Summer is upon us, which means more people heading outdoors for recreational activities. A common problem new runners or joggers may encounter includes a subungal hematoma. Subungal hematoma, or ‘runner’s toe’ refers to a painful condition caused by an accumulation of blood (hematoma) underneath the toenail. Hematomas may develop after acute or repetitive trauma to the nail. Those commonly affected include tennis players, rock climbers and runners due to the recurring forces imposed on the nail causing compression of the nail bed. It is a common crush type injury and may also occur when dropping a heavy object on the toes or stubbing them.

Main symptoms include dark or blackened appearance of the skin beneath the nail, along with pain.  Pain results from the pressure of the collection of blood underneath the nail.  Pain may subside after a couple of days, leaving only the discoloration of the nail bed, which may take months to resolve. The condition usually resolves over time and may be treated acutely with rest, ice, and NSAIDs.  The nail may even fall off as it grows out.  To prevent further injury or reoccurrence, consider changing shoes to ones with a wider toebox.

If pain and swelling is intense or there is pus coming from the nail, seek help from a podiatrist. Treatment options for more concerning cases of subungal hematomas include trephination. A medical professional will create holes through the top of the nail in order to relieve the pressure. Call your podiatrist today if you have questions about your subungual hematoma.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Ankle arthritis is a painful gradual process that can make daily physical activities difficult since the ankle joint provides much of the support and motion stability needed for standing, walking, and running. Arthritis commonly occurs in the ankle joint after a post-traumatic injury, but can it also occur from the gradual wear and tear of the joint or from an inflammatory process such as rheumatoid arthritis. Older patients are often believed to be more prone in developing arthritis, but in a post-traumatic injury such a rotational ankle fracture with cartilaginous damage, it can also commonly occur in younger patients especially from sports.

The symptoms of an arthritic ankle joint are swelling, warmth, and pain during motion and physical activity. There may also be increased pain in the morning or after a period of sitting and resting. Your podiatrist or doctor will ask questions about your ankle pain such as any past history of ankle injuries, will examine your ankle, and will access your gait as well as order x-rays of weight-bearing ankle views. Though there is no definitive cure for ankle arthritis, there are various conservative treatments and lifestyle modifications to manage the arthritis.

The following are non-surgical treatments that your doctor may recommend for an arthritic ankle:

• Lifestyle modifications: Rest and reduce aggravating activities (i.e. running). Staying active with low-impact activities (i.e. swimming). Weight loss may also decrease stress on the ankle joint.
• Physical therapy: Exercises to increase supportive strength and stretch the soft tissues around the ankle joint. Warm or cold compress to relax the stiffness and decrease the swelling of the ankle joint.
• Shoe wear and/or orthopedic devices: Supportive shoes and orthotics to reduce the pressure place on the ankle joint. Taking care to avoid high heels and sandals. Assistive devices such as an ankle brace, cane/walker, or an ankle-foot orthosis (AFO) may also help to stabilize and provide further support the ankle.
• Medications: Pain relievers, NSAIDs, and topical medications such as Voltaren gel, capsaicin cream, and/or Lidocaine patches.
• Injections: Corticosteroid injections to decrease the inflammation or swelling. Hyaluronic acid injections may also be done to provide lubrication for the ankle joint.

If conservative treatments are not providing any pain relief, your doctor may advise the surgical route. Based on the severity of your ankle arthritis, your doctor will decide which surgery is best to treat your arthritic condition. Some surgical options are arthroscopic debridement to clean out the ankle joint, ankle arthrodiastasis to stretch out the ankle joint, ankle arthrodesis (fushion), and total ankle replacement (arthroplasty).Call your podiatrist today to assess an effective treatment for your chronic ankle pain to relieve the painful symptoms and support long-term healthy ankle function!

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Having an accessory navicular bone, also known as a Kidner foot, is a type of enlarged or extra bone located on the navicular tuberosity of the inner midfoot. An accessory bone is generally asymptomatic in the beginning but can often cause pain and difficulty fitting into a shoe especially when the bony prominence rubs against the shoe. This is commonly seen in those with a flexible flatfoot and those who are more prone to having trauma to the area of the posterior tibial tendon, which attaches to navicular tuberosity.

