Common Foot & Ankle Problems

Neuroma (Morton’s Neuroma)

Symptoms

  • Burning/Numbing sensation
  • Cramping
  • Pebble under foot sensation
  • Massage foot
  • Radiates to toes
  • Aggravated by walking/ foot gear (heels/ tight shoes)
  • Pain relief by rest

Causes

  • Entrapment of nerve in foot as it passes between the metatarsal heads (ball of foot)
  • Entraped nerve undergoes vascular and neurological degernative changes
  • Trauma
  • Metatarsophalangeal joint deviation
  • Soft tissue lesion (ganglion/ lipoma)

Other potential causes for your foot pain

  • Interdigital Bursa
  • Capsulitis
  • Stress Fracture (Metatarsal)
  • Degenerative disk disease
  • Soft tissue tumor
  • Peripheral Neuropathy
  • Tarsal Tunnel Syndrome
  • Lesion of medial/ lateral plantar nerve
  • Freidberg’s Infarction
  • Arthrosis of metatarsophalangeal joint
  • Synovial Cyst
  • Plantar pad degeneration

Treatment

  • Goal- Decrease inflammation and remove pathologic forces
  • Injections
  • Wider Shoes
  • Tapping & Padding
  • Surgical Excision
  • Orthotics
  • Physical Therapy


Callosities (Corns and Calluses)

Causes

  • Foot deformities (bunions, hammertoes, etc)
  • Poor fitting shoes
  • Bony prominences
  • Hammertoes
  • High activity levels

Protection?

Mechanical stress–>hyperkaratosis–> increase pressure–>hyperkaratosis

Treatment

  • Symptomatic relief
  • Debridement
  • Padding
  • Footgear
  • Creams

Surgery


Paronychia

Causes

  • Disruption between the nail plate and fold
  • Aggressive manicuring
  • Ingrown nail
  • shoegear
  • Penetrating trauma

Presentation

  • Inflammation
  • Unilateral or Bilateral
  • Purulent drainage

Complications

  • Abscess formation
  • Osteomyelitis
  • Sepsis

Treatment

  • Soaks
  • Incision and Drainage
  • Nail Avulsion


Athletes Foot (Tinea Pedis)

Affects~ 15% of US population

Dermatophyte (Most common organism)

  • 3 genera (Trichophyton, Micosporum and Epidermophyton)

-Infected skin fragments

-Infects and destroys keratin

Symptoms

  • Erythema
  • pruritic
  • Scaling
  • Fissuring
  • Pain
  • Hyperkaratosis
  • Maceration

Differential Diagnosis

  • Psoriasis
  • Dyhidrotic eczema
  • Atopic dermatitis
  • Xerosis
  • Conatact dermatitis
  • Syphillis

Diagnosis

  • KOH
  • Culture

Treatment

  • Change Environmental factors
  • Foot Hygeine
  • 30-40% cure rates with washing feet b.i.d
  • OTC agents (1-2x qd x 4 wks)

-Lotrimin (clotriamazole)

-Meconazole (Monistat-Derm)

-Terbinafine (Lamisil AT)

-Tolnaftate (tinactin)

-Undecyclenic Acid (Desenex)

Recurrence very common*


 

Onychomycosis- fungal nail infection

2-13% prevalence

~ 50% diagnosed from appearance

Symptoms

  • Thick- hyperkaratotic stratum corneum

Hard- tissue hydration, previous tx, vascular status, organism

  • Maloder- trapped debris and bacteria
  • Discolored
  • Separation of nail from nail bed

Complications

  • Physical and Occupational
  • Inablitity to cut ones nail
  • Inability to wear work boots
  • Psychological State
  • Feeling less attractive
  • Embarrassment
  • Feeling of poor health

Social Complications

  • Avoidance or problems with social interactions
  • Somatic
  • Pain and discomfort from nails

Serious Complications

  • Bacterial infection

Nail bed ulceration due to the accumulation of subungal debris

Definite Diagnosis

  • KOH prep
  • PAS staining
  • Culture

-T. rubrum in nail

Age Association

  • Considered age related
  • Changes in immune system
  • Changes in skin
  • Vascular changes

-<0.5%� under 18

-15-20%�between 40-60

-30%� by age 60

Treatment

  • Presentation and severity
  • Medical condition and current medications
  • Physician and patient preference
  • Cost of therapy
  • Debridement
  • Topical

-Lack of penetration of agent into the nail

-Inconsistent penetration of drugs into target tissue

  • Oral

-Good tissue levels

-Side Effects: Skin rash (12%); GI (11%)-Nausea, diarrhea, dyspepsia, abdominal pain; Abnormal liver-function test (2.4%); Headache (3.3%)


 

Plantar Warts

Papillomas- tumors of the skin and mucosal surfaces formed by keratinocytes that have been transformed by HPV

~ 130 different kinds

most diverse virus infecting humans

Infect cornified (keratinization) stratified squamous epithelium of skin or cornified mucous membranes

  • Verruca plantaris

Transmission of Warts

  • Contact

-directly- person to person; worse if skin is macerated,

-indirectly- exposure after minor trauma (skin abrasion); common in swimming pools and communal washing area

