Podiatrists on average can see anywhere from 5 to 35 patients in a day. There are hundreds of foot conditions but there are a few that are seen over and over. Here are the top 5 issues and the standard treatment suggestions.
Plantar Fasciitis
Plantar fasciitis is undoubtedly the most common foot issue that a podiatrist treats. The plantar fascia is a soft tissue structure on the bottom of our feet. This structure extends from the heel bone and attaches to all five toe joints. The plantar fascia is not very stretchy—it's kind of like a rope; you can wiggle a rope, but you can't stretch it. So, when the arch lowers as we're walking, tension is delivered to this piece of tissue. The pain in the bottom of the heel is caused when the tissue weakens and then finally tears, most often at its insertion point on the heel bone. This tear causes swelling, pain, and inflammation.
Treatment options for plantar fasciitis include activity modification, supportive shoes, arch supports, stretching, and ice. We recommend avoiding all weight-bearing exercise to help resolve plantar fasciitis. You can still bike, swim, or do upper body exercise; however, avoid exercises such as walking, hiking, or tennis. Supportive shoes are critical in healing plantar fasciitis. Think of the shoe as the brace for this injury. The more support the shoe provides, the less work the foot has to do. We encourage wearing shoes with a stable sole, firm heel counter, and laces. A laced shoe provides a better fit, and a better fit means better support.
Arch supports are a must in healing plantar fasciitis. When we walk, all of our arches collapse to some degree; this is called pronation, our built-in shock absorber. When the arch is lowering, it puts added strain and stretch through the plantar fascia. By using an arch support, you can minimize this stretch and strain, and therefore heal the tear quicker. We also recommend stretching your calf muscles daily. The calf muscle turns into the Achilles tendon, which attaches to the back of the heel bone. This tendon continues underneath the heel bone to rethicken and form the plantar fascia; it is all one piece. By stretching the calf muscle, you will reduce the overall tension going through this system, which will make it easier to heal. As simple as it sounds, icing is very effective; too much inflammation around the injury can interfere with healing. Daily ice can reduce the inflammation, which will allow you to heal sooner.
Flat Feet
Whether you were born with flat feet or your flat feet were acquired over time, flat feet may add to increased strain through the soft tissue structures of the foot and ankle such as muscles, ligaments, and tendons. The foot is made up of 26 bones and functions ideally with a stable arch. When we walk, we like the arch to be stable so that it serves as a rigid lever aiding in ambulation. When the arch collapses, such as in flat feet, the soft tissue structures surrounding the bones in the feet are required to work harder to provide this stability. This can cause foot pain related to flat feet.
Treatment for flat feet would include supportive shoes and arch supports. Again, the more support the shoe provides, the less work the foot needs to do. This will aid in alleviating pain related to flat feet. If the flat foot is flexible, an arch support or an orthotic can maintain a normal position of the arch, which in turn would allow the foot to function in a more stable manner.
Tendonitis
Tendonitis is when the tendon or the tendon sheath becomes swollen, which causes associated pain. Tendonitis can be caused by an acute injury, overuse, or secondary to a functional problem of the foot. Temporary immobilization of the inflamed and painful tendon will help to resolve the issue. Also, reducing inflammation by icing and possibly taking anti-inflammatories could help resolve the tendonitis.
Great Toe Joint Problems
There are many issues that happen within the great toe joint; however, the most common are bunions and arthritis. Bunions are a skeletal deformity that results in the big toe joint being unable to function to the capacity that it was designed to. The big toe joint essentially ends up working in a crooked manner. Over time, this may result in swelling and pain of this joint.
A non-surgical approach to resolving bunion pain includes supportive shoes with adequate room in the toe box and again, arch supports or orthotics. The more support the shoe provides to the big toe joint, the less work it has to perform, and therefore, may result in less pain. Arch supports or orthotics can aid in the function and mechanics of big toe joint motion as well as distributing pressure away from that swollen joint.
Toenail Problems
The two most common toenail problems that we see are fungal infections of the toenails or a previously damaged toenail which results in thickening and discoloration; this is known as a dystrophic toenail. Both of these toenail problems can result in pain to the tips of the toes. Local care with antifungal medications or keratolytic medications may help improve the condition of the toenail problem.
Written by Jeffrey Hurless, DPM