Services

At Pennsylvania Foot and Ankle Associates, we use the most advanced technology and podiatric treatment methodologies to provide an exceptional level of care to our patients. Our surgeons and staff members are highly experienced in treating pain in the foot and a wide range of foot and ankle conditions. Below, we have compiled a list of some of the more common foot and ankle conditions we diagnose and treat in our offices for your convenience.

We also offer medical pedicures, Keryflex treatments, and laser treatments for pain and fungus in the Northeast Philadelphia, Yardley, and New Hope.

Foot Conditions and Treatments for Pain in the Foot

Achilles Tendon

The Achilles tendon is the largest tendon in the human body and it can withstand forces of 1,000 pounds or more. But, despite its high-tensile strength, it is also the most frequently ruptured tendon. When the Achilles tendon becomes inflamed or overused, the result is a painful condition that’s known as Achilles tendonitis and it is something that both professional and weekend athletes can suffer from.

What Causes Achilles Tendonitis?
Achilles tendonitis is a chronic injury that can be brought on by a wide range of physical activities and habits, but it is mostly a result of either a lack of flexibility in one’s calf muscles or simple overuse of the tendon.

When the calf muscle loses its flexibility, the Achilles tendon naturally shortens and thereby the tension in the tendon is increased. Overuse of the tendon is usually attributed to frequently running up hills or stairs, increasing one’s training mileage, or performing a lot of speed running.

Signs and Symptoms of Achilles Tendonitis
In most cases, the Achilles tendon will give the patient advanced warning that this injury may be starting to develop. Early warning signs include a gradual onset of pain in the back of the ankle just above the heel, which can occur at any time but usually after running.

The pain increases during exercise and tenderness and stiffness in the area can be experienced in the morning upon waking, with the symptoms gradually easing up as the tendon stretches and warms up. Other symptoms include a sluggish feeling in the leg and in some cases, mild to severe swelling of the area.

In chronic conditions, small lumps or bumps may be felt when running your hand over the Achilles tendon.

How is Achilles Tendonitis Diagnosed?
The foot and ankle surgeon examines the foot for pain, tenderness, and swelling in the affected area. The flexibility, range of motion, alignment, and reflexes of the foot and ankle are also evaluated. In some cases, the surgeon may order an x-ray, ultrasound, or MRI of the Achilles tendon to help determine whether or not the tendon is damaged or ruptured.

Treatment Options for Achilles Tendonitis
Most cases of Achilles tendonitis can be successfully treated using a variety of conservative treatment methods, including:
• Specialized bandaging of the area to restrict motion of the tendon
• Non-steroidal anti-inflammatory medications
• Resting the tendon
• Physical therapy specially-designed for treating Achilles tendonitis (including stretching, massage, ultrasound and appropriate exercises to strengthen the weak muscle group in front of the leg and the upward foot flexors)
• Custom-made arch supports (Orthoses)

When is Surgery Needed?
Although most cases of Achilles tendonitis respond very well to the conservative treatments listed above, some cases are more severe and the patient may not receive relief from these techniques or the tendon may in fact be torn. In these situations, your foot and ankle surgeon may recommend surgery to repair the tendon.

Ankle Fracture

An ankle fracture is a break in one or more of the three bones that make up the ankle joint. The break can occur in the tibia, the fibula, the talus, or a combination of bones depending on the severity of the injury.

How Do Ankle Fractures Occur?
When the ankle is forced beyond its normal range, either inward or outward, a fracture can occur. Ankle sprains are caused by the same type of activity, albeit at a reduced severity. Fractures commonly occur when running or jumping on an uneven surface or when the foot is firmly planted and the body is twisted. Poor-fitting footwear or sport-related equipment can also attribute to some fractures.

Signs and Symptoms of an Ankle Fracture
A fractured ankle will usually appear very swollen and in some cases there may be mild to severe bruising. Moderate to severe pain will also be experienced whenever attempting to move the ankle. Diagnosis is usually confirmed via an X-ray of the affected foot and in some cases, a CT scan or MRI will be ordered to evaluate the tendons and cartilage around the ankle to determine whether or not they suffered any damage related to the accident.

Conservative Treatment Options for Ankle Fractures
Most non-severe ankle fractures can be successfully treated without surgery. In these cases, a cast or splint is used to help stabilize the ankle joint. The ankle is immobilized for several weeks in order for the bones to mend. Once the cast or splint is removed, the patient will usually partake in a course of physical therapy to help strengthen the muscles around the ankle.

When is Surgery Needed?
If the ankle has experienced a severe fracture that is not treatable by conservative means, then the doctors at Pennsylvania Foot and Ankle Associates may recommend surgery to repair the break. If this is the case, ankle will be stabilized using a series of screws and plates. A cast will be applied once surgery is completed to further immobilize the foot during the recovery period. Recovery from ankle surgery can take anywhere from four to eight weeks depending on the severity of the injury.

Bunions

A bunion, which is also referred to as hallux valgus or hallux abducto valgus, is often described as a bump on the side of the big toe. However, a bunion is actually more complicated than just a “bump.” The visible bump actually reflects changes in the bony framework of the front part of the foot as the big toe starts leaning toward the second toe rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.”

Signs and Symptoms of Bunions
Bunions are a progressive disorder that will gradually worsen over time. The condition slowly changes the angle of the bones over several years until a prominent bump becomes noticeable. In many cases, the patient may not even be aware of their condition as symptoms don’t usually appear until the later stages of the disorder.

When they do arise, however, the signs and symptoms of bunions typically include:
• Pain or soreness in the area
• Inflammation and redness in the are
• A burning sensation
• Numbness
In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.

What Causes Bunions to Form?
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing them. Although wearing shoes that crowd the toes won’t usually cause bunions, it sometimes makes the deformity get progressively worse. This may explain why women are more likely to have symptoms than men.

How are Bunions Diagnosed?
Bunions are readily apparent – the prominence is visible at the base of the big toe or the side of the foot. However, to fully evaluate the condition, your foot and ankle surgeon may request x-rays to determine the degree of the deformity and assess any changes that have occurred.

Because bunions are progressive, they don’t go away, and will usually get worse over time. But, not all cases are alike – some bunions progress more rapidly than others. Once your surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs.

Treatment Options for Bunions
In the majority of cases, conservative treatments to help reduce the pain associated with the bunion and periodic evaluation are all that’s required. To reduce the chance of damage to the joint, however; ongoing periodic evaluation and x-rays by your surgeon may be advised. Conservative treatments typically include:
• Custom orthotic devices
• A change in shoe wear (wearing shoes with wide toe boxes rather than pointed shoes)
• Padding placed over the bunion to help minimize pain
• Changes in your activities
• Non-steroidal anti-inflammatory medications
• Applying ice to the affected area
• Corticosteroid injections (rare)

When Is Surgery Needed?
Bunion pain is usually effectively reduced by conservative treatments. But, if those treatments fail to relieve the pain and that pain interferes with your daily activities, then it’s time to discuss surgical options with your foot and ankle surgeon. Together, you can decide if surgery is best for you.

Pennsylvania Foot and Ankle Associates offer a variety of surgical procedures to treat patients suffering from painful bunions. Our procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, and correct any soft tissue changes that may also have occurred. The primary goal of surgery is the reduction of pain.

In selecting the procedure or combination of procedures for your particular case, your foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

Cavus Foot

Cavus foot is a term that is used to describe a foot with a very high arch. Due to the high arch, extra pressure is placed on the heel and ball of the foot when standing, resulting in pain, instability, and poor posture.

Who is at Risk for Cavus Foot?
Cavus foot is a condition that can develop in one or both feet and it can affect anyone at any age although it is most prevalent in those suffering from certain neurological conditions like cerebral palsy, spina bifida, polio, muscular dystrophy, Charcot-Marie-Tooth disease, or stroke. Some cases of cavus foot can also be genetic in nature.

