An ingrown toenail is a very common nail condition that causes pain, swelling, and warmth at the nail border. As the nail continues to grow into the skin, bacteria can get into the skin and lead to a soft tissue toenail infection called paronychia that results in redness, pus, and a bad odor. Once paronychia occurs, it is important to see your podiatrist as you may be prescribed oral antibiotics to rid the infection and then treat the ingrown toenail. Some risk factors of ingrown toenails are improperly trimming the nails, tight-fitting shoes, or trauma. Your doctor or podiatrist may recommend some at-home care treatment options for ingrown toenails without an active infection such as warm water foot soaks with Epsom salt and wearing proper shoe gear with plenty of room for the toes. However, home care treatments do not address the underlying problem of the ingrown nails and frequently reoccurs.

Often times, your doctor will also perform a minor toenail procedure in the office using local anesthetics to surgically remove the ingrown toenail without pain. If the ingrown nail grows back and becomes a chronic recurrent problem, your doctor may further recommend to permanently remove the offending nail at the nail border. This is called chemical matrixectomy as the nail roots and matrix are chemically destroyed. Partial nail avulsion is one of the most common toe surgeries and is very effective in resolving a painful ingrown toenail.

Your doctor or podiatrist may advise various treatment options as discussed above. So, if you are having painful ingrown toenails, call your podiatrist today to best treat them and to prevent ingrown toenails by learning how to properly trim toenails.

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

Posterior Tibial tendon dysfunction (PTTD) is a painful and progressive condition where there is an inflammation or rupture in a major tendon called the posterior tibial tendon. This tendon functions to support the arch of the foot and overtime, PTTD causes the foot to flatten. Most often PTTD occurs from overusing the tendon through physical activities such as running, walking, hiking or climbing stairs. Patients may experience symptoms of swelling, flatting of the foot, and medial arch pain especially near the insertion site of the posterior tibial tendon. The heels maybe also turn outward along with the ankles rolling inward.

The following are treatment options that may be considered by your doctor or podiatrist for PTTD:

• Orthotics or functional bracing to provide your foot with arch support
• Ice, rest, and immobilization with a below the knee cast/ CAM boot to allow the tendon to heal
• Shoe modifications to improve the arch support
• Medications such as NSAIDs to reduce the pain and inflammation
• Physical therapy

If PTTD is not treated early enough, the condition may continue to worsen and therefore it is important to see your podiatrist to correctly diagnosis and treat PTTD as soon as possible. Your foot doctor may have you perform a single or double heel rise to examine the extent of the PTTD. To also determine if the PTTD is a flexible or rigid deformity, your podiatrist may lift up your big toe while you are weight bearing to test if the medial arch can be recreated. This is called a “Hubscher maneuver.” If after failing conservative treatments as listed above and the PTTD continues to progress further, surgical treatments may be needed to best address PTTD. Your doctor or podiatrist, who is a foot and ankle surgeon, may advise various options such as tendon transfer, osteotomy of bone cuts to mold a arched foot, and/or joint fusion. So if you are suffering from painful flat feet, call your podiatrist today to diagnosis and treat PTTD in order to prevent a permanent PTTD deformity.

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

Morton’s neuroma is a painful benign fibrotic enlargement and swelling of the 3^rd common digital nerve in the foot often as a result of nerve compression or micro-trauma. This entrapment syndrome is more common in females possibly due to certain shoe gear with high heels and a small toe box. When walking, especially in these types of constrictive shoe gear, the common digital nerve becomes compressed between the adjacent metatarsal bones and against the deep transverse metatarsal ligament.

