Patient’s typically don’t appreciate how important their feet are until they hurt. 80% of people will suffer from a foot or ankle alignment at some point in their life. Foot and ankle pain is not normal and should not be ignored. At Foot and Ankle Physicians of Ohio conservative efforts typically can resolve patient’s discomfort. When this isn’t the case surgical options are available. Below are some of the more common ailments we treat, however when unsure we tell patients “If it’s below your knee we treat it!”.
Plantar Fasciitis is a painful condition affecting the arch and heel. It is caused by a tight Achilles tendon resulting in inflammation and microtearing of the ligament on the bottom of the foot. Typically this condition does not warrant surgical repair, however can predispose patients to stress fractures of the heel as well as complete rupture of the ligament if left untreated. Conservative options include stretching regimens, NSAIDs, injections, orthotic foot inserts as well as physical therapy. Dr. Hewitt is trained in advanced therapies such as endoscopic repair as well as amniotic injections for those who fail conservative options.
Bunions are a malalignment of the great toe joint. This malalignment can occur on the outside of the foot called a “Tailors Bunion”. Hammertoes are when the lesser toes curl. When these deformities are not painful Dr. Hewitt can prescribe modalities that slow the progression of the deformities. When left untreated dislocation of the toe joints can lead to arthritis, nerve irritation, and difficulty finding shoe gear. When painful there are both conservative and surgical options to address the pain and appearance of the feet. Dr. Hewitt is trained in minimally invasive procedures focused on correcting these digital deformities.
Dr. Hewitt treats all foot and ankle fractures having graduated from a Level I Trauma Center and continuing to take call in the hospital setting. Podiatrists treat everything from high velocity injuries such as calcaneal and ankle fractures to midfoot dislocations and fractures as well as small toe fractures. Not all fractures need surgical correction. Radiographs and or more advanced imaging such as MRI or CTs can help decide if the fractured bone is displaced enough to need surgical correction.
Surgical correction of fractures can be performed with both internal fixation such as screws and plates or with external fixation holding fracture pieces in the correct position with wires affixed to the foot from outside the foot. Bone typically takes 6-8 weeks to heal, however with early intervention, advances in fixation, bone stimulation and biologics there are circumstances where your surgeon may be able to progress you back to activities sooner.
Arthritis is the degeneration of cartilage which results in loss of motion, pain, swelling and bony prominences. Arthritis can occur in any joint in the body and may due to gout, rheumatologic diseases, trauma, as well as normal wear and tear on the joint. There are both conservative and surgical interventions available to ease pain and maintain mobility. Based on clinical examination and radiographic review your surgeon may suggest conservative treatment such as injection, bracing and orthotics, anti-inflammatory medications and physical therapy. Surgical options depend on the joint and location in the foot and ankle. Surgery options range from cleaning debris and bony spurs from the joint, replacement and at times fusing the joint.
Dr. Hewitt is certified in Ankle Replacement Surgery, a relatively new option for the treatment of ankle arthritis. She also routinely performs more minimally invasive procedure to help the body regenerate and heal existing cartilage called “Diastasis”. For more information about treatment alternatives for foot and ankle arthritis call 614-782-3668 to schedule a consultation with a foot and ankle physician.
Flat feet, a pronatory foot, or fallen arches, are when one or both feet may be flat on the ground, and shoes may wear unevenly, especially on one side, or they may wear out more quickly than usual. Flat feet can be painful then tendons and ligament fatigue or when the cartilage of the foot joints begins to wear unevenly resulting in arthritis.
There are generally two types of flat feet. Those that are flexible meaning you can recreate an arch with inserts or bracing. Some flat feet are rigid meaning the foot is fixed in a flat position and cannot be moved.
Treatment for flat feet vary depending on severity, pain level, soft tissue and joint involvement. After clinical and radiographic assessment your physician may employ a treatment regimine that can vary. Conservative treatments include immobilization, orthotics, bracing, antiinflamatory medication, injections and physical therapy. When conservative efforts fail surgery is often employed. Dr. Hewitt routinely performs a variety surgical procedures aimed at correcting painful flat feet. Surgery usually addresses both deformed bones as well as correcting injured soft tissues. Recovery time depends on which type of procedures are performed.