Other than a bony prominence to the inside of the midfoot, your doctor or podiatrist will clinically find that the prominence is also tender to touch and that you may have pain with walking or physical activity.  Your doctor will obtain a history of any acute injuries and will conduct a foot-related physical exam as well as order foot x-rays to accurately diagnose an accessory navicular bone. Plain radiographs are necessary to help rule out a navicular fracture and to classify one out the three types of accessory navicular: Type 1 is where the accessory bone is within the posterior tibial tendon, Type 2 is an accessory bone is connected by cartilage to the navicular, and Type 3 is enlarged navicular tuberosity.

Your podiatrist may recommend conservative treatments such as a change in shoe gear, activity modification, and offloading pads to help alleviate the pain. When conservative measures have failed to manage the condition, an outpatient surgery called the Kidner procedure may be done to trim off the extra accessory navicular bone. In addition, it may be necessary to also surgically reattach the posterior tibial tendon to the navicular, which would require a longer recovery process.

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A dancer’s fracture, also known as an avulsion fracture, is a break off the base of the 5^thmetatarsal bone, which is the long bone of the midfoot that attaches to the 5^th (little) toe. This type of fracture occurs due to an inverting and twisting injury of the ankle and foot causing a small break in the bone, which is common in dancers and athletes.

Typical symptoms are pain, swelling, and bruising to the lateral aspect of the foot as well as difficulty with walking. Other associated conditions with a dancer’s fracture are sesamoiditis, ankle sprains and/or ankle instability. You should see your doctor or podiatrist immediately to best evaluate your condition through a history, physical examination, and imaging studies such as x-rays to confirm the diagnosis of a dancer’s fracture.

Some conservative treatments your doctor may advise are immobilization in a walking boot or crutches and only weight-bearing to a tolerated status. After 6 weeks of the injury, adequate bone healing should occur to transition into stiff sole shoes, but often a full recovery may require 12 weeks or more. Due to the lack of blood supply in location of a dancer’s fracture, there may be a possibility of a non-union where the bones do not heal back together. If the blood supply to the base of the 5^thmetatarsal bone is deficient or the bone fracture is displaced, then your doctor may also recommend some surgical options such as placing a compression plate, tension band, or a screw to align and stabilize the fracture site. Your podiatrist may also recommend a bone stimulator to help with the bone healing in a delayed or non-union bone. Early diagnosis and evaluation of a dancer’s fracture is critical for the proper treatment and healing of a 5^th metatarsal bone fracture so call your podiatrist today to avoid any long-term complications!

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Ankle sprains are one of the most common sport injuries but can occur in people of all ages. Ankle sprain injuries can also occur from simply losing your balance and/or taking a wrong step on an uneven surface. The cause of an ankle sprain is an abnormal twisting or rolling of the ankle joint usually from the foot being plantar flexed and inverted which places strain on the ankle ligaments. There are three grades of ankles sprains depending on the extent of the ligamentous injury: Grade I (mild sprain – overstretch ligaments), Grade II (moderate sprain- partial tear), Grade III (severe sprain – complete tear). Most ankle sprains are low-grade sprains where there is pain along the lateral outer side of the ankle and will heal with conservative treatments.

The following are conservative functional treatments that your doctor or podiatrist may recommend for a low-grade sprain:

• Treat immediately with RICE therapy (Rest, Ice, Compression, Elevate) and NSAIDS (anti-inflammatory mediations).
• Treat the first 3 weeks in an ankle brace or wrap which helps to stabilize the ankle while the ligaments are healing and will also help control the swelling.
• Work on ankle range of motion (ROM) exercise the next 3 to 6 weeks to build the ankle strength back up and prevent any adverse effects of immobilization on the cartilage, bone, and muscle.

