Tag Archive for: foot pain

Tarsal Tunnel Syndrome

Because the symptoms of tarsal tunnel syndrome (TTS) can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated. That’s why the place to start is with one of the accomplished and highly skilled specialists at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. Without treatment, TTS can lead to nerve damage. If you develop nerve damage, it can be permanent and irreversible. You may have difficulty walking, exercising, or performing your daily activities. Delayed treatment often requires more aggressive interventions. That’s why you should see Advanced Orthopedics now.

OVERVIEW

Tarsal tunnel syndrome (TTS), otherwise known as tibial nerve dysfunction or posterior tibial nerve neuralgia, is a compressive neuropathy of the foot caused by entrapment of the tibial nerve as it passes through the tarsal tunnel. While nerve compression syndromes like carpal tunnel syndrome are common in the wrist, the same type of compression in the foot is less common. This makes tarsal tunnel syndrome somewhat rare and often underdiagnosed. Some facts include:

  • Women are approximately 3 times more likely to develop it
  • Peak age of onset is 40-60 years old
  • More common in middle-aged women
  • Contributing Factors for Female Predominance
  • Women typically have smaller tarsal tunnels
  • Hormonal influences (similar to carpal tunnel syndrome)
  • Higher rates of inflammatory conditions
  • More likely to have flat feet (pes planus)
  • Higher prevalence of rheumatoid arthritis
  • Occupational Factors
  • Jobs requiring prolonged standing
  • Professions with repetitive ankle movements
  • Work that involves sustained plantar flexion
  • Anatomical Considerations
  • Higher rates of ankle instability
  • Greater foot mobility/flexibility
  • Prevalence and Risk Factors in Athletes:
  • Most common in runners and athletes who do a lot of jumping or cutting movements
  • More frequent in athletes with flat feet (pes planus) or high arches
  • Can be triggered by overtraining, especially on hard surfaces
  • Often seen alongside other conditions like plantar fasciitis or posterior tibial tendonitis

THE TARSAL TUNNEL

The tarsal tunnel – the source of tarsal tunnel syndrome – is a narrow space that lies on the inside of the ankle next to the ankle bones, known as the tarsal tunnel.  The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel—arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome. Specifically, the tarsal tunnel is formed by:

  • Ankle bones: The tunnel is bordered by the medial malleolus (the bony prominence on the inside of the ankle) and the calcaneus (heel bone).
  • Ligaments: The flexor retinaculum is the key ligament that forms the roof of the tarsal tunnel, covering and protecting the structures within.

Within the tarsal tunnel, the posterior tibial nerve branches out into smaller nerves that innervate the foot, providing sensation and motor function. The tunnel protects these nerves and structures, but swelling, inflammation, or other issues can lead to conditions such as tarsal tunnel syndrome, resulting in pain, numbness, or weakness in the foot.

The tarsal tunnel itself has four separate compartments, not just one continuous tunnel as often assumed. Each compartment has its own unique risk factors for compression. The tibial nerve helps carry sensory and motor function messages from your brain to 21 different muscles in the lower part of the leg.

WHAT IS TARSAL TUNNEL SYNDROME?

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space. While nerve compression syndromes like carpal tunnel syndrome are common in the wrist, the same type of compression in the foot is less common. This makes tarsal tunnel syndrome somewhat rare and often underdiagnosed. It is most common in runners and athletes who do a lot of jumping or cutting movements.

Read more about Tarsal Tunnel Syndrome on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with an foot and ankle specialist today.

Post Tibial Tendon Dysfunction

Post-tibial tendon dysfunction (PTTD) is a painful condition. Without treatment, the collapsed flat foot that develops from PTTD eventually becomes rigid, and arthritis develops in the foot and ankle. Post tibial tendon dysfunction is usually progressive, which means it will keep getting worse, especially if it isn’t treated early. The place to get the right diagnosis and the very best treatment is from the experts at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. Their experience with PTTD is unmatched.

OVERVIEW

The average adult takes 4,000 to 6,000 steps per day. Considering the weight and stress placed on the feet each day, it’s easy to see how approximately 80% of people will experience a foot-related problem at some point during their lives. Post-tibial tendon dysfunction is also known as posterior tibial tendonitis or posterior tibial tendon insufficiency and is most currently renamed progressive collapsing foot deformity (PCFD). It often occurs in women over 50 and may be due to an inherent abnormality of the tendon. Post tibial tendon dysfunction is the most common cause of adult-acquired flatfoot deformity. Although this condition typically occurs in only one foot, some people may develop it in both feet.