Signs and Symptoms of Cavus Foot
The most noticeable sign of cavus foot is when the foot has a very high arch when standing. Other signs and symptoms can include:
• Hammertoes
• Claw toes
• Calluses on the ball or on side or heel of the foot
• Instability caused by the heel tilting inward
• Frequent ankle sprains
• Foot drop (a weakening of the muscles in the foot and ankle that results in the foot being dragged when walking)
• Pain when walking or standing

How is Cavus Foot Diagnosed?
Cavus foot is diagnosed by using several pieces of information, including the patient’s family medical history, a physical examination of the affected foot, and a foot test to examine the patient’s coordination, walking pattern, and muscle strength. The surgeon may also examine the patient’s shoes for signs of wear in a pattern associated with the condition. In some cases, x-rays may be ordered to further assess the condition and if a neurological cause is believed to be in existence, then the patient may be referred to a neurologist for further evaluation.

Non-Surgical Treatment Options for Cavus Foot
Cavus foot can sometimes be successfully treated without surgery in cases where a neurological disorder is not the cause. Typical conservative options include:
• Orthotic devices
• Specially-designed shoe modifications
• Leg and foot braces

When is Surgery Needed?
If the patient has not been able to be effectively treated by non-surgical methods, then surgery may be required. In cases where a neurological disorder is present, surgery may help reduce the pain and help improve stability for a certain period of time, after which additional surgery may be required due to the ongoing progression of the disorder. In either case, you surgeon will discuss all of the surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Charcot Foot

Charcot foot is a degenerative condition that will progressively worsen over time if treatment is not administered. Commonly associated with nerve damage, this condition results in reduced sensation and decreased muscular reflexes in the affected foot. Frequent injuries and traumas tend to occur to the foot as a result of the lack of sensation and this too lends to progressive damage concerning the ligaments, bones, and cartilage in the foot.

Who is at Risk of Developing Charcot Foot?
Charcot foot is most commonly experienced by people who have been diagnosed with diabetes mellitus, partly due to the fact that high levels of glucose in the blood is a trademark cause for neuropathy. Between 60% and 70% of diabetes patients suffer nerve damage that can lead to Charcot foot and approximately 0.5% of those actually do develop the condition. The most prevalent incidence is found in patients over 50 years of age who have had diabetes for over 15 years.

Signs and Symptoms of Charcot Foot
As the nerves in the affected foot start to lose their ability to transmit signals to the brain, the foot becomes increasingly at risk of being injured. Therefore, common signs and symptoms of Charcot foot also involve actual injuries to the foot, including:
• Joint dislocations
• Instability
• Swelling and redness of the foot and ankle
• Heat and pain insensitivities
• Calluses and/or ulcers
• Muscle weakness
• An audible grating sound when the foot joint is moved (in cases of subluxation)
• Deformity of the foot
• Septic arthritis with fever and malaise (in some cases)

How is Charcot Foot Diagnosed?
Charcot foot is diagnosed by the surgeon taking into account the patient’s current medical status and their family’s medical history. Imaging tests like X-rays may be ordered to help determine the extent of the damage and diagnostic MRIs may also be required in order to differentiate Charcot foot from another condition, like a foot infection. Certain laboratory tests, such as arthrocentesis, may also prove helpful in diagnosing this condition.

Conservative Treatment Options for Charcot Foot
The goals of most Charcot foot treatment plans involve protecting and stabilizing the affected foot. This can involve placing the foot in a walking cast or total contact cast and having the patient use crutches in order to prevent putting weight on the foot. It is important that treatment for the underlying cause of the Charcot foot, namely the diabetes, also be administered and closely monitored during the treatment period, which can last as long as eight weeks.

When is Surgery Needed?
In cases where the foot is severely deformed or the patient is suffering from chronic ulcers on the foot, surgery may be recommended.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Chronic Ankle Instability

Chronic ankle instability is a condition in which the ankle unexpectedly gives way when walking, running, or in some cases, even standing still. This condition will worsen over time and the patient will experience an increase in incidences if treatment is not administered.

Signs and Symptoms of Chronic Ankle Instability
Ankle instability is a leading factor in cases involving turned or sprained ankles. Over time and with repeated ankle injuries, the patient is then considered to suffer from chronic ankle instability. The most common signs and symptoms associated with this condition include:
• Repeated turning of the ankle episodes
• Swelling in and around the ankle area
• Chronic discomfort in the ankle
• Pain and/or tenderness in the ankle

What Causes the Ankle to Weaken?
Patients who suffer from chronic ankle instability have usually experienced a previous sprained ankle injury in the affected foot. In most cases of chronic instability, the sprain did not heal properly or the patient was not rehabilitated completely. As a result, the ligaments and muscles surrounding the ankle are not strong enough to support the patient and their balance can be compromised. As the patient suffers repeated ankle turnings, their ankle continues to weaken and the risk of spraining their ankle is increased.

How is Chronic Ankle Instability Diagnosed?
The foot and ankle surgeon will inquire about the patient’s medical history and ask about any previous ankle injuries or instability experiences. A complete physical examination of the affected foot will be conducted and in some cases, X-rays or other imaging tests may be ordered to help further evaluate the foot.

Non-Surgical Treatment Options for Chronic Ankle Instability
Chronic ankle instability can be successfully treated without surgery in a high percentage of cases. Typical non-surgical treatment options include:
• Physical therapy to help strengthen the muscles and ligaments in the ankle area
• Ankle brace
• Non-steroidal anti-inflammatory medications to reduce pain and swelling

When is Surgery Needed?
If the patient does not experience any improvement in the ankle’s stability after trying the non-surgical treatments, then the foot and ankle surgeon may recommend surgery. Surgery usually consists of repairing or reconstructing the damaged ligaments in the ankle and foot. Recovery time is dependent upon the severity of the injury and the types of procedures performed.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Common Toenail Problems

At Pennsylvania Foot and Ankle Associates, we treat a wide range of common toe problems and toenail fungus, including the following:

Onychia
Onychia is an inflammation of the tissue that surrounds the nail plate. This area is called the nail fold. This painful toenail condition usually results from the introduction of microscopic pathogens through small wounds in the skin. The inflammation is usually accompanied by the formation of pus and the eventual shedding of the nail.

Onychocryptosis
Onychocryptosis is another name for an ingrown nail and this condition can affect the fingernails as well as the toenails, but it most commonly affects the toes. Patients who suffer from onychocryptosis will experience pain and inflammation as the nail cuts into one or both sides of the nail bed. In severe cases, infection can arise. Treatment for mild cases involves trimming and rounding the nail, but in more severe cases where an infection has occurred, surgical excision of the ingrown portion of the nail down to its bony origin is usually recommended in order to prevent recurrence.

Onychomycosis
Onychomycosis is a toenail fungus that is also known as tinea unguium. This type of fungal infection is contagious and it is caused by the same fungal organisms that cause ringworm in the skin. Signs of onychomycosis include discoloration and thickening of the nails. The affected nails may also appear chalky and the nails may start to crumble. In most cases, powerful oral and/or topical antifungal medications are required in order to treat the infection.

Paronychia
Paronychia is a bacterial or fungal infection that develops where the nail and skin meet. In acute cases, the affected area will usually appear red and swollen and pus will usually form. The pus will eventually cause the nail to separate from the skin. In chronic cases of paronychia, the skin around the nail will appear less red and the toenail will usually have a greenish hue to it. The discoloration is due to Pseudomonas infection.

Subungual Hematoma
A subungual hematoma is a pooling of the blood under the nail as a result of a recent trauma to the nail. This painful condition can also be caused by repeated minor trauma to the nail from activities such as running in undersized shoes. In cases where the subungual hematoma is causing pain, the podiatrist will drain the blood to relieve the pressure using one of a variety of different measures.

If you are suffering from a toenail problem that is causing you pain or discomfort, then schedule an appointment with one of our doctors today. We can help you find the relief you’re looking for so you can return to your regular activities as quickly as possible.

Corns and calluses

Corns and calluses, also known as hyperkeratosis, are common conditions that we treat with great regularity in our offices. Corns and calluses can develop on any part of the foot and symptoms can vary from mild to moderate depending on the location and severity of the problem.