The following are common symptoms of Morton’s neuroma that patients may experience:

• Burning pain, numbness, and/or electrical cramping sensation that occasional radiates to the toes
• Sharp pain that worsen when weight bearing, barefoot walking, and/or in narrow shoe gear
• Splaying of adjacent toes to the affected interspace upon weight bearing
• The feeling of walking on a wrinkled up sock or a pebble
• Pain with palpation of the affected interspace
• Relief with shoe removal

The treatment for Morton’s neuroma may begin conservatively with simply some shoe gear modifications such as avoiding high-heeled shoes, constrictive narrow shoes, and choosing shoes with a wider toe box. Applying metatarsal padding may also help to relieve pressure proximal to the neuroma by helping spread the metatarsal heads out. A similar concept is to get custom orthotics with the metatarsal pad to help alleviate the pressure on the metatarsal heads. Other conservative treatments your podiatrist may recommend are NSAIDs, physical therapy, and activity modifications. Injections into the affected interspace with corticosteroids or sclerosing alcohol may also help alleviate the pain and shrink the neuroma down. If after a series of injections are not providing pain relief, your physician may surgically decompress the nerve or perform a neurectomy of excising out the neuroma.

Start your New Year off on the right foot and call your podiatrist today if you are experiencing symptoms of Morton’s neuroma as this is a common painful forefoot condition that can be treated.

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

Tarsal tunnel syndrome is a painful foot condition that is similar to the hand condition of carpal tunnel syndrome in that the pain occurs through a nerve entrapment. In the case of tarsal tunnel syndrome, the nerve being compressed is one of the major nerves in the foot called the posterior tibial nerve. This nerve runs through an area in the foot called the tarsal tunnel located inside the medial aspect of the ankle joint just beneath the medial malleoli bone. Patients often report pain along with an abnormal sensation behind the foot medially to the heel or plantar foot to where the arch of the foot is.

The following are other symptoms of tarsal tunnel syndrome that patients may experience:

• Burning pain
• Numbness
• Paresthesia
• Pins & needles or tingling sensation
• Discomfort worsened with standing or at night
• Relief with shoe removal

This condition may be more common in athletes such as runners or dancers especially those with over-pronated foot types. Biomechanically, overpronation causes the foot to roll in when walking which can over-stretch the posterior tibial nerve. A podiatrist will be able to do a biomechanical foot exam to determine if overpronation is the provoking cause of the tarsal tunnel syndrome. Your doctor may also order a nerve conduction test and do a clinical exam called the Tinel’s test, which involves tapping the tarsal tunnel area and eliciting the radiating pain, to confirm the diagnosis of the tarsal tunnel syndrome. Some conservative treatments your doctor may recommend is icing, resting from any aggravating activities, and/or taking NSAIDs to help with pain relief. A series of corticosteroid injections may also help alleviate the pain. If the pain continues to persist despite these conservative treatment efforts, then surgical decompression of the nerve may be indicated. The surgical procedure is called tarsal tunnel release that involves freeing the soft tissue structures to make more space for the nerve. Call your podiatrist today if you are experiencing the similar symptoms listed above to help best access and address tarsal tunnel syndrome.

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

Complex regional pain syndrome (CRPS) is a painful chronic condition in the lower extremity lasting more than six months that occasionally occurs after an injury. Although the cause of CRPS is often unknown, it is important to recognize the signs and symptoms of CRPS as the treatment is most effective when started early.

The following are various signs and symptoms of CRPS:

• Intense burning or throbbing pain in a leg or foot
• Pain occurring from a non-painful stimuli
• Sustained muscle contractions or muscle spasms causing twisting, repetitive movements, and/or rigid joints
• Sensitivity to touch or cold
• Swelling of painful area
• Changes in skin temperature, color, and texture
• Changes in hair and nail growth

The beginning signs of CRPS are most commonly pain, swelling, redness, and hypersensitivity, which may last for days to weeks. Over time, motor changes may occur along with change in skin temperature, color, and texture. Once these changes occur, the condition is often irreversible. If you experience constant, severe pain that affects your leg or foot, call your podiatrist as soon as possible to confirm the diagnosis of CRPS as early treatment is vital for this painful chronic condition. Your podiatrist may treat the condition with neurological stimulation, physical therapy, and may recommend taking medications such as vitamin C, Gabapentin, and/or corticosteroids.