ABOUT TENDONS

Approximately 25% of the bones in the body are found in the feet. The foot is a complex mechanical structure of the human body composed of 33 joints, 26 bones, and over a hundred muscles, ligaments, and tendons that all work together to bear weight, allow for locomotion, and transmit force. Tendons are flexible, cord or rope-like bands of connective tissue that connect muscles to bones. They essentially work as levers to move one’s bones as muscles contract and expand. When one contracts (squeezes) the muscle, the tendon pulls the attached bone, causing it to move. When the tendon is injured or breaks down, it may no longer be able to support the arch, making specific movements difficult. These movements may include standing, walking, running, or standing on the toes.

WHAT IS POST-TIBIAL TENDON DYSFUNCTION?

One of the many tendons is the posterior tibial tendon. This tendon originates in the calf and extends down to the inner part of the ankle, where it is connected to the bone in the middle of the foot. Posterior tibial tendon dysfunction (PTTD) is a condition that leads to inflammation or a tear in the tendon. When the tendon is damaged, it can no longer support the arch of the inside of the foot. There are four posterior tibial tendon dysfunction stages:

  • Stage I: The tendon is stretched or injured but otherwise intact.
  • Stage II: The tendon is torn (ruptured) or not working properly. The foot is deformed.
  • Stage III: The foot is significantly deformed. There are degenerative changes to the connective tissue (cartilage) in the back of the foot.
  • Stage IV: There are degenerative changes to the ankle joint. In this stage, the ankle and foot both become deformed, and there may be arthritis in the ankle.

The inability of the tendon to support the arch of the foot leads to a condition known as a “flat foot.” The American Academy of Orthopedic Surgeons defines a flat foot as a condition in which the foot’s arch lies flat on the inner side and the foot points outwards. PTTD is often called adult-acquired flatfoot because it is the most common type of flatfoot developed during adulthood.

Read more about Post Tibial Tendon Dysfunction on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with an foot and ankle specialist today.

Mortons’ Neuroma

With Morton’s Neuroma, what may start out feeling as if you’ve got a pebble in your shoe can progress and have serious consequences. This thickening of the tissue around one of the nerves leading to the toes can lead to long-term nerve damage and permanent loss of sensation. Typically, there’s no outward sign of this condition, such as a lump, so many people just ignore it. But the more a digital nerve is subjected to constant pressure, the protective tissue that sheathes it just continues to thicken to the point of restricting all weight-bearing activities. Morton’s Neuroma won’t go away on its own. This is why you should start with a consultation with a skilled foot and ankle orthopedic specialist at the Colorado Center of Orthopedic Excellence in Colorado Springs, Colorado.

OVERVIEW

Morton’s Neuroma is a common condition of the foot that affects women around 8-to-10 times more than men. Females are at much higher risk because the anatomical construction of a female foot is inherently higher and narrower which exposes the metatarsals to extra pressure and strain. Morton’s Neuroma typically affects people between the ages of 30 and 60, although it can occur outside of this age range as well. Morton’s Neuroma symptoms are typically on one side of the foot, usually between the third and fourth toes, but the pain can extend outwards or even involve the whole side of the foot. Rarely, a foot may contain two separate Morton’s neuromas. Studies have shown that up to 33% of all patients with pain in the ball of the foot have untreated Morton’s Neuroma.

ABOUT THE FOOT

The foot is a complex mechanical structure composed of 33 joints, 26 bones, and more than a hundred muscles, tendons, and ligaments.  The foot plays a crucial role in mobility, supporting the body’s weight, absorbing shock, and facilitating propulsion. It adapts to various surfaces and movements, such as walking, running, jumping, and balancing. The nerve branches in the forefoot at the level of the web spaces between the toes are called common digital plantar nerves. Due to its complex structure and heavy use, the foot is prone to various problems including Morton’s Neuroma.

WHAT IS MORTON’S NEUROMA?

A neuroma is a growth or tumor of nerve tissue. The most common neuroma in the foot is a Morton’s Neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. Intermetatarsal describes its location in the ball of the foot between the metatarsal bones. Morton’s Neuroma is not a typical nerve tumor. It is a benign tumor caused by nerve degeneration and thickening of plantar digital nerves due to entrapment, such as compression and squeezing or exposure to chronic pressure.