What are Corns and Calluses?
Corns and calluses are similar as they are both conditions in which the skin becomes thickened as a result of constant pressure. In the case of a callus, the skin thickening is more diffuse and commonly found on one or more of the toes or under the ball of the foot. A corn, on the other hand, is more of a localized thickening of the skin. Corns appear as a horny thickening of the skin with a cone-shaped mass pointing into the skin. In some cases, a corn may be surrounded by calluses along its outside edges.

It is important to understand that the development of corns and calluses is completely normal and it is the body’s way of protecting the skin that is constantly under pressure. That said, corns and calluses can develop to the point that they are painful and thereby treated the patient’s immune system as something foreign to the body.

What Causes Corns and Calluses?
There is only one cause for both corns and calluses – too much pressure being applied to the affected area. In some cases, the pressure can be accompanied by friction which helps acerbate the conditions. Common causes of corns and calluses on the feet include:
• Wearing footwear that is too tight
• Hammertoes and other toe deformities
• A bony prominence in the foot or toe
• Biomechanical or gait abnormalities that results in pressure being applied to certain parts of the foot
In most cases, the corn or callus is a symptom of another underlying problem or condition.

The Importance of Having Corns and Calluses Professionally Treated
If you have corns or calluses on your feet, then you should seek treatment by a foot and ankle surgeon as soon as possible. While these conditions are not normally painful early-on, they will worsen if treatment is not administered. As long as pressure is being applied to the affected area, the problem will not go away. In severe cases, painful and dangerous ulcers will develop in the area. Once an ulcer develops, the risk of infection increases and this can pose some serious complications for patients who suffer from diabetes, poor circulation, peripheral neuropathy, and other health conditions.

Some people with corns and calluses think to self-treat the conditions using over-the-counter products or by trimming away the hardened skin. We strongly urge our patients to avoid attempting self-treatment. The risks of doing so include potential dangerous infections and/or damage to the surrounding tissue. For the safest and most effective treatment, a patient should see a podiatrist.

Diabetic Complications

Patients with diabetes regularly suffer from foot conditions which are acerbated by the disease, the most common of which include neuropathy and poor blood circulation. Because neuropathy causes one to lose sensation in his or feet and poor circulation makes it difficult for cuts, scraps, and other injuries to heal, it is very important to pay close attention to your feet and ankles if you have been diagnosed with diabetes as otherwise minor injuries could become elevated into serious complications and health concerns.

Common Foot and Leg Problems Associated with Diabetes
Diabetes increases the risk for patients suffering a wide range of foot, ankle, and leg complications. If a patient has diabetes and treatment is not administered, many complications and injuries can progressively worsen to the point that the leg could be lost or the patient’s very life could be placed at risk. The following represent the most common foot, leg, and ankle problems associated with diabetes.
• Infections
• Ulcers
• Corns
• Calluses
• Dry skin
• Ingrown toenails
• Bunions
• Hammertoes
• Charcot foot
• Artery restrictions

What is a Foot and Ankle Surgeon’s Role in Diabetes Treatment?
While treatment for the diabetes itself is overseen by other health specialists, a foot and ankle surgeon plays a significant role in helping the patient reduce the risk of amputation. Foot and ankle surgeons have special surgical and conservative techniques that are effective for joint reconstruction and for promoting wound healing in the lower extremities. Regular checkups with a foot and ankle surgeon are recommended as part of a strong diabetes treatment regimen.

What Can I Do to Help Lower My Risk of Injury?
There are several things a patient with diabetes can do to help reduce their risk of experiencing painful foot, ankle, or leg injuries. These include:
• Perform daily inspections of your feet, ankles, and legs to look for any signs of discoloration, swelling, nail changes, and other noticeable differences
• Inspect your toes daily for changes in color. If they turn pink, red, or purple when sitting, then there may be a circulation problem
• Keep your nails trimmed
• Avoid treating corns and calluses yourself and never use over-the-counter medicated pads
• Make sure your floors are free of sharp objects
• Wear shoes at all times, even indoors
• Check your shoes and socks before putting them on
• Have your legs, ankles, and legs tested for loss of sensation by a foot and ankle surgeon on a regular basis

Foot Care Guidelines for Diabetics
Along with injury prevention methods, a diabetic patient also needs to practice excellent foot care. Here is a guideline you can use to help ensure your feet, ankles, and legs are well cared for and your diabetes is held in check:
• Follow your doctor’s orders for keeping your blood sugar under control
• Examine your feet every day
• Wash your feet in warm, not hot, water every day
• Dry your feet thoroughly, including between the toes
• Apply skin lotion to the top of your feet (but not between the toes) to help keep the skin soft and moisturized
• Use a pumice stone to gently smooth corns or calluses (only if your diabetes is under control and you are at low risk of skin injuries)
• Trim your toenails once a week, and trim the nail straight across
• Avoid digging into the corners of your nails
• Wear socks at night
• Avoid crossing your legs for extended periods of time
• Avoid smoking
• Wiggle your toes and rotate your ankles for five minutes, at least two to three times a day to help improve circulation

When is Amputation Necessary?
Amputation is sometimes the only way to restore a diabetic patient’s ability to walk in cases where vascular surgery is unable to improve the blood flow to the feet, but it is the goal of the foot and ankle surgeon to prevent this from occurring. The extent of the amputation depends on many factors, including the part of the foot or leg being affected, the health of the patient, and more. In some cases only one or two toes may require amputation whereas in more severe cases, the lower leg may need to be removed.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Flat Feet

Flat feet is a condition that while common, is often complex, because it has varying degrees of severity. Flat feet cases can feature a wide array of symptoms and the patient’s level of deformity and disability can also differ greatly.

Common Characteristics of Flat Feet Cases
While there are varying types of flat feet cases, they each share a number of similar characteristics that your doctor will use to help diagnose the condition. These common characteristics include:
• Partial or total loss of the arch
• A short Achilles tendon
• Bunions
• Hammertoes
• Toe drift

What is “Flexible” Flat Feet?
Flexible flat feet is a condition that usually begins in childhood or early adolescence and progresses as one enters adulthood. This is one of the most common types of flat feet and it is so named because the arch disappears when the foot is flat against the ground but returns once the foot is raised. Common symptoms of flexible flat feet include:
• Pain in the shin area
• Pain in the heel, arch, ankle, or along the outside edge of the foot
• Weakness in the foot or leg
• Arthritis (as the condition worsens)
• A “turned-in” ankle

How is Flat Feet Diagnosed?
Your doctor or surgeon will examine your feet by observing how they look when you are standing and when you are sitting. The doctor will be looking at three primary components – flattening of the arch, forefoot abduction, and heel valgus. X-rays may be ordered to help diagnose the severity of the condition.

Treatment Options for Flat Feet
There are several different conservative treatment techniques available for most sufferers of flat feet. At Pennsylvania Foot and Ankle Associates, we always provide our patients with a full education about their condition because the better the patient understands the condition, the more proactive they can be in their treatment program. The following non-surgical treatment options are available for flat feet:
• Stretching exercises
• Orthotics
• Immobilization / casting
• Non-steroidal anti-inflammatory medications

When is Surgery Needed?
If conservative treatment has not been successful and the patient is suffering from significant pain and foot misalignment, then surgical intervention may be required. Surgery to repair flat foot can include a number of different techniques and procedures, such as tendon lengthening or augmentation, osteotomies, bone fusions, and/or bone supporting implants. Your surgeon will discuss your surgical options and your recovery expectations prior to you making a decision about your treatment.

Foot Fractures

With 28 bones in the foot, 19 of which are located in the toes (the phalanges and metatarsals), foot fractures are common injuries. It is important for the patient to see a foot and ankle surgeon for proper diagnosis of the injury and the correct treatment even if they were already treated in an emergency room.

Signs and Symptoms of a Foot Fracture
There are two different types of foot fractures, stress fractures and traumatic fractures, and while they are both fractures, they each have different signs and symptoms.