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

Osteochondritis dessicans or osteochondral defect (OCD) is a lesion injury of the talus bone in which the overlying cartilage is damage. There is also increase microtrauma to the talus leading to an increase risk of arthritis in the ankle. The lack of vasculature in the cartilage further separates the cartilage and subchondral bone from the rest of the talar bone and can create a worsening condition called avascular necrosis (AVN). Ankle motion at the site of injury displaces the cartilage and subchondral bone forming a fibrous tissue over the talus and also contributes avascular necrosis of the talus. The cause of the osteochondral defect often is a result of ankle sprain or impact trauma to the ankle joint.

The following are various common treatments that may be considered by your doctor or podiatrist for an osteochondral defect:

• Conservative – rest, ice, NSAIDS, immobilization, etc.
• Physical therapy
• Ankle arthroscopy
• Excision and curettage – excising the damage cartilage and creating micro fracture to be replaced with new fibrocartilage
• Osteochondral Autograft Transplant System (OATS) – transfer of hyaline cartilage to the site of injury

These treatments generally depend on the severity of the talar osteochondral lesion. Less severe cases would only require conservative treatments with immobilization to allow the cartilage and subchrondral bone to heal. Radiographs may not be sufficient to an osteochondral defect and often times additional imaging is needed such as an MRI or a CT scan that can also help determine the severity of the osteochondral defect. Surgical options are very common to treat an osteochondral defect and often have good outcomes. If you have had a history of ankle trauma with persistent pain for at least the past 8 weeks, call your podiatrist as soon as possible to properly diagnosis and address your concerns of an osteochondral defect.

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

Haglund’s deformity, often called pump bump, is a painful bony prominence and bursitis located on the lateral posterior superior aspect of the calcaneus bone above the Achilles tendon insertion. This condition also leads to a retrocalcaneal bursitis in which a painful bursa develops in between the Achilles and superior posterior calcaneus. With a bony prominence, there is a constant and chronic irritation of the pump bump and the back of shoes. Your doctor or podiatrist will order radiographs with lateral views of the foot to confirm a positive diagnosis of a Halgund’s deformity.

The following are conservative treatments that may be considered by your doctor or podiatrist for a painful Haglund’s deformity:

• Shoe modifications – open back shoes or open heels
• Orthotics and heel lifts
• Rocker sole shoes
• NSAIDS
• Steroid injection
• Aspiration of the bursa
• Topical anti-inflammatory and capsaicin cream

If the pain does not resolve with conservative treatments, there are various surgical procedural options that your podiatrist may suggest to you. Furthermore, operative treatments are very common in resolving a painful Haglund’s deformity. Some examples include extracorporeal shock wave therapy (ECSWT), Achilles lengthening, removal of the inflamed bursa, and/or resection of the bony prominence. In general, after surgery, you will need to be in a below-the-knee cast and be non-weight bearing for about 3 to 4 weeks. When you are tired of experiencing chronic pain in the back of the heel, call your podiatrist as soon as possible for the best treatment option of a Halgund’s deformity.

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

Gout most commonly occurs in the big toe joint and is a type of metabolic and arthritic disorder in which there are elevated uric acid crystals within the joint. Uric acid is a byproduct of purines that are a part of many foods we eat, which explains why diet plays an important role in gout attacks. The clinical presentation of gout is often an appearance of a “sausage toe” with a red, hot, swollen painful joint. Gout attacks are usually sudden occurring without warning or any signs of trauma. These gouty attacks can be recurrent over the years.