Read more about Morton’s Neuroma on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with a foot specialist today.

Peroneal Tendon Injury

Your ankle relies on your peroneal tendons for stability so when they are somehow injured, it creates a perfect storm for an unstable joint. At times, an injured peroneal tendon can heal with conservative treatments. Still, if left untreated, complications can develop that can have a negative impact on your life and your ability to get around. Peroneal tendon injuries need to be high on the differential diagnosis list of patients who are seen with persistent pain after an ankle injury. There are treatments that can help, especially when you get that help from the foot and ankle specialists at the Colorado Center of Orthopedic Excellence in Colorado Springs, Colorado. You can trust their experts to give you the best of care.

OVERVIEW

Peroneal tendon injuries refer to injuries involving the peroneal muscles and/or the peroneal nerves which are located in the lower leg on the outside of the calf expanding to the foot. Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. Basic types of peroneal tendon injuries are tendonitis, tears and subluxation (one or both tendons have slipped out of their normal position. Peroneal tendon injuries may occur suddenly or develop over time.

ABOUT PERONEAL TENDONS

To understand peroneal tendon injuries, it’s essential first to understand what the peroneal tendons do. A tendon is a cord of strong, flexible tissue, similar to a rope, often referred to as a “mechanical bridge” connecting muscles to bones. This allows the transmission of muscle strength to the bones and joints.

The peroneal tendons are two tendons that run side by side along the outside of the ankle behind the fibula bone. One attaches along the outermost part of the mid-foot. The other peroneal tendon travels under the foot and adheres to the arch. The purpose of tendons is to connect muscles to bones to allow for smooth movements. Together, they serve to move the foot inward and outward to help stabilize the ankle joint. Because the two peroneal tendons lie on top of each other, they create a lot of friction with movement, which often causes problems like tendonitis or tendon rupture.

WHAT ARE PERONEAL TENDON INJURIES?

Common peroneal injuries include:

  • Peroneal tendonitis: inflammation of the tendons and the protective sheath surrounding them
  • Tendinopathy: the presence of both a tendon tear and tendinitis
  • Peroneal tendinosis: degenerative tears which usually affect peroneal tendons slowly, over a period of years
  • Peroneal tendon tears: partial or complete tear of peroneal tendon
  • Peroneal tendon subluxation/dislocation: peroneal tendons slip out of normal position
  • Ankle sprains: the peroneal tendons can be injured, especially if the foot is forcefully turned inward

Read more about Peroneal Tendon Injury on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with a foot and ankle specialist today.

Bunion? Hammer toe? Ingrown toenail? What’s causing my foot pain?

Does foot pain dominate your day-to-day life? Whether you’re on your feet all day at work, put in a lot of miles on hard surfaces, or are feeling the consequences of unforgiving shoe styles, you don’t have to live with foot pain! Bunions, hammer toe, and ingrown toenails are three common causes of foot pain that can be addressed, often with non-surgical solutions. Learn more about causes, prevention and treatment options for all three.

Bunions

What causes bunions?

A bunion is a bony bump that develops slowly at the base of your big toe due to inward pressure on your toe joint, or arthritis. Bunions are very common – especially among women. In fact, almost one fourth of adults (age 18-65) have bunions. That number goes up to more than one third if you’re over 65.

Pressure pushes the top of your big toe toward your other toes, which in turn pushes the base of your toe outward, eventually causing a bump. Over time this bump – and the pain that comes with it – tend to get more extreme. 

How are bunions treated?

Typically, your orthopedic specialist will recommend non-surgical options first. These include adding padding or inserts to your shoes to reduce the pressure and changing the types of shoes that you wear to an option that doesn’t put pressure on your toes. Other non-surgical options include taking an anti-inflammatory medication.

When surgery is needed: When your bunion pain is too great to walk or wear shoes and other treatments are not helping enough, your doctor may recommend bunion surgery. Surgical methods may vary depending on your bunion, but generally serve to realign the joint and bring the big toe back to its intended position. Surgery is typically done on an outpatient basis.

Hammer toe

While bunions involve the big toe or baby toe (called a bunionette), hammer toe impacts any of the middle three toes. As the name implies, the toe takes the shape of a hammer as it bends at the middle joint. Poor fitting shoes, paired with other factors, are often the culprit in hammer toe cases too. Pressure forces the toe into a bent position and over time the muscles cannot straighten.

What’s the best treatment for hammer toe?