A stress fracture is a tiny, hairline break that is usually a result of repetitive stress being applied to the bone. These are commonly experienced by athletes who increase their running mileage too quickly but they can also result from certain types of foot deformities, an abnormal foot structure, improper footwear, and osteoporosis. Signs and symptoms of a stress fracture include:
• Pain with activities that goes away after resting
• Swelling in the area without bruising
• Pain at the site when pressure is applied

A traumatic fracture is when the bone is broken due to a direct blow or hard impact. The bone can be displaced or non-displaced and in some cases, surgery is required to repair the injury. Signs and symptoms commonly experienced with traumatic foot fractures include:
• Pain at the moment and location of the break (severity of pain can diminish after a few hours)
• An audible “crack” may be heard at the moment of fracture
• Bruising and swelling in the area of the fracture
• Deviation of the toe if the break is in the toe

Why Seeing a Foot and Ankle Surgeon is Essential for Foot Fractures
Some patients cannot distinguish a foot fracture from a sprain and therefore they may decide to forego seeing a specialist. This is a terrible idea that could produce future problems in the affected foot, such as arthritis, chronic pain, long-term dysfunction, a deformity in the foot’s architecture, and other problems.

If you think you may have a foot fracture, keep weight off of the foot and apply ice to the area (no longer than 20 minutes at a time) to help keep swelling under control. Take an aspirin or ibuprofen to help alleviate the pain and call Pennsylvania Foot and Ankle Associates to make an appointment.

Non-Surgical Treatment Options for Foot Fractures
Most foot fractures can be successfully treated without requiring surgery. Typical conservative treatment options include:
• Short-leg walking cast
• Avoidance of certain activities
• Non-steroidal anti-inflammatory medications to reduce pain and swelling

When is Surgery Needed?
If non-surgical treatments have proven ineffective or if the fracture is significant, then the foot and ankle surgeon may recommend surgery. This is rare, however, as most fractures heal well when proper conservative treatment is administered.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Ganglion Cyst

A ganglion is a fluid-filled cyst that forms on the lining of a joint or tendon. They are most commonly found along the top of the foot or on the ankle, although these cysts can form on any part of the foot. Ganglion cysts tend to grow slowly over time until they become irritated and visibly noticeable.

What Causes Ganglion Cysts to Form?
A ganglion cyst forms on the weakened lining of a tendon or joint so the cause of the weakened lining is the true reason for the cyst forming. This is most commonly caused by spot-specific irritation due to ill-fitting shoes or by wearing boots that place too much stress on the foot or ankle. Ganglion cysts are also commonly formed in areas where bone spurs are present due to the increased irritation caused by the bony growth.

Signs and Symptoms of a Ganglion Cyst
Ganglion cysts usually form without any identifying symptoms. All-too-often, the patient is unaware that the cyst is forming until the lump is visible on the foot. Different activities and changes in the weather can cause the cyst to increase or decrease in size. Pain is rare with this foot condition unless the cyst is in an area where it is putting pressure on the nerves located in the overlaying skin. When this occurs, pain, numbness, and tingling may be experienced.

What are the Conservative Treatment Options for Ganglion Cysts?
A ganglion cyst can be successfully treated in many instances without surgical intervention. Common conservative techniques available for treating this condition include:
• Removal of fluid from the cyst
• Limiting certain movements or activities
• Applying ice to the affected area
Non-steroidal anti-inflammatory medications
• Special pads placed around the cyst to help alleviate pressure and friction

When is Surgery Needed?
If conservative treatment has not been successful and the patient is suffering from ongoing pain, then the doctors at Pennsylvania Foot and Ankle Associates may recommend surgical intervention. If this is the case, the ganglion “wall” is completely removed during the surgery. In some cases, additional surrounding tissue may be removed as well. Your surgeon will discuss your surgical options and your recovery expectations prior to you making a decision about your treatment.

Gout

Gout is an acute type of arthritis that is developed in the peripheral joints in the body. The condition is caused by a high concentration of monosodium urate crystals being deposited in and around the joints and tendons as a result of there being an excess of uric acid in the patient’s body.

The excess of uric acid is usually found to occur in patients who either produce too much uric acid or those whose bodies fail to excrete enough uric acid out of their systems. In a great many cases, gout is a hereditary condition but anybody can suffer from it.

Signs and Symptoms of Gout
Common signs and symptoms of gout include:
• A sudden onset of intense pain in one or more joints
• Swelling in and around the affected joints
• Redness and inflammation in and around the joints
• Difficulty walking
• Difficulty wearing shoes
• Pain when trying to move the joint or at the slightest touch

Gout is most commonly found to affect the big toe but it can actually affect any joint. In almost all cases, patients report that there was no previous pain in the area prior to it suddenly occurring. The sudden onset of pain usually occurs in the middle of the night or upon waking in the morning.

How is Gout Diagnosed?
Gout is usually diagnosed via a range of select criteria, including a review of the patient’s family medical history, a thorough physical examination, and blood tests used to determine the level of uric acid in the body. It is important to note that even if the patient has a high level of uric acid in his blood, this does not automatically confirm a gout diagnosis. The only proven method for making a definitive diagnosis is to aspirate fluid from the affected joint. The fluid is then examined under a specialized polarizing microscope to search for evidence of uric acid crystals. If uric acid crystals are found in the joint fluid, then gout can be confirmed. In most cases, the foot and ankle surgeon may also order x-rays to examine the bones and joints in the foot, ankle, and leg to rule out fractures and other bony pathology.

Although aspirating the joint and examining the fluid is the only definitive way to diagnose gout, most patients can be effectively diagnosed without having to go through the procedure. Usually a review of the patient’s family medical history and the patient’s signs and symptoms are enough to allow a positive diagnosis.

Gout Prevention Tips
If your family medical history places you at high risk for gout, then there are certain things you can do to help reduce your chances of suffering from this painful condition. Gout prevention tips include:
• Avoid eating large quantities of red meat, shellfish, beer, wine, salt, and other foods that are high in purines
• Drink between six and eight glasses of water a day
• Schedule regular examinations by a foot and ankle surgeon
• Try to keep stress, trauma, and infections to a minimum
• Tell your doctor about your family’s history with gout as many medications, such as diuretics, can bring on an acute case of gout

Non-Surgical Treatment Options for Gout
Gout can usually be managed through oral non-steroidal anti-inflammatory medications and with an injection of a cortisone/local anesthetic mixture into the affected area. Ice (if not restricted for a circulatory condition), rest, and elevation of the affected foot can also help reduce the discomfort. Drinking plenty of water is beneficial for decreasing the chance of urate precipitation in the kidney and in cases where the pain is severe, oral narcotic medications may be prescribed for temporary use. Wearing loose-fitting slippers can also help alleviate the symptoms to a degree, at least until the patient can see a foot and ankle surgeon.

When is Surgery Needed?
In severe cases of gout where the medicine is not alleviating the pain or in cases where there is a significant amount of uric acid crystals in the joint fluid, then surgery may be recommended in order to remove the build-up of crystals and to repair the joint.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Hallux Rigidus

Hallux rigidus is a condition that’s usually associated with arthritis. It affects the joint located behind the toe, most notably the big toe, and it results in the inability to bend the toe. It is usually more difficult to bend the toe upward than it is to bend it downward.

What Causes Hallux Rigidus?
The exact cause of the condition is presently unknown, but certain situations are believed to exacerbate the problem, such as an imbalanced foot structure or function or a traumatic injury like jamming the toe. Those with low arches or flat feet are higher risk of developing hallux rigidus and heredity may also attribute to the condition’s occurrence. Regardless of what it is caused by, hallux rigidus is a progressive condition that will worsen over time if treatment is not administered.

Signs and Symptoms of Hallux Rigidus
Common signs and symptoms of hallux rigidus can include:
• Swelling around the joint at the base of the toe
• Pain and stiffness in the affected toe joint
• Increased limping
• Inability to wear certain types of footwear
As the condition worsens, the pain associated with it will also increase to the point that the patient will feel pain in the area even when at rest.

