Achilles Tendon

The Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. It also is the most frequently ruptured tendon, usually as a result of a sports injury. Both professional and weekend athletes may suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.

Events that can cause Achilles tendonitis may include:

• Hill running or stair climbing.
• Overuse, stemming from the natural lack of flexibility in the calf muscles.
• Rapidly increasing mileage or speed when walking, jogging, or running.
• Starting up too quickly after a layoff in exercise or sports activity, without adequately stretching and warming up the foot.
• Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort, such as in a sprint.
• Improper footwear and/or a tendency toward overpronation.

Achilles tendonitis often begins with mild pain after exercise or running that gradually worsens. Other symptoms include:

• Recurring localized pain, sometimes severe, along the tendon during or a few hours after running.
• Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone.
• Sluggishness in your leg.
• Mild or severe swelling.
• Stiffness that generally diminishes as the tendon warms up with use.

Treatment normally includes:

• A bandage specifically designed to restrict motion of the tendon.
• Taking nonsteroidal anti-inflammatory medication for a period of time. Note: Please consult your physician before taking any medication.
• Orthotics, which are corrective shoe inserts designed to help support the muscle and relieve stress on the tendon. Both nonprescription orthoses (such as a heel pads or over-the-counter shoe inserts) and prescribed custom orthotics may be recommended depending on the length and severity of the problem.
• Rest and switching to exercises that do not stress the tendon (such as swimming).
• Stretching and exercises to strengthen the weak muscle group in front of the leg, calf, and the upward foot flexors, as well as massage and ultrasound.

In extreme cases, surgery is performed to remove the fibrous tissue and repair any tears.

Ankle Sprains

Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle. The severity of the sprain can impact the degree of damage as well as the type and duration of treatment. If not properly treated, ankle sprains may develop into long-term problems.

Primary symptoms of ankle sprains are pain following a twist or injury, swelling, and bruising.

Treatment includes resting and elevating the ankle and applying ice to reduce swelling. Compressive bandages also may be used to immobilize and support the injury during healing. Serious ankle sprains, particularly among competitive athletes, may require surgery to repair and tighten the damaged ligaments.

To prevent ankle sprains, try to maintain strength, balance, and flexibility in the foot and ankle through exercising, stretching, and wearing well-fitted shoes.

Arthritic Foot & Ankle Care

Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. Although the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.

If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence. However, early diagnosis and proper medical care can limit or slow the damage.

Symptoms of arthritis in the foot and ankle include:

• Early morning stiffness.
• Limitation in motion of joint.
• Recurring pain or tenderness in any joint.
• Redness or heat in a joint.
• Skin changes, including rashes and growths.
• Swelling in one or more joints.

Forms of Arthritis

Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or wear and tear arthritis. Aging usually brings on a breakdown in cartilage, and pain gets progressively more severe. Dull, throbbing nighttime pain is characteristic, and may be accompanied by muscle weakness or deterioration. Many of these symptoms can be relieved with rest. Overweight people are particularly susceptible to osteoarthritis. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.

Rheumatoid arthritis is a major crippling disorder and the most serious form of arthritis. It is a complex, chronic inflammatory group of diseases, often affecting more than a dozen smaller joints during its course. In the foot, it frequently affects both ankles and toes.

Arthritis of the foot and ankle can be treated in many ways, including:

• Physical therapy and exercise.
• Anti-inflammatory medication and/or steroid injections into the affected joint. Note: Please consult your physician before taking any medications.
• Orthotics or specially prescribed shoes.

Athletes Foot

A chronic infection caused by various types of fungus, Athlete's foot is often spread in places where people go barefoot such as public showers or swimming pools. The condition ranges from mild scaling and itching to painful inflammation and blisters. It usually starts between the toes or on the arch and may spread to the bottom and sides of the foot.

General Treatments

Depending on the type of infection you have, various kinds of medication may be used in treating your fungal problem. Successful treatment usually involves a combination of medication and self-care.

If your condition is not serious, over-the-counter and prescription powders, lotions, or ointments can often help treat scaling, itching, and inflammation. Consult us before taking any medication. Foot soaks may help dry excessive perspiration, but you should contact our office first. If your Athlete's foot does not improve, we may prescribe stronger medication.