It’s important to seek diagnosis and treatment of a hammer toe, because they are more easily corrected when not severe. When left untreated, they are more likely to become rigid and require surgery. Treatment again starts with wearing shoes that better fit your forefoot.  Avoiding narrow shoes, and especially high heels with narrow toe boxes is especially important. 

There’s also physical therapy for your toes! This includes stretches and even exercises that strengthen your toes to allow them to return to their intended resting position. You can practice picking things (like a marble) up off the floor or use your toes to scrunch a cloth or towel. There are also a variety of pads and cushions that might help relieve your symptoms too.

If exercise and shoe changes do not help, surgery can be performed to straighten the joint. This is also an outpatient procedure with a fairly short recovery.

Ingrown toenail

Ingrown toenails – a condition where skin grows over the side of the nail or the nail begins to grow into the skin – often cause swelling and pain. It’s most commonly seen on the big toe.  You can prevent ingrown toenails or at least minimize their likelihood by being careful not to cut your nails too short and avoiding rounding their shape at the corners. Trauma, or shoes that are too short or too tight can also contribute to ingrown toenails. 

Ingrown toenail treatment

Because they are painful, people typically want to treat them quickly. This is also a good idea to avoid infection and the need for further treatment. You can soak your foot in warm water to ease the pain but be sure the foot is clean and dry at other times. Again (surprise!) wear comfortable shoes, or even sandals. If you can (gently) separate the toenail from the skin, you can use a bit of cotton swap or dental floss to create some separation while it heals.  Make sure you change this wrapping out daily and keep it clean to avoid infection.

If you have considerable swelling, pain or puss, an infection is likely, and you should see a doctor. They can either partially or fully remove the nail and prescribe antibiotics if necessary.

Whether one of these three foot conditions matches up with your symptoms or not, taking great care of your feet should always be a priority.  If you have chronic foot pain that’s impacting your ability to work, walk or exercise, it may be time to see a podiatric specialist. Schedule a time to come see us (in roomy comfortable shoes, of course)!

Dr. Fred Hainge is one of CCOE’s board-certified podiatric surgeons specializing in foot and ankle conditions.

Foot Care for Arthritis Tips

Arthritis is an inflammation of the joints. When our joints become inflamed, it can cause pain, tenderness, swelling, and stiffness.

Arthritis in the feet and ankles can be especially painful and bothersome, affecting how we walk and function on a daily basis. While there are many different types of arthritis, there are three types that most often cause foot and ankle pain.

These types of arthritis are osteoarthritis (known as just “arthritis,” or wear-and-tear/aging arthritis), rheumatoid arthritis (an autoimmune disease), and post-traumatic arthritis (caused by an injury or fracture).

How Arthritis Affects the Feet and Ankles

Our feet each have more than 30 joints – many of them are tiny. The joints in our feet that are most commonly affected by arthritis are:

  • The joint where the ankle and shin bone meet
  • The joint where the big toe meets the foot bone
  • The joints connecting to the heel bone, inner mid-foot bone, and outer mid-foot bone

Symptoms of foot and ankle arthritis can include trouble walking or weight-bearing.

Ways to Care for Your Feet

If you’ve been diagnosed with foot and ankle arthritis, there are several treatment options available. Let’s talk about these different options and what they entail.

Nonsurgical Treatment Options for Foot Arthritis

Your doctor may try several things before deciding on surgery. Nonsurgical treatment options include:

  • Steroids injected into the joint
  • Anti-inflammatories and pain relievers
  • Physical therapy
  • Weight control
  • Joint-supporting canes
  • Foot/ankle braces
  • Arch supports
  • Orthotics

Your physician may even recommend a combination of those treatments to see what works best for you.

Custom Shoes

Perhaps the most important way to care for your feet and ankles if you have arthritis is to wear shoes that are comfortable, supportive, and properly sized for your feet. When searching, you should ensure that the shoes you buy:

  • Have good heel counter and arch support
  • Have extra cushioning in the mid-soles and outer-soles
  • Have nonslip outsoles
  • Are flexible
  • Can be worn with padded socks (without feeling too tight)
  • Have rubber soles
  • Are shaped like your feet
  • Are not slip-ons or high heels 

Exercise

If you’re suffering from foot and ankle osteoarthritis, the last thing you may want to hear is that you should exercise. However, believe it or not, exercise can help relieve pain in your feet.