How is Hallux Rigidus Diagnosed?
Your foot and ankle surgeon will perform a thorough physical examination of your foot and toes followed in most cases by a diagnostic X-ray.

Hallux Rigidus Conservative Treatment Options
Because hallux rigidus is a progressive condition, the earlier a diagnosis is made, the better the chance of being able to treat this condition non-surgically. Conservative treatment options typically include:
• Orthotic shoe inserts
• Specially-designed shoe modifications
• Non-steroidal anti-inflammatory medications
• Limitations on certain activities

When is Surgery Needed?
If the pain and deformity has not been relieved via conservative methods, then your foot and ankle surgeon may recommend surgery. Surgical options for hallux rigidus are determined by the severity of the condition. In less-severe cases surgery may consist of cleaning up and remodeling the joint. In severe cases, the joint may need to be completely replaced or fused. Other factors that may affect surgical options include the patient’s age, occupation, activity level, and overall physical condition.

Regardless of the case, your surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Hammertoe

Hammertoe is a condition that typically affects the second, third, or fourth toes. When a patient is suffering from hammertoe, the affected toe is bent at the middle joint giving it the impression of a hammer.

Signs and Symptoms of Hammertoe
Hammertoe’s most noticeable sign is the bending of the toe. The affected toe will also commonly develop calluses or corns along the top and/or the front of the toe. Calluses and corns develop because of the intense pressure being applied those parts of the toe when wearing shoes. Pain can also be a symptom, but it is not always present in every case. For example, in some cases the hammertoe deformity may appear mild yet the patient may be experiencing significant pain while in others, patients with more severe deformities may feel only mild or no pain.

What Causes Hammertoe?
The most common causes of hammertoe involve wearing improperly sized shoes and muscle imbalance in the toe but the condition can be acerbated by other factors as well. When shoes are worn that are designed to make your foot look smaller, such as those with narrow toes, they push the toes into a bent position. The pressure is increased when wearing high heels, causing the toes to rub against the shoe. Eventually, corns and calluses will develop on the toes and it will become increasingly difficult to straighten the toe when the shoes are off. This is also a contributing factor to the muscle imbalance in the toe. When the toe is held in a bent position for an extended period of time, the muscle required to straighten out the toe can become tight and incapable of straightening the toe.

Non-Surgical Treatment Options for Hammertoe
Hammertoe can be effectively treated using non-surgical means, and the earlier a patient accepts treatment, the more successful the treatment will be. Depending on the severity of the condition, conservative treatment options can include:
• Changing to a wider, more comfortable shoe with a shorter heel and a roomier toe box
• Cushions or non-medicated pads for the calluses and corns
Toe exercises to help strengthen the muscles

When is Surgery Needed?
The longer a patient waits to seek treatment, the worse the hammertoe deformity will become and in some cases, it may not be able to be corrected through conservative means. If this is the case, then the surgeon may recommend a surgical procedure to correct the toe. The type of surgery is usually dictated by the severity of the condition, but most cases can be treated via an outpatient procedure with a local anesthetic.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Heel Pain

Heel pain is one of the most common ailments treated in our offices. Part of the reason for its prominence is because there are so many different ways one can experience pain in the heel region, including arthritis, collagen diseases, trauma, overuse, stress fractures, nerve entrapments, and more. But, what we find is that a great majority of the heel pain patients we treat are actually suffering from a condition called “plantar fasciitis,” or heel pain syndrome.

What is Plantar Fasciitis?
Plantar fasciitis is a condition in which the band of tissue that runs along the bottom of the foot becomes inflamed. This band of tissue is called the plantar fascia and it is connected on one end at the heel bone. The pain usually runs along the bottom of the foot and/or along the side of the heel and it is most prevalent in the morning upon waking or when standing up after sitting for a period of time. The reason the pain is so intense after a period of rest is because the plantar fascia becomes tight when the foot is at rest.

If treatment is not administered for plantar fasciitis, the condition can worsen. Over time, the plantar fascia will start to thicken and the patient will eventually be diagnosed with plantar fasciosis. It is important to note that the pain of plantar fasciitis can exist with or without a bone spur. Bone spurs can sometimes develop on the heel bone as a result of the plantar fascia being pulled, but this is not always the case. In fact, many patients often mistake their heel pain for being a bone spur when in truth the pain is a result of stretching and irritation of the plantar fascia.

Non-Surgical Treatment Options for Heel Pain
In most cases, conservative treatments can prove very beneficial to helping relieve the heel pain that’s attributed to plantar fasciitis. These treatment options include methods used to decrease the pulling and tightness of the plantar fascia, to increase the support of the plantar fascia during weight-bearing processes, and to reduce the pain, inflammation, and swelling. The treatment options offered in our office include:
• Non-steroidal anti-inflammatory drugs (NSAIDS)
• Taping
• Stretching
• Inserts/orthoses
• Ice
• Massage
• Supportive shoes
• Immobilization with a cast
• Weight loss
• Physical therapy
• Night splints
• Platelet rich plasma (PRP) injections
• Cortisone injections
• Extra corporeal shock wave therapy (ESWT)
• Topaz coblation surgery
• Laser treatments and therapy

In cases where the patient has not responded to conservative treatment techniques, more specialized tests may be required to rule out stress fractures, nerve entrapments, arthritic conditions, and other causes of heel pain. These tests may include MRIs, bone scans, blood tests, nerve conduction studies, and others.

Regardless of the case, your surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Ingrown Nail

An incurvated or ingrown toenail is a painful condition that causes pain and irritation of the toe where the nail meets the skin. Although it can occur on any of the toes, an ingrown toenail is most commonly found on the big toe.

Signs and Symptoms of Ingrown Toenails
An incurvated toenail causes pressure on the skin of the toe to the point that the skin can become significantly irritated. Most common symptoms include tender and swollen skin around the toenail. The skin may also appear red and inflamed and in some cases, the area may become infected.

What Causes Ingrown Toenails?
The primary cause of this painful condition seems to be hereditary since the shape of the toenails’ growth center (matrix) is abnormal in most of the patients that suffer from it. However, improper nail trimming, diseases of the nail, or tight fitting shoes can also cause this problem. It has also been the experience of our office that many cases of infected ingrown nails occur as the result of a pedicure.

Common Misconceptions about Ingrown Nails
Trimming the end of the nail in a “V” shape will not prevent it from becoming ingrown. “Self-digging” in the border of the nail may increase the likelihood of infection. And, despite advertising claims, no medication can cause the nail to “grow out” normally.

Treating Ingrown Toenails
There are several different techniques used for treating ingrown toenails with the chosen one based on the severity of the condition. In mild cases, the nail is simply cut straight across with a slight rounding of the toenails. If the problem is a first time episode, then a topical spray may be used to anesthetize the toe while the offending ingrown border is comfortably removed.

If the nail is significantly ingrown with an infection present, then the border of the nail can be removed easily and comfortably with the use of a local anesthetic in our office. Minimal discomfort is experienced following such a procedure, but the patient’s work schedule is seldom interrupted.

If there is a history of recurring episodes with frequent infections, then we will recommend permanent removal of either the nail border or, very rarely, the entire nail. Healing takes approximately two to three weeks, although there is no disability during this time. The technique of excising the portion of nail matrix which grows the nail, along with applying medication (phenol) to the matrix is the simplest, most effective method of permanent nail removal. No sutures are required, and there is no scarring of the adjacent skin. This procedure has an excellent rate of success. “Normal” skin, which is not sensitive to pressure, develops where the nail once grew.

In some instances where there is severe curving of the nail and pain centrally under the nail plate, X-rays are taken to determine whether or not a bone spur may be present under the nail and thus causing the deformity and pain. Conservative care for this problem consists of well-rounded shoes with a deep toe box, stretching of the shoes over the affected toe and use of pads. If these measures are unsuccessful, then a minor surgical procedure is performed under local anesthesia to remove the spur. The patient can usually return to work the next day in a surgical shoe or an open-toe shoe which is worn for approximately two to three weeks.

