula. Peroneal tendinosis is enlargement and thickening with swelling of these tendons. This usually occurs with overuse, such as a repetitive activity that irritates the tendon over long periods of time. 

Pilon Fracture

The tibia (shin bone) and the fibula are the bones of the lower leg. Pilon fractures are injuries that occur at the lower end of the tibia and involve the weightbearing surface of the ankle joint. The fibula also may be broken. These injuries were first described more than 100 years ago and remain one of the most challenging problems for orthopaedic surgeons to treat. Common causes of pilon fractures are falls from a height and car accidents.

Plantar Fasciitis

If your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis, an overuse injury that affects the sole of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

Plantar Fibroma and Plantar Fibromatosis

A plantar fibroma is a benign (non-cancerous) nodule that grows in the arch of the foot and usually appears between ages 20 and 60. It usually is slow-growing and often less than one inch in size. Some can grow faster and are considered plantar fibromatosis. A plantar fibroma or fibromatosis is a disease of the fibrous tissue that grows between the skin and the underlying fascia.

Plantar Warts

Plantar warts are a common viral skin infection on the bottom (plantar) side of your foot. About 10 percent of teenagers have plantar warts. Using a public shower or walking around a locker room in bare feet increase your risk for developing plantar warts.

Progressive Flatfoot (Posterior Tibial Tendon Dysfunction)

Tendons connect muscles to bones and stretch across joints, enabling you to bend those joints. One of the most important tendons in the lower leg is the posterior tibial tendon. This tendon starts in the calf, stretches down behind the inside of the ankle, and attaches to bones in the middle of the foot. 

Rheumatoid Arthritis of the Foot and Ankle

Rheumatoid arthritis (RA) is a systemic disease that attacks multiple joints throughout the body. About 90 percent of people with RA eventually develop symptoms related to the foot or ankle. Usually symptoms appear in the toes and forefeet first, then in the middle and back of the foot, and finally in the ankles. Other inflammatory types of arthritis that affect the foot and ankle include gout, ankylosing spondylitis, psoriatic arthritis, and Reiter's syndrome.

Sesamoid Injuries

Sesamoids are bones that develop within a tendon. The one most people are familiar with is in the kneecap, however they most commonly occur in the foot and hand. Two sesamoids, each about the size of a corn kernel, typically are found near the underside of the big toe.

Stress Fracture

A stress fracture is a small crack in a bone. These fractures most often are a result of overuse and can occur with an increase in activity. Stress fractures most commonly occur in the weight­bearing bones of the legs. When a bone is subjected to a new stress, such as a new exercise routine, it may not be prepared for the increased workload, and as a result, may develop a stress fracture.

Talus Fracture

A talus fracture is a broken ankle bone. The talus is the bone in the back of the foot that connects the leg and the foot. It joins with the two leg bones (tibia and fibula) to form the ankle joint and allows for upward and downward motion of the ankle.

The talus (ankle bone) sits within the ankle mortise or hinge, which is made up of the two leg bones, the tibia and fibula. There are three joints:

The Diabetic Foot and Risk

People with diabetes are at risk for foot issues, including the possibility of losing a leg. The risk increases when a person has diabetic neuropathy, a type of nerve damage that causes foot numbness, since problems can go unnoticed. Click the button below to learn how to reduce the risk by properly caring for diabetic feet and seeing a doctor as soon as possible if there is an issue.

Toe and Forefoot Fractures

Nearly one-fourth of all the bones in your body are in your feet, which provide you with both support and movement. A broken (fractured) bone in your forefoot (metatarsals) or in one of your toes (phalanges) often is painful but rarely disabling. Most of the time, these injuries heal without surgery. A dislocation can be mistaken for a toe fracture, therefore obtaining X-rays to ensure a correct diagnosis is important.

Toenail Fungus

Toenail fungus (onychomycosis) is an infection of the nail and sometimes surrounding tissue. It is extremely common with 20 percent of the general population and 75 percent of people over 60-years-old affected. Often, the problem is cosmetic, but many patients also experience pain. Sometimes toenail fungus can lead to more serious infections.