Exercise can also help keep your feet and ankles strong and flexible. Your orthopedist or physical therapist can show you exercises that can help with your foot and ankle arthritis, such as big-toe stretches, toe pulls, toe curls, and Achilles stretches.

Self-Care

When it comes to your body, no one knows it better than you do. As such, there are self-care steps you can do to help keep your feet healthy in order to control your foot and ankle arthritis, including:

  • Daily foot inspections
  • Daily foot washes with lukewarm water (be sure to completely dry off your feet afterward)
  • Avoiding exposure by always wearing shoes
  • Not cutting your own toenails
  • Not cutting or filing corns, calluses, or other foot protrusions
  • Not using harsh chemicals on your feet (such as wart removers)
  • Staying active to maintain good circulation

Surgery

If other treatment methods have not proven effective to treat your foot and ankle arthritis, your orthopedist may recommend surgery.

This can include fusion surgery, which involves fusing bones together using screws, pins, rods, and/or plates. Another type of surgery is joint replacement surgery, which involves replacing all or part of the arthritic joint with an artificial implant (prosthesis).

Orthopedists in Colorado Springs

Is your foot arthritis getting you down? The board-certified doctors at Colorado Center of Orthopaedic Excellence are here to help you care for your arthritis and any orthopedic issues you may have. We pride ourselves in providing the best care possible and delivering that care with compassion and respect.

Call us today at (719) 623-1050 to request a consultation, or use our online appointment request form right now. We look forward to helping you live a more active lifestyle with less pain, so you can get back to the life you love.

Podiatrist vs. Orthopedist

When you have a problem with your foot or ankle that needs medical attention, where do you go – to a podiatrist or an orthopedic surgeon? And does it make a difference?

To answer those questions, let’s first look at what each of these specialists do.

A podiatrist is a doctor of podiatric medicine (DPM), specifically a specialist whose focus is strictly on foot and ankle care. That includes treatment of such conditions as:

·       Bunions

·       Toe and hindfoot fractures

·       Diabetic ulcers and wounds

·       Plantar fasciitis (inflammation of connective tissue on the bottom of the foot)

·       Hallux rigidus (stiff big toe)

·       Flat feet

·       Gout

·       Toenail disease

·       Heel spurs

·       Athlete’s foot

·       Corns

An orthopedic surgeon is a medical doctor (MD), specifically a specialist whose focus is on the care of bones, muscles, ligaments, tendons and nerves throughout the body – including in the foot and ankle. In regard to the latter, that includes treatment of such conditions as:

·       Achilles tendon tear and repair

·       Ankle replacement and cartilage restoration

·       Bunions

·       Flat feet

·       Plantar fasciitis

·       Heel spurs

·       Morton’s neuroma (nerve inflammation near the toes)

·       Hammer toe, mallet toe, and claw toe deformities

·       Stress fractures

·       Toe fractures

·       Hindfoot fractures

·       Metatarsal (forefoot fracture)

As you can see, both podiatrists and orthopedists perform many of the same foot and ankle procedures. Both are highly trained and qualified to treat foot and ankle conditions both surgically and non-surgically. The only discernible difference between them is that an orthopedist manages parts of the foot and ankle that pertain to the bones, soft tissues and joints, while a podiatrist manages the same areas, but also the biomechanics and dermatology of the foot and ankle. For instance, a podiatrist is often an integral care provider for people with diabetes who have serious concerns about foot health.

So, who do you choose for diagnosis and treatment of your foot or ankle problem?

It often depends on your particular foot or ankle problem – and how comfortable you are with one doctor over another. But it’s a dilemma you don’t have to face at Colorado Center for Orthopaedic Excellence in Colorado Springs. That’s because our practice specializes in both podiatry and foot and ankle orthopedics.

Our board-certified podiatric surgeon Dr. Frederick Hainge is highly skilled in diagnosing and treating structural and biomechanical issues, wounds, toe and foot deformities, nerve pain, and much more.

Meanwhile, fellowship-trained Dr. John Shank and our team of orthopedic physicians help patients manage their foot and ankle conditions through reconstructive procedures, arthroscopic and open fusion surgeries, physical therapy, and other procedures. And it’s all done under one roof.

The Colorado Center for Orthopaedic Excellence in Colorado Springs regularly treats injuries to bones and joints, providing the best of care. If a foot or ankle injury or pain is cause for concern, our board-certified orthopedic surgeons will quickly diagnose and treat the condition. Call us at (719) 623-1050 today for an appointment.