Foot Problems

It’s easy to take your feet for granted. Day after day they perform without a hitch until that one day when something is just not right. Sit in a busy podiatrist’s office one day and watch the people hobble in on crutches canes, splints and bandages, and you’ll quickly get the drift of this problem

Problems with the feet can be categorized in a number of ways. One category would be trauma, which would include fractures, sprains, lacerations and other soft tissue injuries. A second category would be inflammatory conditions like arthritis or gout. A third category would be mechanical problems of a non-traumatic nature like bunions, tendonitis, or flat feet. A fourth category would be vascular and nerve problems like those which occur with diabetes or peripheral artery disease, or both. A final category might be a miscellaneous category, which would include plantar warts, toe nail disorders, and calluses, as well as dermatological conditions like athlete’s foot and toe nail disorders.
Foot fractures can result from direct blows as well as crush injuries, as well as from exaggerated inward or outward turning of the foot. Anytime a foot is swollen and painful after an injury, a fracture evaluation with x-rays should be accomplished. All the bones in the foot are joined together by ligaments which are prone to strains and tears. Ligaments do not show directly on x-rays, but sometimes there is an inference of sprain or strain when the bone spaces are widened or displaced. When fractures and sprains occur, there can be injury to nerves, arteries, and other soft tissues which must be sought and treated. Foot fractures are most commonly treated with casts and splints, but open fractures and more severe ones may require surgical intervention.
The second category of foot problems is conditions of inflammation with subsequent joint dysfunction. The feet are prone to osteoarthritis, which is wear and tear arthritis, from their chronic weight-bearing function. Conce
ing rheumatoid arthritis, an auto-immune disorder, eventually nine out of ten diagnosed sufferers get the condition in their feet. It causes stiffness, pain, and swelling, and eventually leads to great difficulty walking. Other forms of arthritis that may affect the foot are gout, psoriatic arthritis, Reiter’s syndrome, and ankylosing spondylitis. Treatment of these foot disorders involves systemic specific treatments for the underlying medical problem.
A third category of painful foot problems is mechanical abnormalities of a non-traumatic nature. One such problem is a bunion. The bone at the base of the great toe begins to enlarge as the other toes deviate to the outside of the foot. This makes fitting ordinary shoes very difficult and causes painful walking. Treatment is often surgical with a bunionectomy. Other deforming abnormalities include hammer toes, claw foot, and flat feet. Treatment is often special shoes, though sometimes surgery is an option.
A fourth category is the problems seen with foot circulation abnormalities as in diabetes and peripheral artery disease. The principal manifestation is the foot ulcer which is extremely difficult to heal. The foot ulcer can enlarge or go progressively deeper, or it can lead to gangrene and amputation. The sensory nerve function is also abnormal in diabetes, so that the normal foot sensations of weight-bearing are compromised, and unrecognized damage ensues. Peripheral artery disease is treated either with vasodilating medicine, or surgical stenting or obstruction bypass to restore normal blood flow. Diabetic foot ulcers are treated with careful control of blood sugar, debridement of the wound areas, and restoration of maximal blood flow.
The fifth category is the miscellaneous foot conditions like those affecting the nails and skin. Athlete’s foot is a common condition caused by fungus growing in the skin between the toes. Because the shoed feet are moist, dark, and warm, ideal conditions for fungal growth are created. This is usually treated with antifungal creams or solutions, along with antifungal powder to dry the feet. The same conditions are true for the nails; however, the fungus may be present for years and years and require several weeks of oral antifungal treatment.
The purpose of this article is to provide an outline of common foot disorders. The ultimate message is to take care of foot problems as they arise in a timely manner so they do not get worse. Your feet are your wheels, and if they are not working as they should, you’re grounded. Be sure to discuss any foot problems you may be having with your doctor. This is especially true if your foot problems are related to chronic medical conditions like rheumatoid arthritis, diabetes, or peripheral artery disease.
John Drew Laurusonis

Doctors Medical Center

www.doctorsmedicalctr.com