Bunions

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Valgus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoe.

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain.

Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.

Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

• Protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems.
• Removal of corns and calluses on the foot.
• Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth.
• Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.
• Exercises to maintain joint mobility and prevent stiffness or arthritis.
• Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.

Surgical Treatment

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

Calluses

Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas.

Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist's instructions.

Corns

Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas.

Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist's instructions.

Diabetic Foot

Diabetes is a lifelong chronic disease that is caused by high levels of sugar in the blood. It can also decrease your body's ability to fight off infections, which is especially harmful in your feet. When diabetes is not properly controlled, damage can occur to the organs and impairment of the immune system is also likely to occur.

With damage to your nervous system, you may not be able to feel your feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which can lead to an abnormal pressure on the skin, bones, and joints of the foot during walking and other activities. This can even lead to the breakdown of the skin of the foot, which often causes sores to develop. If you have diabetes, it is important to prevent foot problems before they occur, recognize problems early, and seek the right treatment when a problem does happen.

Diabetic Complications and Your Feet

When it comes to your feet, there are several risk factors that can increase your chances of developing foot problems and diabetic infections in the legs and feet. First of all, poorly fitting shoes are one of the biggest culprits of diabetic foot complications. If you have red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new proper fitted shoes must be obtained immediately. Additionally, if you have common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or orthotics from your podiatrist may be necessary to further protect your feet from other damage.

People who have long-standing or poorly controlled diabetes are also at risk for having damage to the nerves in their feet, which is known in the medical community as peripheral neuropathy. If you have nerve damage, you may not be able to feel your feet normally and you may also be unable to sense the position of your feet and toes while walking and balancing, which can cause even more harm to your feet.

Normal nerves allow people to sense if their shoes are too tight or if their shoes are rubbing on the feet too much. With diabetes, you may not be able to properly sense minor injuries, such as cuts, scrapes and blisters-all signs of abnormal wear, tear, and foot strain. The following can also compromise the health of your feet:

• Poor circulation
• Trauma to the foot
• Infections
• Smoking

Diabetes can be extremely dangerous to your feet, so take precautions now. You can avoid serious problems such as losing a toe, foot, or leg by following proper prevention techniques offered by your podiatrist. Remember, prevention is the key to saving your feet and eliminating pain.

Flat Feet

Flat feet are a common condition of the foot structure. In infants and toddlers, prior to walking, the longitudinal arch is not developed, and flat feet are normal. Most feet are flexible and an arch appears when children begin standing on their toes. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches.

Flat feet are generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).

Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated.

Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.

Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive flatfoot. Note: Please consult your physician before taking any medications. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

Fungus Toenails

Since fungal nails are usually more resistant and more difficult to treat than Athlete's foot, topical or oral antifungal medications may be prescribed. Permanent nail removal is another possible form of treatment for fungal nails.

After a fungal nail infection has cleared up, you can take steps to prevent the infection from coming back.

Keeping the fungus under control will help prevent a fungal infection of the skin from reinfecting the nail. Before bed, thoroughly wash and dry your feet, and apply a non-prescription anti-fungal cream to the entire foot from the ankle down. Use the cream every night, then gradually apply it less often. Keep your feet dry. Dry feet are less likely to become infected. Apply powder to your dry feet after you take a shower or bath.

Other tips:

• Don't share nail clippers or nail files with others.
• Don't share shoes or socks with others.
• Try not to injure your nail, such as by cutting it too short (trauma to the nail may lead to infections).
• Wear dry cotton socks, and change them two or three times a day if necessary.
• Wear dry shoes that allow air to circulate around your feet (tight, enclosed, moist shoes contribute to fungal toenail infections).
• Wear shower sandals or shower shoes when you are at a public pool or shower.

Prevention

Follow basic foot care guidelines and you more than likely can head off most common foot fungus problems.

Geriatric Foot Care

It's normal for people to experience some foot problems as they age. But experts say that problems with feet can be the first sign of more serious medical conditions, particularly among older adults. Health problems, such as arthritis, diabetes, nerve issues, and circulatory disorders, may first be manifested in the feet. That is why it is important to pay attention to your feet and seek medical attention as soon as you notice a problem.

