Learn more about the anatomy of your feet.
Many people experience pain and discomfort from injury, overuse, or functional conditions of the feet and ankles. Check out this interactive foot model to learn more about the complexities of the foot.Contact Us
Calluses & Corns
Bunions (hallix valgus)
Crossover Toe & Hammertoe
Achilles Tendon Disorders
Plantar Fasciitis or Fasciosis
Tibial Tendon Dysfunction
Chronic Ankle Sprain
A neuroma, or pinched nerve, is a painful condition caused by a benign growth of nerve tissue most often found between the third and fourth toes. It brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot. Neuromas are generally associated with pain between the toes which is brought on by walking, and the patient may describe the pain as similar to having a stone in their shoe. Most people who develop neuromas are women.
Conservative treatment should include total contact orthotics specifically to address neuromas and transfer pressure off of the ball of the foot. These orthotics would include metatarsal pads or a metatarsal bar. Shoes should also be evaluated for width issues. A rocker sole shoe modification may be prescribed to offload this area and to address pain by limiting the range of motion.
Heel Spurs are painful bony growths located on the underside of the heel. Visible by X-ray, heel spurs can protrude as far as half an inch from the heel bone. Heel spur syndrome is characterized by pain in the same area with no indication of bone enlargement.
Heel spurs are caused by foot muscle and ligament strain when the band of tissue that connects the heel and the ball of the foot is excessively stretched or repeat tears of the membrane that covers the heel bone. They can be caused by running, improperly fitted shoes, biomechanical imbalance, or obesity. A custom foot orthotic with a soft Poron type material or a horse shoe cut-out may be added to the orthotic for heel offloading. The footwear will also be evaluated to determine if it could be the cause.
Extensor tendonitis is characterized by the painful inflammation of the extensor tendons that are located on the top of the foot. These tendons have little padding to protect them from injury.
Pain from extensor tendonitis is typically located near the midpoint of the top of the foot and often increases as the injury becomes progressively worse. For most patients, only one foot is affected, but some experience symptoms in both feet. The pain usually builds gradually as use of the injured tendon continues.
Extensor tendonitis can be worsened by excessive activity, tight shoes that press against the top of the foot, or running uphill. Many times, the wearers shoe is packed out and contributing to the problem. I like to evaluate the shoe midsole to determine if there needs to be a change. Also, custom total contact orthotics with a deep heel cup, paired with a supportive shoe, helps to relieve the pain.
Calluses & Corns
Corns and calluses are thickened areas of skin that are caused by foot irritation, excess pressure on the foot, or repeated rubbing against the foot, for example, by improperly fitted shoes. Calluses are generally located on the bottom of the foot, whereas corns are often located on top of the foot or between the toes. In addition, calluses are usually flat and wide while corns are thicker or deeper and can involve skin lesions.
Women who regularly wear high heels may develop calluses on the balls of their feet. Patients with foot deformities including hammer toe are more likely to develop corns and calluses. Corns and calluses can become very painful and can lead to more serious foot conditions if patients have diabetes or decreased circulation. Usually a custom foot orthotic with metatarsal raises and cut outs for the problem areas reduce or eliminates these challenges. The shoes also need to be evaluated for excessive rubbing. A different shoe may be recommended with the foot orthotics. For severe cases we use rocker soles or re-last the shoe to fit properly.
Bunions (hallux valgus)
Bunions are a common foot disorder characterized by a bump on the side of the big toe. The bump associated with bunions results from progressive changes to the bony framework of the forefoot, specifically the big toe. Instead of pointing straight ahead, the toe leans toward the second toe causing the bones to become out of alignment and causing the characteristic bump, which gradually becomes more prominent.
Bunions caused by the inherited structure of the foot make some people more likely to develop bunions. Wearing shoes that crowd the toes can cause the disorder to become progressively worse. Many patients suffer from the pain of bunions for years before seeking treatment. Accommodative foot orthotics and therapeutic shoes are often used to accommodate the deformity.