Preventative Tips
Most patients can prevent ingrown toenails by following a few simple tips:
• Trimming the toenails straight across with no rounded corners
• Wearing comfortable-fitting shoes and socks that are not too tight
• Practicing good foot hygiene by keeping your feet clean at all times

Neuroma

A neuroma is a painful condition that affects the front of the foot between two of the toes. Although it can occur between any of the toes, it is most commonly found between the third and fourth toes. Common symptoms of a neuroma include:
Pain in the front part of the foot
• Aching
• Burning
• Numbness
• Tingling
Sufferers of neuromas commonly describe the sensation as if they are walking on a stone or a rolled-up sock. In some cases, the pain may radiate into the toes or along the bottom of the foot.

What Exactly is a Neuroma?
A neuroma is a benign thickening of the nerve that runs between the metatarsals and branches to the toes. Also known as “perineural fibrosis,” a neuroma produces significant pain in the foot because the inflamed nerve is trapped under the ligament that connects the metatarsal bones. Because of this, tight shoes, high-heels, and rigorous activity involving the feet will usually aggravate the condition. The pain can sometimes be partially relieved by removing the shoe and gently rubbing the affected area.

How is a Neuroma Diagnosed?
The patient will undergo an initial x-ray to rule out any fractures or foreign bodies within the affected foot. Once it has been determined that the foot has no evidence of fractures or foreign bodies, then the diagnosis is made by the treating Podiatrist by correlating the clinical symptoms.

In cases that prove difficult to diagnose, there are two additional tests that may be required. The first test is a gadolinium MRI and the second test is a diagnostic ultrasound. It is important to note that these tests are expensive and require the expertise of a radiologist specially trained in performing a musculoskeletal MRI or a diagnostic ultrasound. However, at Pennsylvania Foot and Ankle Associates, we treat a great number of patients suffering from neuromas, so these additional tests are seldom necessary.

How is a Neuroma Treated?
There are several different ways a neuroma can be treated through conservative means. The following treatment methods have proven to be effective at treating most cases of neuroma:
• Padding or elevating the metatarsals
• Cushions
• Shoe inserts
• Orthotics
• Physical therapy
• Anti-inflammatory medications
• Laser therapy
• Injections
At Pennsylvania Foot and Ankle Associates, we also offer a NEW treatment program that consists of a series of local injections that shrinks and eliminates the affected nerve completely.

When is Surgery Needed?
If conservative treatment has not been successful and the patient has not received adequate relief from pain, then surgical removal of the neuroma can be performed in our office or as an outpatient procedure under local anesthesia with mild sedation.

Generally, there are two surgical approaches to treating a neuroma: the affected nerve is either removed or it is released. Your foot and ankle surgeon will determine which approach is best for your condition.

Osteoarthritis

Osteoarthritis is a common condition in which the cartilage between the joints eventually breaks down over time. As the cartilage deteriorates, it can become increasingly difficult to move the affected joints without stiffness and pain. When osteoarthritis affects the foot, it is generally found in the big toe although it can also be found in the ankle or in the middle joint of the foot. Osteoarthritis is a degenerative condition that does worsen as the patient ages but there are certain treatment options that can improve function and alleviate pain.

What Causes Osteoarthritis?
For most patients, osteoarthritis is a natural step in the aging process. Thus, it is considered a “wear and tear” condition. Over time and through repeated actions, certain joints in the body eventually get worn down and the cartilage between the joints can wear away. This results in pain and inflammation in the joint.

Repeated injuries to a particular joint, like frequently stubbing one’s big toe, can also lead to an increased prevalence of osteoarthritis in that joint. Osteoarthritis in the feet is commonly attributed to dropping things on one’s foot or jamming the toe. If the ankle is the area affected, this is usually a result of a previous fracture or severe sprain.

Osteoarthritis in the feet can also be a result of abnormal foot mechanics, so people with flat feet or high arches are typically higher at risk of developing this condition.

Signs and Symptoms of Osteoarthritis
Common signs and symptoms of osteoarthritis in the feet include:
• Pain and inflammation in the joint
• Swelling in the area where the pain is felt
• Difficulty bending the joint
• Difficulty walking
• Bone spur formations
• Blisters or calluses (over the location of the bone spur)

How is Osteoarthritis Diagnosed?
A complete examination of the foot is conducted by a foot and ankle surgeon. He or she will usually be looking for signs of swelling, pain, and limited mobility in the joint. X-rays are commonly ordered to help aid in the diagnosis and to evaluate the extent of the disease. In some cases, bone scans and MRIs may also be ordered.

Non-Surgical Treatment Options for Osteoarthritis
There are several different options available for treating a patient who is suffering from osteoarthritis in the feet. These treatment options tend to include:
• Anti-inflammatory medications
• Steroid medications injected into the joints
• Pads
• Arch supports
• Cane or brace to support the foot joints
• Shoe inserts
• Custom shoes
• Physical therapy

When is Surgery Needed?
In some cases, conservative treatments may not sufficiently alleviate the pain associated with osteoarthritis and when this happens, surgery may be recommended by the treating foot and ankle surgeon. The primary goal of the surgery is to reduce pain and increase the function in the foot. The foot and ankle surgeon will choose the best surgery options based on a number of different factors unique to the patient.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Onychomycosis

Onychomycosis is a fungus that grows in and around the toenail, causing the affected toenails to become discolored and thick. The nail will usually appear yellow or light brown in color and while the nail does thicken due to the fungus, it is actually brittle. Studies show that this condition affects between 10% and 25% of the population.

What Causes Onychomycosis?
Onychomycosis can result from a variety of causes. The fungus is most commonly experienced by adults and its development has been tied to certain behaviors such as:
Getting pedicures done with tools that were not cleaned properly
• Wearing closed-in footwear
• Allowing the feet to remain moist for an extended period of time
• Living in a humid or damp area
• Frequent visits to public swimming pools
• Showering at the gym without sandals
• Toenail fungus can also be a problem for people who have immune system disorders, skin or nail injuries, nail diseases, and deformed toenails.

Signs and Symptoms of Onychomycosis
Common signs and symptoms of onychomycosis in the toenails include:
• Discoloring of the nail
• Dull appearance to the nail
• Thickening of the nail
• Debris under the nail
• Brittleness
• Crumbling along the outside edge of the nail
• Deviation in the shape of the nail
• Loosening of the nail

How is Onychomycosis Diagnosed?
A complete examination of the foot is conducted by a foot and ankle surgeon. He or she may also scrape a sample from under the tip of the nail for evaluation under a microscope. The sample may also be sent to a laboratory for a culture to confirm the diagnosis.

Can Onychomycosis Be Treated Without Removal of the Nail?
In most cases, this condition can be effectively treated without requiring the nail to be removed. But it is important to understand that over-the-counter topical medications are ineffective at resolving this problem. The most effective treatment options tend to include oral anti-fungal medications and laser treatments. When prescribed oral anti-fungal medications, you can expect the treatment program to last anywhere from two to three months and depending on the medication prescribed, lab tests may be required to monitor liver function.

In more severe cases, the affected toenail may still have to be removed and even this does not eliminate the chance that the fungus could return. In most cases, changing how one takes care of his or her feet will help cut down the risk level.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Pediatric Flatfoot

Pediatric flatfoot is a common occurrence in children as most are born with a minimal arch. In most cases, children are born with what is known as “flexible flatfoot,” meaning that the arch is flexible. This condition will rectify itself naturally as the child ages. But, in cases where the child is born with “rigid flatfoot,” treatment may be required to prevent future impairment.

How is Pediatric Flatfoot Diagnosed?
The foot and ankle surgeon will examine the child’s feet and in some cases order X-rays to help aid in the diagnosis. During the examination, the surgeon will look specifically for signs of an arch while standing. Children who have no visible arch when standing or sitting tend to suffer from rigid flatfoot. Children with flexible flatfoot may have no arch when standing but then have an arch when sitting or lifting the foot.