Generally, you may return to normal activity within 6 to 12 weeks after collagen remodeling and healing has occurred. For a more severe sprain, the pain may be presented deeper within the ankle along with a “pop” sensation when the injury happened indicating a torn ligament. You should see your doctor or podiatrist to be best evaluated, as he or she will order an x-ray to rule out any broken bones. Without any radiographs, it can be difficult to differentiate a severe ankle sprain from an ankle fracture. If you are unable to bear weight and there is major swelling or bruising then this may also indicate a more serious injury such as an ankle fracture and you should seek medical attention as soon as possible.

Without proper treatment, an ankle sprain may become more severe and can cause chronic ankle instability leading to further pain and development of arthritis. So call your podiatrist today for proper rehabilitation and treatment of an ankle sprain!

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Plantar warts are small rough skin growth caused by a viral HPV (human papillomavirus) infection, which is the most common viral infection of the skin. Walking barefoot is a risk factor since the virus enters the skin often on the heels or soles of the feet through thin breaks or cuts on the feet. They often appear to be similar to other skin lesions such as small calluses or porokeratosis. However, warts differ in the clinical presentation of having no skin lines, a peppered grainy appearance, and black pinpoint deposits or bleeding when debrided. These wart lesions may also be tender when located on plantar weight bearing surfaces.  It is best to have your podiatrist diagnose and treat a plantar wart to efficiently remove the wart as self-wart removal may do more harm than good and may also reoccur.

Most plantar warts are harmless and may have spontaneous remission within a year or two. When warts are painful/spread/reoccur it is best to treat them by completely removing the wart.

The following are various treatments that your podiatrist may consider which may also require repeated treatments:

• Cryotherapy (with liquid nitrogen) at 2 and 4 week intervals. The freezing destroys the cells that contain the virus and also stimulate an immune response to fight the viral warts.
• Salicylic acid or acetic acids – a peeling medication that removes the skin layers containing the wart.
• Cantharone (Cantharidin) every 2 weeks for a total of 4 applications.
• Electrcodesiccation and curettage – this minor surgery requires local anesthetic and may also leave a scar as it involves cutting away the wart.
• CO2 laser – burns the wart off and may also cause scarring of the skin.

Remember to take preventative actions for plantar warts by avoid walking barefoot especially in public area such as the pool or shower rooms. Some warts may be treated with over-the-counter treatments but they often reoccur or do not work. If you notice that you are having these stubborn painful plantar warts, call your podiatrist today to step in the right direction of becoming wart free!

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Unlike obvious acute injuries, stress fractures have a more insidious and subtle onset. Stress fractures are small hairline cracks cause by microtrauma from overuse or repetitive normal cyclic loading on the bone. Some risk factors are a change or increase in physical activity, and even a change in shoe gear can contribute to a stress fracture. Stress fractures most often occur in the second and third metatarsal bones in the foot as these are commonly thinner and longer than the first metatarsal and so has a greater reactive force against the ground. Other common locations are the calcaneus bone in the heel and the navicular bone in the midfoot.

If stress fractures remain untreated, the condition can worsen especially during weight bearing activity so it is important to notices the signs of a stress fracture.

The followings are common symptoms to look out for in a stress fracture:

• A non-distinct, deep, and dull achy pain
• Pain relieved with rest and brought on by activity
• Tenderness at the stress fracture site
• Pain that progressively worsens
• Swelling in the affected area

Your doctor may order x-rays to help confirm the diagnosis of a stress fracture; however, it is important to note that the stress fracture may not be seen on an x-ray early on as the fracture is so thin and minute. Other imaging studies can be ordered such as an MRI or a bone scan to further help detect a stress fracture earlier as these are more sensitive than an x-ray. Some treatments your doctor may recommend are NSAIDs, rest, ice, and elevate your foot as well as discontinuing any high-impact physical activities. Your doctor may also dispense a stiff-soled shoe or a CAM boot and have you use crutches if walking is too painful. Surgery is not routine for stress fractures as conservative treatments are often sufficient with the recovery process of 6 to 8 weeks for the fracture to heal. Call your podiatrist today for your best chance of a full recovery and restart your activities pain free after a stress fracture!