Crossover Toe & Hammertoe
Crossover toe is a common condition in which the second toe leans toward the big toe, eventually crossing over and lies on top of the big toe. It is characterized by pain and swelling in the base of the toe and ball of the foot. This progressive disorder typically occurs over a period of time, but it can appear more quickly due to injury or overuse.
Hammertoe involves the abnormal bending of the joints of the second, third, fourth, or fifth toes. Often worse when wearing shoes, hammertoe includes problems like pain or irritation of the toe and sometimes corns or calluses caused by constant friction against the shoe on the bottom of the toe or ball of the foot that becomes progressively worse over time. In severe cases, open sores may form. We most often use accommodative orthotics with offloads for the hammer toe tips to reduce calluses and pain. We also use an extra depth shoe, bubble patch, or a ball and ring stretcher to accommodate the deformity.
Achilles Tendon Disorders
Two common disorders of the Achilles tendon are Achilles tendonitis (characterized by acute, temporary inflammation) and Achilles tendonosis (progressive degeneration with microscopic tears). Symptoms include pain, aching, or tenderness of the area between the calf muscle and the heel bone. Very rarely chronic degeneration may result in rupture of the tendon.
Both Achilles tendonitis and tendonosis are caused by a sudden increase in repetitive activity which stresses the tendon. Athletes and those with excessive pronation (a flattened arch) have a higher risk of developing Achilles tendon disorders due to increased demands placed on the tendon during walking or running. Custom foot orthotics are often prescribed. A heel rise is a short-term pain reliever. For severe cases, a podiatrist may need to do surgery, while some patients do well with physical therapy.
Plantar Fasciitis or Fasciosis
Plantar facioiosis is a disorder that involves pain of the plantar fascia, a band of tissue that extends from the toes to the heel. Plantar fasciitis impacts the same area and is characterized by inflammation of the plantar fascia. Symptoms include pain at the base of the heel that increases over a period of months.
Plantar fasciitis is generally caused by structural issues of the foot. Those who have arch problems (either high-arched or overly flat feet) may develop the disorder. Both Plantar fasciitis and facioiosis can be caused or made worse by non-supportive footwear worn on hard, flat surfaces. Jobs that require long hours on the feet can also contribute to these conditions.
When custom foot orthotics are prescribed, a patient that has a high arch with a rigid foot will do well with a layer of Poron added to the heel area of the orthotic for cushioning. The shoe should also be evaluated to make sure that it is supportive. If it can be easily twisted, it is worn out and needs to be replaced. We have had great success eliminating this type of foot pain.
Posterior Tibial Tendon Dysfunction (PTTD)
Posterior tibial tendon dysfunction is a common foot and ankle condition which occurs when the tendon becomes torn or inflamed. The condition is characterized by pain and swelling on the inside of the foot and ankle, trouble walking or standing, and pain that is worse with activity. The tendon stabilizes the arch and supports the foot during walking and running. PTTD is often caused by acute injuries or overuse.
As PTTD becomes more advanced, the arch flattens even more, and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably, and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle. In the beginning, a good stable shoe will be recommended with custom foot orthotics, and later an ankle gauntlet will be prescribed to provide support and relieve pain.
Shin splints (medial tibial stress syndrome) are characterized by pain located on the inner edge of the tibia (shin bone) and are a common exercise-related problem that develops from repetitive physical activities like running.
They are caused by inflammation of the tendons, muscles, and bone tissue around the tibia. Shin splints usually occur after sudden changes in frequency, duration, or intensity of physical activity. Patients may also be more likely to develop shin splits if they have rigid arches, flat feet, or exercise with improper footwear.
Runners, dancers, and military recruits are the groups most frequently diagnosed with the condition. Total contact custom foot orthotics are typically prescribed, and your shoes should be evaluated to determine if they need to be replaced. We may recommend a different type of shoe.
Chronic Ankle Sprain
Chronic ankle sprain results from injury to one or more ankle ligaments, most often on the outside of the ankle. These ligaments provide stability by limiting the ankle's side-to-side movement. The severity of ankle sprain ligament damage ranges from stretched, partially torn, or completely torn.