The following are treatments that may be considered by your doctor or podiatrist for gout:

• Diet – stay hydrated and avoid purine-rich foods such as alcohol, seafood, and red meats
• NSAID – indomethacin or naproxen for acute gout attacks
• Colchicine – anti-inflammatory for acute gout attacks
• Allopurinol – for overproducer of uric acid and the treatment of the chronic gout
• Probenecid – for undersecreter of uric acid and the treatment of chronic gout

Gout can be a very painful intense condition that can stiffen the joints but with treatments prescribed by your doctor such as in the above list will work well to resolve the gouty attack. Those who have chronic gout may have hardened deposits of uric acid crystals in the soft tissue causing a palpable lump called tophi. When this occurs, your doctor may suggest a fluid needle aspiration to remove the tophaceous substance. Often times, your doctor will also culture the tophaceous material and view it under a polarized light microscopy to confirm the diagnosis of gout by visualizing the urate crystals.

Most people can manage and prevent future gouty flare-ups once the diagnosis of gout is made in simply modifying diet and drinking lots of water. When you experience a sudden attack of gout, call your podiatrist as soon as possible to best treat this painful condition.

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

Insertional Achilles tendinosis is when micro trauma or tears occur on the Achilles tendon from repetitive overload stress. Over time this can also lead to Achilles tendon inflammation especially where it inserts into the heel bone called the calcaneus. This is an acute or chronic condition that is associated with pain and swelling at the back of the heel or ankle region.

The following is a list of other possible signs and symptoms of insertional Achilles tendon injury:

• Achy pain on first step with redness or swelling at the back of the heel
• Sharp pain or palpation at the back of the ankle where the Achilles inserts
• An associated lump located on the heel bone with an overuse or chronic injury
• Irritation with shoe gear rubbing against the heel

This painful condition is common among athletic or work-related overuse injuries as well as repetitive friction from improper shoe gear. Your podiatrist or doctor may order radiographic imaging to determine if you have a prominent heel bone or calcaneal tuberosity called a Haglund’s deformity that is contributing to the friction and irritation to the area.

Your podiatrist may suggest to modify some activities such as avoid walking uphill or on uneven surfaces, and walking in open back shoe gear. Other alternative treatments a podiatrist may prescribe are to immobilize you in a walking boot as well as taking NSAIDS to decrease the tendon inflammation. Your doctor or podiatrist may also recommend physical therapy that focuses on stretching the calf muscles to relieve the strain on the Achilles tendon. If conservative treatments fail, then surgery may be indicated especially in chronic cases. So call your podiatrist today to diagnosis and best treat insertional Achilles tendinosis!

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

After an ankle sprain or repetitive strain on the ankle joint, lingering pain localized in the front and outside part near the ankle could be a condition called Sinus Tarsi Syndrome. This is an acute or chronic painful condition on the lateral aspect of the sinus tarsi, which is a small tunnel sitting between the talus and the calcaneus of the hindfoot, that is part of the subtalar joint. Sinus Tarsi Syndrome often includes localized pain to the sinus tarsi region, swelling, pain when weight bearing, and range of motion of the subtalar joint with inversion or eversion. Other than an ankle sprain, another risk factor of sinus tarsi syndrome is having flat feet or a very pronated foot type because of increased pressure on the sinus tarsi that can lead to soft tissue impingement in the small tunnel canal of the sinus tarsi.

The following are treatments that may be considered by your doctor or podiatrist for Sinus Tarsi Syndrome:

• Rest, icing, and decreasing any painful physical activities
• Orthotics to correct the over-pronation position of the foot
• Ankle bracing to stabilize the foot and prevent the painful subtalar range of motion
• Oral Nonsteroidal anti-inflammatory drugs (NSAIDs) – ibuprofen
• Corticosteroid Injections
• Surgery – either through open surgery or close surgery (arthroscopy) to surgically remove soft tissue plug that causes the painful sinus tarsi impingement. Another surgical option is a subtalar joint fusion.

Sinus Tarsi Syndrome can be a very debilitating condition if not treated and is therefore important to have the correct diagnosis by a podiatrist to properly address this problem. Usually conservative treatments are quite effective such as orthotics in which a podiatrist can prescribe custom orthotics to correct any abnormal foot biomechanics contributing to the painful foot condition. Although rarely indicated, surgery may be considered after all conservative treatments have been exhausted.

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