Ankle Sprains are among the most common sports related foot and ankle injury. When the ankle turns in or out forcefully the ligaments that hold the ankle joint in place can be torn. These ligaments are like a pound of uncooked spaghetti. Initially just a few spaghetti strands may have cracked with injury. Continued activity or inappropriate rehabilitation may result in complete rupture of the ligament much like breaking the package of spaghetti in half. When the ligaments surrounding the ankle are not tight enough patient’s experience pain, swelling, and often a feeling of being unstable on the ankle or that the ankle may give out on them. Arthritis can also be caused by chronic instability when patients have a history of multiple ankle sprains not rehabbed appropriately. Physicians can assess the degree of tearing based on examination. Xrays need to be taken with initial injury to assure no bones are broken. Once fracture is ruled out the injured ligaments are often immobilized with boots or braces with anti-inflammatory medication administered to decrease swelling and discomfort. Rehabbing the ligaments strong and tight is important to avoid the need for surgical reconstruction in the future.
Surgery typically consists of tightening the ligaments or reattaching them to bone with anchors. At times grafts taken from cadaver or engineered are used to reinforce the repair. Much in the way a knee can be arthroscopically cleaned the ankle can be cleared of inflammation and early arthritic changes in a minimally invasive approach.
Because we are on our feet all day it is common for the tendons to become painful due to overuse, altered biomechanics, or traumatic injury. The largest muscle in the lower leg is the Achilles and commonly injured. Other tendons around the sides of the ankles and top of the feet can also be affected. Tendons typically micro tear and do not completely rupture at onset of pain. Diagnosing these injuries are typically done with clinical examination, radiographic evaluation and at times secondary imagining to show the soft tissues in greater detail such as MRI. Depending on the severity of the injury your Foot and Ankle Surgeon will likely perform some combination of rest, immobilization, anti-inflammatory medication or injection followed by strengthening and correcting the underlying biomechanical pathology that cause the tendon to become injured. At times surgery is warranted to fix or reconstruct the injured tendon.
Loss of sensations, poor blood flow and foot and ankle pressure points or deformity caused by diabetes predisposes diabetics to ulceration, infection and limb loss. Limb preservation in patients with diabetes mellitus is a challenging process that aims to prevent major limb loss in a population often plagued by multiple health risks. More than 60% of nontraumatic amputations are attributed to diabetes, 85% of which are preceded by a foot ulcer.
Prevention is aimed around blood sugar control, periodic foot examinations, callus maintenance, , deformity prevention and accommodation with shoe gear, and patient education. Surgical intervention frequently becomes necessary in the face of infection, remove dead tissue, close chronic wounds, eliminate structural causes of tissue breakdown, and reconstruct deformities.
Neuropathic induces softening of bones and deformity, commonly referred to as Charcot foot, is most commonly encountered in patients with diabetes-induced peripheral neuropathy, but is also encountered in patients with neuropathy secondary to other causes, such as drug and alcohol abuse, HIV, syphilis, and radiculopathy.
Patients with a CHARCOT foot will have xrays findings of progressive bone destruction and joint dislocations that clinically presents as a swollen, red, and hot foot, ankle, or both that somewhat resembles infection. This will result instability and collapse of the foot. If healing fails to restore an acceptable posture following conservative treatment methods, surgical correction becomes necessary to construct a stable straight foot capable of walking and standing. Surgical reconstruction involves removing infected bone and soft tissue, reducing prominent bony structures that pose a risk for tissue breakdown, correcting angulation of bones, and multiple joint fusions using various methods of fixation, including screws, plates, nails, and external halo fixation devices .
Prolonged periods of elevated blood sugars can result in diabetic neuropathy. Neuropathic pain is typically treated with better blood sugar control. When symptoms persist vitamin supplements and medications can be prescribed to help with the pain patients are faced with. In some patients blood sugar control and medication does not sufficiently address pain. Dr. Hewitt often employs surgical decompression or release of chronically scarred down nerves in the lower legs to help regenerate nerve fibers and reduce pain.