Sprained ankles generally result from a sudden injury that forces the ankle joint out of its normal position, often when participating in sports, walking or running on an uneven surface, or wearing inappropriate shoes. Chronic ankle sprains can also occur because of weak ankles, a condition that is sometimes inherited or when previous ankle or foot injuries may weaken the ankle and lead to future sprains.
Other Foot Conditions
Two peroneal tendons stabilize the foot and ankle and run side-by-side beneath the outer ankle bone. One is located under the foot and attaches near the inside of the arch, and the other attaches to the outer part of the midfoot. Peroneal Tendon injuries are most common in individuals who participate in sports that involve repetitive ankle motion. Injuries may be acute (sudden onset) or chronic (worsening over time). People with high arches may be at a greater risk for developing peroneal tendon injuries which include tears, tendonitis, and subluxation. Tendonitis involves an inflammation of one or both tendons caused by repetitive activities, overuse, or trauma (including ankle sprain). Symptoms of tendonitis include weakness, instability, and pain of the foot and ankle as well as swelling and warmth to the touch.
Inflammation is the body's natural defense in response to an injury, irritation, or surgery and brings increased blood flow to an area of the foot resulting in fluid accumulation. Inflammation can be acute (rapid onset) or chronic (progressing over time) and include pain, swelling, redness or increased warmth of the skin. Acute inflammation is an immediate response to trauma from injury or surgery. Chronic inflammation is ongoing response related to long-term medical conditions like arthritis.
Ulcer and Wound Care
Foot ulcers are painful open sores on the foot often caused by diabetes. Less severe ulcers are shallow red craters involving the surface skin. More severe foot ulcers can become very deep craters that extend through the entire thickness of the skin. Foot ulcers sometimes impact bones, tendons, and other deep structures of the foot. Our goal is always to prevent an amputation. Ulcer and wound healing can be greatly improved by off-loading of weight from the injured area.
Custom accommodative foot orthotics along with extra depth shoes are prescribed. We provide expert offloading to high-pressure areas. For a Charcot foot or any other major foot deformity, we re-last the shoe, changing its shape to accommodate the deformity. We often add rocker soles or excavate and soft fill the midsole of the shoe for additional offloading of the problem area. We may recommend extended steel shanks if more rigidity is required. We use specialty materials to limit shear in the shoe and can do cut outs or spot stretching of the upper for additional relief.
Flatfoot is a complex disorder with diverse symptoms that include partial or total collapse (loss) of the arch of the foot. Other symptoms may include "toe drift," (toes and forefoot point outward), or the heel tilts toward the outside and the ankle appears to turn in. A short Achilles tendon may also be associated with flat foot. Some patients with flat feet also suffer from bunions and hammertoes, and those with diabetes, rheumatoid arthritis, or obesity may have an increased risk of developing flatfoot.
Flexible flatfoot begins in childhood or adolescence and may become progressively severe into adulthood. It typically occurs in both feet and is characterized by inflammation or tears of the tendons and ligaments of the arch. Symptoms may include pain in the arch, heel, ankle, or on the outside of the foot, shin splint pain, "turned-in" ankle, and weakness of the foot or leg.
The tarsal tunnel is located on the inside of the ankle and is covered with a ligament (the flexor retinaculum) that protects associated arteries, veins, tendons, and nerves including the posterior tibial nerve which is central to tarsal tunnel syndrome. Tarsal tunnel syndrome is due to the compression of the posterior tibial nerve that results in symptoms anywhere along the nerve path on the inner ankle and foot.
Patients with tarsal tunnel syndrome may experience symptoms including pain, shooting pain, tingling, burning, and numbness on the inside of the ankle and/or on the bottom of the foot. Symptoms may also extend to the toes, heel, or calf. Symptoms are made worse by overuse of the foot, prolonged standing, walking, and exercising. If left untreated, the condition may progresses to include permanent nerve damage.
Those with flat feet may have greater risk for developing tarsal tunnel syndrome. Typically, a custom foot orthotic is prescribed with a slight heel lift for pain relief and deep heel cups to limit movement of the heel. It must provide total contact to support the arch, effectively reducing collapse.