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A Ganglion Cyst is a benign growth that arises from a herniated dense connective tissue from tendon sheaths or joint capsules. The cyst is a synovial sac filled with gelatinous fluid and is the most common benign soft tissue mass to occur in the foot, often on the top of the foot. The exact cause of ganglion cysts is unknown, but it is thought to be either from repetitive microtrauma, mucosal degeneration, and/or the union of small cysts due to soft tissue degeneration.

A ganglion cyst can be asymptomatic but can be associated with one or more of the following symptoms:

• Visible soft tissue lump that is firm, smooth, rounded, rubbery, and may grow other time
• Skin irritation, tingling or burning sensation especially if the cyst is on a nerve
• Difficulty wearing shoes
• Dull or achy pain

Diagnosis of a ganglion cyst is done clinically by shining a light source through the cyst and having it transilluminate. Your podiatrist may also perform an x-ray, ultrasound, MRI, or excise it and send it to pathology. Often it can resolve on it’s own through spontaneous resolution. Some various treatment options that your doctor may recommend are shoe modifications and aspiration by draining the fluid from the cyst but this option has a high recurrence rate. Surgery may also need to be done to surgically remove the cyst. Surgery has a lower recurrence rate than aspiration alone but nonetheless there is still the risk for the ganglion cyst to reoccur especially if the synovial stalk of the cyst was not completely removed.

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Tailor’s bunion, also known as a bunionette, is a bony prominence or bump on the base of the little fifth toe bone that can be painful and be difficult fitting into shoes. These little bunions are historically called tailor’s bunion due to the fact that in the past they often happened in tailors who sat cross-legged on hard surfaces for a long periods of time causing pressure on the outside aspect of the tailors’ feet.

Some symptoms of a tailor’s bunion are pain that is exacerbated by shoe gear, redness, swelling on the outside of the feet, and/or callous formation. A major risk factor is improper fitted shoe gear that is too tight and causes the fifth toe to be held in an inappropriate position.

The following are conservative treatments for Tailor’s bunions, which may involve:

• Change of shoe gear and avoid tight shoes
• Icing and NSAIDs
• Orthotics
• Padding such as bunionette pads or toe spacers
• Corticosteroid injection to reduce inflammation

Most of these treatments will help provide pain relief however when all conservative treatments have failed, your podiatrist may then recommend surgical options especially if your tailor’s bunion is more prominent. The surgery is a common procedure of removing a wedge of bone from the lateral prominent 5^th metatarsal bone bump. Call your podiatrist today to best treat your tailor’s bunion and prevent it from getting worse.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Capsulitis involves chronic inflammation of the ligaments around the base of the toe joint which composes of the metatarsal phalangeal joint capsule. Capsulitis can occur in any toe joints but most commonly affects the second toe. When the chronic inflammation is not treated, the ligaments over time can weaken causing dislocation of the toe. This is why capsulitis can also sometimes be referred to as predisolcation syndrome.

Capsulitis is a progressive painful condition that gradually worsens if left untreated so early diagnosis and treatment are important. The initial symptoms are swelling and pain at the ball of the foot near the second toe joint, and pain walking barefoot. In later stages of capsulitis, the joint ligaments weaken, leading to failure of the joint to stabilize the toe. The end stage of capsulitis is the toe crossing over as the unstable toe drifts towards the big toe.

Capsulitis is a very common condition that can occur at any age and the following are various conservative treatments for it:

• Rest and ice
• NSAIDs relieve the pain and inflammation
• Taping for the toe to stay in the correct position
• Physical therapy
• Shoe modification and orthotics

Once the second toe begins drifting to the big toe, it will unfortunately not return to the normal correct position. When this happens, your podiatrist may then advise surgical options with you. Some surgeries your podiatrist may discuss with you are to surgically repair a plantar plate tear or a synovectomy to clean out any inflamed synovial tissue around the joint. So call your podiatrist today to prevent or to correct your second toe crossing over the big toe!

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office