common foot and ankle injuries: you don’t have to suffer!

Foot and Ankle Injuries: You Don’t

Have to SufferWarren A. Chiodo, DPM

Summit Medical Group- Berkeley HeightsBensley Pavilion, 2nd Fl.

Understand what a Podiatrist is and how they can help you

Understand that painful feet and ankles are not normal and can indicate/lead to bigger issues

Understand why you are having foot and ankle pain

Understand what treatment options are available to resolve your foot and ankle pain

Objectives

Dermatological◦ Plantars warts◦ Fungal nails and

Athlete’s feet◦ Melanomas and

other cancerous lesions

Biomechanical Bunions and

hammertoes Heel pain Flat Feet and High

arches

Categories of Foot and Ankle Issues

Sports Medicine and Trauma◦ Ankle Sprains◦ Achilles Tendonitis◦ Ankle Fractures◦ Foot fractures

Pediatrics◦ Clubfoot◦ Flat feet◦ Calcaneal

Apophysitis (heel pain)

◦ Foreign bodies

Categories of Foot and Ankle Issues

Systemic Problems◦ Diabetes Mellitus

Peripheral Vascular Disease

Neuropathy

◦ Rheumatoid Arthritis◦ Gout

Categories of Foot and Ankle Issues

Plantar Warts◦ Caused by virus◦ Can be found in

gyms, locker rooms, pools, salons

◦ Can be painful if on weight bearing surface of foot

Dermatological Issues

Treatments◦ 1st Visit: Biopsy and

topical treatment◦ Subsequent Visits:

Debridement and repeat applications of topical treatments

◦ Possible surgical excision, oral anti-viral, or topical anti-viral as needed

Dermatological Issues

Onychomycosis◦ Fungal infection of

nails Generally occurs after

any microtrauma to nail plate that exposes nail bed

Athlete’s Foot (Tinea pedis)◦ Fungal infection of

skin

Dermatological Issues

Onychomycosis Tinea Pedis◦ Prescription topical

anti-fungal solutions, gels, creams, lotions

◦ Over-the-counter creams and powders

◦ Soak in tea tree oil or tanic acid (black tea)

Dermatological Issues

Melanomas and Other Cancerous lesions

Benign Skin Lesions

Dermatological Issues

PUNCH BIOPSY!!

May require surgical intervention or referral for further oncological workup

If benign, can continue to observe or excise

Dermatological Issues

Bunions and Hammertoes

Biomechanical Issues

Bunions and Hammertoes◦ Conservative Care

Injection therapy Toe sleeves Alternative shoe gear Custom Molded Orthoses

◦ Surgical Intervention Generally considered the only long-term treatment

for symptomatic bunions and hammertoes

Biomechanical Issues

Bunion surgery

Biomechanical Issues

Heel Pain a.k.a Plantar Fasciitis◦ Caused by excessive strain on the ligament on

bottom of foot◦ May develop a heel spur◦ Generally worst when getting up from rest or

after long periods of activity◦ Pulling, sharp pain in bottom of heel or

throughout the arch

Biomechanical Issues

Plantar fasciitis◦ Injection therapy

1-3 injections

◦ Stretching Daily

◦ Icing Frozen bottle of water

◦ Custom Molded Orthoses

◦ Night splint◦ Physical Therapy

Biomechanical Issues

Plantar fasciitis◦ 90% of people get

resolution of symptoms with conservative care

The unlucky 10% have minimally invasive options◦ Radiofrequency◦ Platelet rich plasma◦ Shockwave therapy◦ Fasciectomy with or

without heel spur resection

Biomechanical Issues

Ankle Sprains◦ Generally caused by

twisting ankle towards outside (inversion)

◦ Can damage ligaments and tendons

◦ Common in sports or when you least expect it

Sports Medicine and Trauma

X-rays Ambulatory cast

CAM Walker Gameday Brace REST, ICE,

ELEVATION Physical Therapy

Sports Medicine and Trauma

Ankle Sprains◦ Generally 4-6 week

recovery◦ Should see steady

improvement◦ If no improvement,

may need an MRI

Sports Medicine and Trauma

Achilles Tendonitis◦ Pain at insertion on

posterior heel or lower leg

◦ Due to overuse and/or excessive tightness

◦ Could lead to rupture if chronic degeneration of tendon

Sports Medicine and Trauma

Achilles Tendonitis◦ Immobilization with

heel lift◦ Stretching and icing◦ Prolotherapy

Injection therapy◦ Night Splint◦ Physical Therapy◦ Surgical Intervention

Sports Medicine and Trauma

Ankle Fractures Foot Fractures

Sports Medicine and Trauma

Foot Fractures If no displacement, can try conservative care

If displaced or unstable, requires surgical intervention

Complications: non-unions, mal-unions, post-traumatic arthritis

Sports Medicine and Trauma

Clubfoot◦ Typically 1st born

child◦ Requires serial

casting ASAP◦ May require surgical

intervention

Flat Feet◦ All foot bones are

not developed until 6 yrs of age

◦ Can be flexible or rigid

◦ If rigid, may require CT or MRI

Pediatrics

Flat feet◦ Normal ligamentous

laxity◦ How do I know if my

child’s flat foot is a problem or normal?

◦ If rigid Coalition- abnormal

joint fusion Tendon spasm

Stretching Physical Therapy Orthotics

Surgical Intervention??

Pediatrics

Calcaneal Apophysitis◦ Heel pain in children◦ Generally seen in

active children during activities

◦ May occur in overweight children

Pediatrics

Foreign Bodies◦ Splinters, needles,

glass

May be taken out and irrigated in office◦ Aftercare may

include soaking and topical antibiotic vs. oral antibiotic

May require surgical procedure if deep

Pediatrics

Diabetes Mellitus◦ Routine foot

examinations◦ Vascular studies◦ Nerve conduction

studies◦ Wound Care◦ Diabetic Shoes and

Insoles

Systemic Diseases

Rheumatoid Arthritis◦ Leads to foot

deformity Custom molded

orthoses Injection therapy for

pain Possible Surgical

intervention

Gout◦ Uric Acid causing

inflammation of joint◦ Generally seen in

big toe joint◦ Treated with

injection therapy or anti-inflammatories

Systemic Diseases

Thank you!!!

Any Questions???

The End!