Ingrown toenails are a common condition in which the corner or side of a toenail grows into the flesh. The result is pain, redness, swelling and, sometimes, an infection. Ingrown toenails usually affect your big toe. A physician can numb the toe and remove the incurvated piece of nail. This can be made to permanently remove the nail by application of a medication to kill the root. Soaking and wound care instructions are typically dispensed and the procedure can be performed in the office. You may be prescribed antibiotics if there is infection around the ingrown nail.
If you have diabetes or another condition that causes poor blood flow to your feet, you're at greater risk of complications of ingrown toenails including limb loss so seeing a podiatrist immediately is recommended.
Warts are due to a virus and they tend to affect children’s feet more than adults. Plantar warts are easy to catch and they can spread rapidly—they are highly contagious. Worse, plantar warts can be irritating or even painful. Treatments include topical acid applied at home, acid applied in the office by the physician and surgical excision of the wart.
Children’s feet differ from adult feet and have differing needs. Some parents (and even some pediatric specialists) believe children will outgrow a foot problem, and though this may happen, you should not take a chance with your child. If you suspect a pediatric foot problem, have Dr. Hewitt or a competent podiatrist check your child’s feet.
Common Pediatric Children's Foot Problems
Foot problems in your child may appear at birth, shortly thereafter, or once your child is walking. Walking abnormally is often the first sign that something is wrong with your child’s foot or their feet. Adolescents and teenage children may develop foot or ankle problems and these should not be ignored. It is important to watch for any foot deformities or limping in your adolescent or teenage child.
Pediatric Heel Pain
Heel pain in a child is a common problem. One of the first signs you may notice is your child limping. Pediatric heel pain is differs from adult heel pain in that the child’s foot is still growing, and as a result, more flexible.
Your child’s heel pain may be due to an abnormality of the heel bone’s growth area. In these cases, the growth area of the heel bone becomes inflamed, and pain worsens when your child tries to walk or participate in sports. Conservative treatment for heel pain in children is almost always successful and centers around changing the pull of muscles around the inflamed growth plate.
In-toeing or Out-toeing in Children
In-toeing is often referred to as walking pigeon-toed. Instead of the foot pointed straight-ahead, the foot turns inward. Sometimes in-toeing occurs with only one foot, or it may affect both feet. The child may limp, stumble or even trip and fall when running or walking. In-toeing may be due to a structural issue with the foot itself or related to the leg or hips.
Out-toeing is the reverse of in-toeing, where the child’s foot points outward when they are walking. Again, this problem can affect one or both feet, and it can cause the child to stumble or even fall when running or walking.
Both in-toeing and out-toeing are considered structural problems and when these problems are caught early they are easy to correct. Most parents are able to spot in-toeing or out-toeing in their child, usually shortly after the child begin to walk.
Toe-Walking in Children
Some toddlers or even older children may walk more on their toes or the front of the their foot, rather than putting their heel down on the ground. The child who toe-walks may appear to “bounce” as they walk.
This problem may be due to bone abnormality in the child’s foot or a neurologic issue, though more often is due to the tendon at the back of the leg, called the Achilles tendon, being too short.
Most of the time, a tight Achilles tendon can be treated conservatively, though in severe cases Dr. Hewitt can perform a surgical procedure to help lengthen the Achilles tendon.
Bunions in Children
Some people mistakenly believe bunions is an “old person’s” problem. The truth is many children develop bunions. Often a child develops a bunion secondary to another, more significant, deformity of the foot.
Most of the time, bunions in children can be treated without any type of surgery. It is important for parents to bring in their child as soon as they see a bunion beginning to form. In some cases, surgery may be necessary based on severity, pain level and xray findings.
Flatfeet in Children
A pediatric Flatfoot is common foot problem. A flatfoot is a foot that has a very low arch or no height to the arch. A child with a flatfoot may or may not have pain. Flatfeet are related to the development of all kinds of foot, ankle and leg pain and problems. Your child may have difficulty walking or may complain of “tired” feet.
Physicians must first decide if the flat foot is flexible, meaning it can move, or rigid, meaning the joints in the back of the foot do not move freely. This can be decided with clinical exam, xrays and sometimes MRI or CT scanning. Treatment is based off this delineation and range from orthotics to help raise the arch to surgery to create an arch.
Ingrown Toenails in Children and Plantar warts
These are commonly seen in children and treated similar to when seen in the adult population.
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