Signs and Symptoms of Pediatric Flatfoot
Common signs and symptoms of pediatric flatfoot include:
• Pain when wearing certain types of shoes
• Pain when running or walking for lengthy periods of time
• Awkward running or walking styles
• Outward-pointing heel when standing
Can Pediatric Flatfoot Be Treated Without Surgery?

As stated earlier, most cases of pediatric flatfoot resolve themselves over time without the need of surgery or conservative treatments. In cases where treatments are required, usually custom-made orthotics proves to be the most effective treatment method.

When is Surgery Needed?
Surgical intervention for this condition is rare except in the most severe cases of rigid pediatric flatfoot. If the patient does not respond to conservative treatment techniques, then the foot and ankle surgeon may recommend surgery to help alleviate the pain and to restore correct foot function. There are several surgical techniques available for this condition with each depending upon factors such as foot type and severity of the deformity.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Peroneal Tendon Injuries

There are two peroneal tendons in the foot. One tendon is connected to the outer part of the mid-foot while the other runs under the foot and is attached to the inside of the arch. The primary function of these two tendons is to stabilize the foot and ankle.

There are three types of peroneal tendon injuries: tendonitis, degenerative tears, and subluxation.

Signs and Symptoms of Peroneal Tendon Injuries
Tendonitis is one of the most common types of peroneal tendon injuries. This inflammatory condition is caused by repetitive use or overuse of the tendon. It can also be attributed to certain traumas like ankle sprains. Signs and symptoms of tendonitis include:
• Swelling
• Pain
• Area is warm to the touch
• Weakness or instability in the ankle

Degenerative tears are progressive in nature and tend to worsen over time. This condition is also a result of overusing the tendon to the point that it becomes over-stretched and weak. Common signs and symptoms of a degenerative tendon tear include:
• A change in the height of the arch
• Sporadic pain along the outside of ankle
• Weakness or instability in the ankle

Subluxation is when one or both tendons slip out of their normal position. This can often be caused by a sprain or other trauma. It can also occur in people who are born with variations in the shape of their bones or muscles. Subluxation is also a progressive condition, so when the following symptoms are experienced, it is important to seek a foot and ankle surgeon as soon as possible in order to help prevent further damage to the tendon. Signs and symptoms associated with this condition include:
• Sporadic pain along the back outside area on the ankle
• A “snapping” feeling around the ankle bone
• Weakness or instability in the ankle

How are Peroneal Tendon Injuries Diagnosed?
Peroneal tendon injuries can be difficult to self-diagnose because they can often resemble other types of injuries. For this reason, it is extremely important to seek diagnosis and treatment from an experienced foot and ankle surgeon. In order to properly diagnose these conditions, the surgeon will perform a thorough examination of the foot and ankle in order to look for signs of swelling, pain, inflammation, and weakness. X-rays and a diagnostic MRI may also be ordered to help determine the extent of the injury.

Conservative Treatment Options for Peroneal Tendon Injuries
Peroneal tendon injuries can sometimes be successfully treated without requiring surgery, but this does depend on the type and severity of the injury. Conservative treatment options for these conditions include one or more of the following:
• Cast or splint immobilization
• Anti-inflammatory medications
• Physical therapy
• Bracing

When is Surgery Needed?
When a patient has a severe tendon injury that cannot be treated through conservative techniques, the foot and ankle surgeon may recommend surgery to repair the tendons and improve the stabilizing structure of the foot. The type of surgery used is determined by a number of factors including the patient’s lifestyle, current health condition, and more.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Plantar Fibromas

A plantar fibroma is a fibrous knot of tissue growth that can sometimes develop along the inside bottom surface of the foot. The non-malignant tissue builds up within the plantar fascia, the band of tissue that runs from heel to toes on the inside arch of the foot, and unless it is treated, it will not reduce in size or go away on its own.

Signs and Symptoms of Plantar Fibromas
A plantar fibroma is visually noticeable as a lump in the arch of the affected foot. The lump will feel firm to the touch and it may or may not have pain associated with it. When pain is present, it can sometimes radiate from the lump to the toes. In most cases, pain is aggravated by pressure that’s applied to the lump by the patient’s shoes, but pain can also result from walking around barefoot as well.

How is a Plantar Fibroma Diagnosed?
A foot and ankle surgeon examines the foot and presses on the affected area. In some cases, an MRI or a biopsy may be ordered for further evaluation in order to help aid in the diagnosis.

Treatment Options for Plantar Fibromas
A plantar fibroma can usually be treated successfully with conservative treatments such as custom orthotic devices, physical therapy, topical medications, and steroid injections. While the tissue mass never truly disappears with non-surgical treatment methods, the pain can be effectively relieved using these measures.

Orthoses, often know as orthotics or custom-made arch supports, are inserts for your shoes that mechanically correct the foot, as well as support the deformed area, therefore reducing the discomfort. Orthotics usually last several years before your foot prescription may change. In the case of custom orthoses for fibromas, the orthoses are usually customized with special areas of padding to relieve the pressure on the painful fibromas.

When is Surgery Needed?
Should the mass continue to grow in size or the conservative treatments prove ineffective at relieving the patient’s pain, then surgical removal of the plantar fibroma may be required. Although surgical correction often relieves the problem, it can potentially lead to complications such as nerve entrapment, a painful scar, and recurrence of the problem. Additional fibromas can develop even after removal of any existing lesions.

Posterior Tibial Tendon Dysfunction

Posterior tibial tendon dysfunction, or PTTD as it is more commonly called, is a condition that occurs when the posterior tibial tendon in the foot becomes overextended and inflamed. When this occurs, the foot’s arch is inadequately supported and the patient may develop flatfoot. The posterior tibial tendon is essential for supporting the foot and helping the foot function while walking, so injuries to this tendon can make it difficult to walk or stand comfortably.

Also called “adult-onset flatfoot,” PTTD is one of the most common types of flatfoot diagnosed in adults. Posterior tibial tendon dysfunction is progressive, so early treatment is highly recommended in order to minimize the pain and instability caused by it.

Signs and Symptoms of Posterior Tibial Tendon Dysfunction
Common signs and symptoms of early onset posterior tibial tendon dysfunction include:
• Pain along the inside of the foot
• Inflammation and redness
• Swelling
• Flattening of the arch
• An inward rolling of the ankle
As the condition worsens, the signs and symptoms will change. For instance, there may still be pain experienced along the inside of the foot, but eventually the pain will shift to the outside of the foot as well. The toes will also start turning outward and the ankle will continue to roll inward. As the condition continues to worsen, most patients develop arthritis in the affected foot and ankle.

What Causes PTTD and How is It Diagnosed?
The most common cause of PTTD is simply overuse of the tendon. Therefore, runners, climbers, hikers, and other types of athletes are high-risk candidates for developing posterior tibial tendon dysfunction.

Diagnosis is made after closely examining the affected foot or feet and after reviewing the patient’s medical history. Imaging tests such as X-rays, MRIs, CT scans, and ultrasounds may also be ordered to help in the diagnosis of PTTD.

Non-Surgical Treatment Options for Posterior Tibial Tendon Dysfunction
PTTD can be effectively treated without surgery if treatment is administered by a professional foot and ankle surgeon as early on in the condition’s development as possible. Common conservative treatment techniques include:
• Rest
• Icing down the foot and ankle
• Non-steroidal anti-inflammatory medications
• Steroid injections
• Leg cast or walking boot immobilization
• Braces
• Orthotics
• Physical therapy

When is Surgery Needed?
If the condition has progressed to the point that conservative treatment techniques prove ineffective, then surgery may be recommended by the foot and ankle surgeon. There are several different types of procedures that can be used to help treat PTTD, including a tendon transfer, a gastrocnemius recession which lengthens the Achilles tendon, a tenosynovectomy, an osteotomy, and bone fusion. While most patients respond very well to surgical intervention, they should expect to still experience pain in the foot for up to 12 months after their surgery.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Puncture Wounds

Puncture wounds are different than cuts on the foot. Whereas a cut is a slice in the skin of the foot, a puncture wound is a hole that can be as deep as the object that punctured the foot. Unfortunately, although these types of wounds are among the most common types of foot injuries experienced, they are among the least likely to be treated properly as most people choose to forego treatment for something they deem insignificant.