Treatments

Therapies are based on destruction, immunostimulation, and antimitotic effect

Wart clearance requires complex and variable process of:

-Skin barrier protection

-Innate and acquired immunity

  • Physical

-surgical destruction

-electrodesiccation

  • Chemical

-cantharidin

-formaldehyde

-salicyclic Acid (different concentrations; destroys infected cells; placebo controlled study suggest a cure rate of 65%)

  • Cryotherapy

-destroys the epithelium through single or multiple freeze-thaw cycle necrosis occurs with ice formation, cellular dehydration, and ultimately, vascular stasis

-Induces local inflammation

Cure rates of 52% (aggressive) and 32% (gentle)

  • CO2 Laser- vaporizes warts

-Burn skins–>blister–> Immune response

Pulse Dye Laser (~585 nm)-emmits pulses of light absorbed by the red blood cells within the lesion; starves the lesion of blood

Excision- removes warts and cuaterizes blood vessels

Contact Sensitizers

Dinitrochlorobenze-involves an autoimmune response to a concentrated chemical

  • Dinitrochlorobenzene (DNCB)
    squaric acid dibutyl ester-allergic reactions common side effect

Intralesional Bleomycin- Causes necrosis of epidermis; body forms blisters beneath wart

Bleomyin- wart is deroofed; blister comes off with wart

-Wide range of cure rates-16-94%

Factors affecting treatment Wart success

  • Age
  • Site
  • Comorbid disease
  • Patient preference
  • Source of infection
  • Patient lifestyle


Bunion (Hallux Valgus)

Causes

  • Tight, ill fitting shoes
  • Biomechanical abnormalities
  • Crista erosion
  • Excessive Pronation
  • Arthritic conditions
  • Neuromuscular disease
  • Tibial sesamoidectomy

Clinical Symptoms

  • Painful bump on side of foot
  • Widening of forefoot
  • Pain with shoegear/ ambulation
  • Swelling
  • Redness

Treatment

  • Wider, lower-heeled shoes
  • Bunion pads
  • Ice
  • OTC analgesics
  • Patient education
  • Footwear evaluation


 Big toe Joint Arthritis (Hallux Limitus/Rigidus)

Causes

  • Trauma (including repetitive microtrauma)
  • Family history
  • Flatfeet (Excessive Pronation)
  • Female Gender
  • Long First Metatarsal
  • Short First Metatarsal
  • Family History

Clinical Symptoms

  • Decreased range of motion in the big toe joint accompanied with pain and swelling
  • Stiffness and pain with ambulation and standing; usually relieved by rest
  • Pain with shoegear/ ambulation
  • Bony bump on top of big toe joint

Treatment

  • Rigid shoe gear
  • Custom orthotics
  • Ice
  • OTC analgesics
  • Steriod Injection
  • Surgery


Hammertoes

Causes

Symptoms

  • Dorsally contracted digit
  • Corn
  • Metatarsalgia

Treatment

  • Palliation of corns and calluses
  • Padding
  • Shoegear modification
  • Arthroplasty
  • Arthrodesis
  • Joint implant


Heel Pain

Affects 1/10 people in a lifetime

Common Causes

  • Nerve entrapment
  • Fat pad atrophy
  • Calcaneal stress fracture
  • Arthritis
  • Tumors ( calcaneal or soft tissue)
  • Achilles insertional problems
  • Subchondral bursitis
  • Calcaneal periostitis
  • Plantar Fasciitis

Symptoms

  • Pian in Heel especially after taking the first few steps in the morning (Poststatic dyskinesia)
  • Dull aching pain

Risk factors

  • Athletes
  • Runners
  • Overweight
  • Prolonged standing
  • Hard surfaces
  • Going Barefoot

Treatment

  • ~ 90% respond to conservative treatment
  • Tapping and padding
  • Orthotics
  • Ice/Heat
  • Injections
  • Shockwave
  • Ionotophoresis
  • Stretching/ Physical Therapy
  • Show modification
  • Night Splint/ Casting
  • Surgery
  • Partial or total resection of the plantar fascia


Flatfeet

Causes

  • Neuromuscular
  • Flexible Flatfoot
  • Tarsal Coalition (fusion between bones in foot)
  • Posterior Tibial Tendon Tendonitis
  • Flexible Flatfoot (not relating to Posterior Tibial Tendon Dysfunction)
  • Arthritis
  • Trauma

Treatment

  • Custom molded Foot Orthotics (Inserts that goes inside shoes)
  • Braces (Richie etc.)
  • Tendon Procedures (Transpositions etc)
  • Jont Fusions
  • Osteotomies
  • Injections
  • Coalition resection

Guidelines for Proper Shoe Fit

Properly fitted shoes do not need to be broken in, but instead should be comfortable to wear right out of the box.

Shoes should be fitted on both feet during weight bearing, preferably at the end of the day when the feet are most swollen.

Allow a space of one-half inch between the end of the shoe and the longest toe. In athletic shoes, allow up to one inch. Check the width. Adequate room should be allowed across the ball of the foot. The first metatarsophalangeal (Big Toe) joint should be in the widest part of the shoe. The heel should fit snugly.

