What is Podiatry?

Podiatry is the branch of medicine which specializes in the treatment of medical and surgical conditions of the foot and ankle. Although the scope of practice does vary from state to state, in Ohio podiatry is defined as “the medical, mechanical and surgical treatment of ailments of the foot, the muscles and tendons of the leg governing the functions of the foot, and superficial lesions of the hand other than those associated with trauma.”

Podiatrists in the state of Ohio are medical specialists in the treatment of medical conditions of the foot and ankle, and surgical specialists in the corrections of orthopedic conditions of the foot and ankle.

There are a multitude of common foot problems. Some of the more common foot problems involve such simple problems as routine foot care, ingrown toenails and warts. More complex problems may involve diabetic ulcers/infections, and major surgical procedures for conditions such as tendinitis or flat feet. Other common problems include heel pain, neuromas and bunions.

Corns/calluses are a thickening of the outer layer of the skin that form in areas of increased friction or pressure. Corns will usually form on toes as a result of increased pressure because of improper fitting shoes or deformities of the toes. Calluses will usually form on the ball of the foot, and commonly result from excessive activity or weight-bearing on hard surfaces, or underlying bony abnormalities.

Conservative treatment may include periodic debridement of the thickened skin, padding, changing shoes or lifestyle modifications. Surgery may be indicated if conservative measures fail. Surgical procedures are geared toward removing the cause of the lesion, which may include removing spurs, straightening hammertoes and/or bunion correction.

Ingrown toenails are a result of the borders of toenail applying excessive pressure on the surrounding skin. This pressure may even lead to a break in the skin and subsequent infection. Ingrown toenails may result from tight fitting shoes, trauma, improper nail trimming, abnormal nail structure or fungal infection.

Treatment may be as simple as trimming the corner of the nail.  If the area has become infected, this may require trimming the nail border and removing any infected tissue under local anesthetic and/or oral antibiotics. A recurrent or chronic ingrown toenail may need to have the side of the nail permanently removed. These procedures are performed in the office, and rarely result in loss of work.  

Warts are a viral infection that affects the outer layer of the skin. They often present as a callous like growth with pinpoint black dots. They may be solitary or in clusters. Treatment for warts may include topical medication, oral medications, surgical curettage or laser therapy. With any treatment for these lesions, there is always a chance of reoccurrence.

Hammertoes describe a contracted or curled up position of single or multiple toe joints, frequently on both feet. The cause of the contracted position of the toes is usually from abnormalities in the structure and function of muscles and tendons. Tight or poor fitting shoes may contribute to formation of these deformities.

Conservative treatment is limited to wider and good fitting shoes, splinting and padding.  Associated corns may be debrided or padding for symptomatic relief. Surgical intervention is reserved for cases in which conservative treatment does not adequately control symptoms. Surgery may include tendon transfers or release, fusion of the knuckle into a straightened position, or removal of prominent bone to allow the toe to assume a more straightened position.

There are several common sources of heel pain, including stress fractures of heel bone, Achilles tendinitis and plantar fasciitis. 
    
Plantar fasciitis is the most commons cause of heel pain.  The plantar fascia is a large ligament like structure, which originates from the heel bone and inserts in the ball of the foot. Plantar fasciitis develops when this ligament begins to develop small micro tears, resulting in painful inflammation. There are a variety of factors that may lead to this, including a lowered or elevated arch, trauma, overuse or poor foot mechanics. The pain associated with this condition is most pronounced with the first step in the morning or after prolonged sitting. Classically, one will experience a sharp pain with the first few steps, which does diminish but not completely resolve after several steps.
    
Treatment may include stretching exercises, anti-inflammatory medications, cortisone injections, supportive shoes, custom inserts and surgery.

Neuromas frequently cause numbness, burning or shooting pain in the ball of the foot, which may radiate into the toes. It is caused by thickening of a nerve in the ball of the foot from repetitive trauma. This may be caused by bones in the foot rubbing together, as a result of excessive activity or tight fitting shoes.
    
Treatment may involve X-rays to rule out osseous pathology, cortisone injections to reduce inflammation, padding, taping, proper shoes or orthotics. Some cases may ultimately require surgical excision of the inflamed portion of the nerve.

A bunion most commonly affects the big toe joint. They develop when the big toe shifts laterally and impinges upon the second toe, and rotates in a counterclockwise direction. Retrograde pressure of the big toe results in prominence of the bone along the inside of the foot. Symptoms from a bunion may include shoe pressure on the prominent bone or bump pain. Also painful calluses, hammertoes, ingrown toenails or pain in the ball of the foot may occur.
    
Various factors may lead to the development of bunion deformities. Poor or tight fitting shoes may contribute. Family history is frequently contributory, as well as altered biomechanics. The deformity does tend to progress and increase in severity with time.
    
Initial treatment is primarily conservative and aimed at symptomatic relief. It includes wider and good fitting shoes, anti-inflammatories, lifestyle modification or padding. Surgery may be required in a bunion deformity and is reserved for cases where the symptoms are not controlled by conservative means.

Degenerative, or osteoarthritis, is the most common type of arthritis in the foot and ankle. Symptoms of arthritis tend to start slowly but often steadily increase over a period of months to years. They may include anything from stiffness in the morning, aching and throbbing, swelling around the joint, to overt pain. Movement of the joint frequently becomes limited if bone spurs form around the joint. Causes of osteoarthritis in the foot include trauma, wear and tear and misalignment of the foot/joints.
   
Treatment is initially aimed at reducing pain. It may include ice, anti-inflammatory medications or cortisone. Stiff shoes or inserts may limit symptoms by reducing movement of the involved joint. Surgery is indicated if symptoms begin to limit patient activities. Surgery may include trimming or shaving bone spurs, realigning the joint,  joint fusion or implants. 

Tendinitis is inflammation of a tendon, a strong fibrous structure that connects muscles to bone. This may develop behind your ankle or on either side of the foot. If symptoms continue to progress or remain untreated, it may ultimately result in rupture of the involved tendon. These symptoms may develop as a result of overuse, poor biomechanics or foot structure, or trauma. Conservative therapy may involve ice, anti-inflammatories, limitation of activities, physical therapy, rest, bracing, good fitting shoes or custom orthotics. In severe cases, surgery may be required to repair the damaged tendon and/or correct abnormal foot structure.

Flat feet refer to a reduced height of the medial longitudinal arch. It is frequently associated with bulging of the bone below the ankle bone on the inside of the foot, outward tilting of the heel bone, and/or the toes pointing outward. Symptoms vary widely in flat feet. In children, growth pains, tired legs, or inactivity may be a sign of flat feet. Cramping and fatigue are also frequent complaints in children and adults. Most of these complaints are going to be associated with the multitude of muscle/tendon imbalances and joint derangements present with flat feet. These muscle/tendon and joint derangements subsequently result in an increased frequency, earlier onset, and severity of other foot problems, which may include arthritis, tendinitis, bunions, neuromas and hammertoes.
    
Conservative treatment for this condition may include anti-inflammatory medications, stretching exercises or custom supportive orthotics. Surgery designed to correct the alignment of the foot is reserved for severe deformities or when symptoms are not controlled by conservative measures.