The problem with this is that a puncture wound can result in infections or other complications, like foreign material being left behind in the foot after removal of the object. Because of this, it is very important to have the foot examined by a foot and ankle surgeon within 24 hours of the puncture occurring.

Common Causes for Foot Puncture Wounds
Puncture wounds in the feet are most common during the spring and summer months when people are more likely to wear thin footwear like sandals or to go barefoot. Objects that are commonly responsible for puncturing the foot include:
• Glass
• Nails
• Sewing needles
• Medical needles (such as those for administering insulin)
• Toothpicks
• Wood splinters
• Seashells
• Thumbtacks

Why are Puncture Wounds in the Feet Dangerous?
When a foreign object pierces the skin of the foot, there is a very good chance that dirt and debris such as skin, pieces of sock or shoe, and pieces of the object itself can be forced into the foot. This results in puncture wounds being classified as “dirty wounds.” If these unsanitary particles remain in the foot, they can cause additional problems, with some being serious, in the future.

How is a Puncture Wound Treated?
Proper treatment of a puncture wound in the foot begins with a thorough cleaning of the wound. Then, as the wound is healing, additional examinations should be performed by a foot and ankle surgeon to monitor the healing progress and to look for any signs of infection or other complications. Wound cleaning and treatment by a foot and ankle surgeon is recommended for all puncture wounds in the feet, even if treatment was already administered in an emergency room.

What to Do When You Suffer a Puncture Wound in the Foot
1. Seek medical treatment immediately
2. Get a tetanus shot as soon as possible (should have one every five years)
3. See a foot and ankle surgeon within 24 hours of the injury
4. Avoid putting any weight on the injured foot
5. Follow your doctor’s directions for caring for your foot
6. Keep the dressing clean and dry
7. Monitor your temperature regularly
8. Take your antibiotics as directed if prescribed and finish the complete course of treatment
9. Call your doctor immediately if you experience a fever or notice pain, swelling, or redness at the site of the injury

Rheumatoid Arthritis

Rheumatoid arthritis, or RA, is a systemic disease that causes the body’s immune system to attack itself. Rather than protecting the body’s joints, the body’s immune system produces substances that inflame and destroy the joints.

RA is a painful and degenerative condition that is usually first noticeable in the toes and fingers. In fact, more than 90% of people who suffer from rheumatoid arthritis experience pain, swelling, and stiffness in their toes and ankles.

What Causes Rheumatoid Arthritis?
The exact cause of rheumatoid arthritis is unknown, although research does suggest that one’s genes and family medical history play significant roles. In most cases, the disease is triggered by a chemical or environmental change.

Signs and Symptoms of RA
Common signs and symptoms of rheumatoid arthritis in the feet include:
• Pain and inflammation in the joints
• Swelling in the toes or around the ankle
• Difficulty bending the joint
• Difficulty walking
• Formation of corns or bunions
• Formation of lumps around the joints
• Loss of appetite
• Fever
• Lack of energy

How is Rheumatoid Arthritis Diagnosed?
Rheumatoid arthritis can be difficult to diagnose because so many of its symptoms can be mistaken for other illnesses. The foot and ankle surgeon will perform a thorough examination of the patient’s feet and ankles. He or she will also review the patient’s personal and family medical history. Blood tests are usually ordered to determine the patient’s rheumatoid factor, which is usually elevated in most cases of RA, and to check the patient for anemia, which is another common sign that the patient may have RA. X-rays may also be ordered to evaluate the extent of deformity or damage to the joints.

Non-Surgical Treatment Options for Rheumatoid Arthritis
If a patient is determined to have rheumatoid arthritis, then the foot and ankle surgeon will usually refer him or her to a rheumatologist for specialized medical treatment of the disease. Meanwhile, the foot and ankle surgeon may prescribe special shoes to the patient to help make it easier to walk, or a cane, crutches, or orthotic devices may also be used. Exercise is very important for those with RA, so the foot and ankle surgeon may recommend physical therapy or provide the patient with certain exercises they can perform at home.

When is Surgery Needed?
In some cases where the deformity or loss of cartilage is severe, the foot and ankle surgeon may recommend surgical intervention in order to help improve foot function and alleviate the pain. Surgery is also sometimes used to treat bunions and hammertoes resulting from RA. There are a number of different surgical options available, including fusion and arthroplasty. It is important to note that since RA is a chronic and progressive disease, the long-term success of such surgeries is not entirely known.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

Sprains

A sprained ankle is an injury to the ligaments in the ankle caused by “rolling” the foot. Rolling of the foot occurs when foot twists inward or outward depending on the direction of the force being applied. This usually occurs when the foot is pivoting on the heel or when pushing off with the plantar in a flexed position. Common causes of sprains include walking, running, or jumping on an uneven surface or when a laterally directed force is applied to the foot thus causing the ligaments to stretch beyond their normal range.

Classifications of Ankle Sprains
There are three classifications of sprained ankle injuries – Grade1, Grade2, and Grade 3. In a Grade 1 sprain, there is slight stretching and minor damage to the fibers of the ligament. Common signs and symptoms include minimal tenderness and swelling. In a Grade 2 strain, a partial tearing of the ligament occurs, resulting in decreased range of motion, instability, and moderate swelling and tenderness. Grade 3 is the most severe type of sprain. This involves a complete rupture of the ligament which results in severe instability and significant pain and swelling.

How is an Ankle Sprain Diagnosed?
Since a severe sprain can be symptomatically similar to an ankle fracture, the foot and ankle specialist will usually order X-rays of the injured ankle to rule out any fractures. A complete physical examination of the foot will also be administered. In some cases, once the swelling and bruising resolve, a MRI may also be ordered to verify the severity of the damage to the ligaments.

Non-Surgical Treatment Options for Sprains
Most ankle sprains can be treated without requiring surgery. Grade 1 sprains are usually treated by resting the ankle, applying ice to the injury, wrapping the ankle in compression dressing to help stabilize the foot, and keeping the foot elevated above the level of the heart for 48 hours. Non-steroidal anti-inflammatory medications are also usually prescribed to help reduce pain, swelling, and inflammation.

Grade 2 sprains are treated in the same manner, however because of the extended time needed to recover; a splint or immobilization device may be used to help prevent the ankle from moving.

Treatment for Grade 3 sprains usually consist of a short leg cast or a cast-brace for two to three weeks.

As the recovery progresses, rehabilitation exercises and ultrasound or electrical stimulation can also be administered to help reduce pain and swelling in the foot. Proprioception training and agility drills may also be added to the rehab to help increase strength, range of motion, and balance.

When is Surgery Needed?
Surgery to repair a sprained ankle is rare, but not an impossibility. In some cases where the patient does not respond to conservative treatments, the foot and ankle specialist may recommend surgery. There are two types of surgery usually associated with sprains – arthroscopy and reconstruction.

An arthroscopy is when the surgeon cleans out the joint, removing any loose bone fragments or pieces of cartilage. This procedure is also used when the ligament is caught in the joint itself.

A reconstruction is when the surgeon repairs the ruptured ligament using sutures or stitches. In some cases, the surgeon may use other ligaments or tendons in the foot and around the ankle to repair the torn ligament.

Regardless of the case, you surgeon at Pennsylvania Foot and Ankle Associates will discuss all of the conservative and surgical treatment options available to you so you can make the most informed decision about your treatment plan.

It is important to seek professional medical treatment with any injury or problematic issue in the feet, ankles, or legs as many of the above conditions can take years to develop and will worsen over time if treatment is not administered. If you are experiencing pain in the foot or discomfort in your lower leg or your ankle, please contact the office nearest you to schedule an appointment today.