The fit over the instep should be checked. A shoe that laces allows for adjustment of this area.


 Prevention Tips

Wash your feet every day. Clean between your toes then dry your feet well, and wear clean socks, or hosiery. Dry, clean feet help stop a fungus from taking root, growing, or spreading. An extra tip: Socks made of nylon and other synthetic materials shed moisture, wicking it away faster.

Use a talcum foot powder to keep your feet clean and dry. Moisture and sweat help the infection take root and grow. Talcum powders help more than cornstarch powders.

Wear shower shoes (flip-flops) when walking in public swimming and shower areas. This helps keep you from picking up a toenail fungus infection from someone else. (Or from spreading an infection if you have one.)

Clip your toenails straight across so that the toenail does not extend beyond the tip of the toe. This will reduce the risk of breaking, cracking, or splitting the toenail.

Get manicures and pedicures only at salons and spas that sterilize their tools. This will reduce the risk of picking up a fungus from a tool that was recently used on an infected nail. You may even want to keep a set of your own tools to bring with you for the manicurist to use.

Wear comfortable shoes that fit properly and are made of materials that breathe, such as canvas, leather, or mesh materials. The less moisture that’s trapped in your shoes, the less chance a fungus has to take root, grow, and spread.

Examine packages of artificial nails and nail polishes before buying and using them. Some trap moisture under the nail and create good conditions for a fungus to grow.

Milwaukee Podiatrist

MEET OUR
PODIATRIST

Dr. Deacon is a highly-skilled physician with extensive education and experience in treating disorders of the lower extremity.

PODIATRY SERVICES

PODIATRY
SERVICES

We are a full-service podiatry health center specializing in the diagnosis, treatment, & preventive care relating to the foot & ankle.

Testimonials

"He was always very positive; he is a great doctor with wonderful communication. Dr Deacon suspected that I had a condition that went outside his expertise and encouraged me to get it checked out, his suspicion was correct, and because of him I am living a healthier happier life."

P. FERGUSON

"Dr Deacon made sure that he was open (in regards to scheduling time) and could see me around my schedule; Dr Deacon was very punctual. He had a very friendly open environment. He took the time to really get to know my medical history and me. He was open and honest with me and made me feel more like a friend then a patient. I was sad to see he moved to Milwaukee, I would recommend anyone to him."

P. MCHALE

"I really appreciate that Dr Deacon really took the time to listen to my concern, he took the time to explain the orthotics in detail and what is the best fit for me. I am a first time user for them and he really made me
comfortable in my shoes!"

M. MISTRY

"Dr. Deacon was very pleasant and always put a smile on our faces.
We loved seeing him."

B. MULLEN

"I have appreciated Dr. Deacon. He is very skilled at what he does. He cares a lot about his patients."

T. HARPER

"Dr. Deacon is the best...he knows patient care and analysis. He is personable and gives the right diagnosis."

H. HYMAN

"...Dr. Deacon is a very good doctor...you will be very lucky to have him
as your doctor."

J. HEYWOOD

"Dr Deacon is a wonderful, kind doctor and is very concerned with
about his patients."

L. HARRIER

"Dr Deacon was an excellent human being, he treated me like a patient and not an number.... He was very sensitive and had good bedside manner....I am really upset that he is gone form the clinic where I live. I have nothing but good things to say about Dr. Deacon. He's Awesome!....I love the guy. He was an excellent individual plus an excellent doctor.
He fixed my feet very well."

A. THORNE

"Dr. Deacon made the family feel comfortable, Dr. Deacon was kind."

T. ST. MARTIN

Testimonials

"He was always very positive; he is a great doctor with wonderful communication. Dr Deacon suspected that I had a condition that went outside his expertise and encouraged me to get it checked out, his suspicion was correct, and because of him I am living a healthier happier life."

P. FERGUSON

"I really appreciate that Dr Deacon really took the time to listen to my concern, he took the time to explain the orthotics in detail and what is the best fit for me. I am a first time user for them and he really made me comfortable in my shoes!"

M. MISTRY

"Dr. Deacon was very pleasant and always put a smile on our faces. We loved seeing him."

B. MULLEN

"I have appreciated Dr. Deacon. He is very skilled at what he does. He cares a lot
about his patients."

T. HARPER

"Dr. Deacon is the best...he knows patient care and analysis. He is personable and gives
the right diagnosis."

H. HYMAN

"...Dr. Deacon is a very good doctor...you will be very lucky to have him as your doctor."

J. HEYWOOD

"Dr Deacon is a wonderful, kind doctor and is very concerned with
about his patients."

L. HARRIER

"Dr Deacon was an excellent human being, he treated me like a patient and not an number.... He was very sensitive and had good bedside manner....I am really upset that he is gone form the clinic where I live. I have nothing but good things to say about Dr. Deacon. He's Awesome!....I love the guy. He was an excellent individual plus an excellent doctor. He fixed
my feet very well."

A. THORNE

SCHEDULE YOUR APPOINTMENT TODAY!

414.326.9034 | Request Appointment

SCHEDULE YOUR APPOINTMENT TODAY!

414.326.9034
Request Appointment

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