Here are some foot care tips for older adults:

• Practice good foot care. Check your feet regularly or have a member of your family check them for you.
• Keep blood circulating to your feet as much as possible. Do this by putting your feet up when you are sitting or lying down, stretching if you've had to sit for a long while, walking, having a gentle foot massage, or taking a warm foot bath.
• Wear comfortable shoes that fit well to prevent pressures that can lead to friction and infection and keep your foot structure properly aligned.
• Avoid exposing your feet to cold temperatures.
• Don't sit for long periods of time (especially with your legs crossed).
• Don't smoke because it decreases blood supply and increases the chance of swelling and other circulatory problems.

Hammertoes

Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Causes of hammertoe include improperly fitting shoes and muscle imbalance.

Treatment for the condition typically involves wearing shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions, or nonmedicated corn pads may also relieve symptoms.

In severe cases, hammertoe surgery may be recommended to correct the deformity.

Heel Spurs

Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.

Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy. Note: Please consult your physician before taking any medications. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat the heel pain.

Infections

Athlete's Foot and fungal nails are the most common fungal problems with feet. A fungus is a common mold that thrives in dark, warm moist areas. On the feet, it can grow on and between toes, as well as on soles and toenails. Fungal problems can be a result of the environment (socks, shoes, heat, and humidity) or weakened immunity from disorders such as diabetes.

Chronic fungal infections are most common in adults, while acute fungal infections are seen more often in children.

Ingrown Toenails

Ingrown toenails, also known as onychocryptosis, is usually caused by trimming toenails too short, particularly on the sides of the big toes. They may also be caused by shoe pressure (from shoes that are too tight or short), injury, fungus infection, heredity, or poor foot structure. Ingrown toenails occur when the corners or sides of the toenail dig into the skin, often causing infection. A common ailment, ingrown toenails can be painful. Ingrown toenails start out hard, swollen, and tender. Left untreated, they may become sore, red, and infected and the skin may start to grow over the ingrown toenail.

In most cases, treating ingrown toenails is simple: soak the foot in warm, soapy water several times each day. Avoid wearing tight shoes or socks. Antibiotics are sometimes prescribed if an infection is present. Note: Please consult your physician before taking any medications. In severe cases, if an acute infection occurs, surgical removal of part of the ingrown toenail may be needed. Known as partial nail plate avulsion, the procedure involves injecting the toe with an anesthetic and cutting out the ingrown part of the toenail.

Ingrown toenails can be prevented by:

• Trimming toenails straight across with no rounded corners.
• Ensuring that shoes and socks are not too tight.
• Keeping feet clean at all times.

Injuries

According to the American Academy of Orthopaedic Surgeons, doctors have noticed an increase in the number and severity of broken ankles since the 1970s, due, in part, to the Baby Boomer generation being active throughout every stage of their lives.

The ankle has two joints, one on top of the other, and three bones. A broken ankle can involve one or more of the bones, as well as injury to the surrounding connecting tissues or ligaments.

There are a wide variety of causes for broken ankles, most commonly a fall, an automobile accident, or sports-related trauma. Because a severe sprain can often mask the symptoms of a broken ankle, every ankle injury should be examined by a physician.

Symptoms of a broken ankle include:

• Bruising.
• Swelling.
• Immediate and severe pain.
• Inability to put any weight on the injured foot.
• Tenderness to the touch.
• Deformity, particularly if there is a dislocation or a fracture.

The treatment for a broken ankle usually involves a leg cast or brace if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to secure the bones in place so they will heal properly.

Metatarsalgia

Pain in the area between the arch and toes, or ball of the foot, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this mid-portion of the foot. Also known as dropped metatarsal heads, metatarsalgia can cause abnormal weight distribution due to overpronation.

Metatarsalgia occurs when one of the metatarsal joints becomes painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia also can be caused by arthritis, foot injury (from sports, a car accident, or repeated stress), hard surfaces (cement or tile floors), and specific footwear (rigid-soled work boots).

A simple change of shoes may solve the problem. In more severe cases, custom orthotics may be prescribed to alleviate the pain and prevent overpronation.

Neuromas

A neuroma is an enlarged, benign growth of nerves, most commonly between the third and fourth toes. Neuromas are caused by tissue rubbing against and irritating the nerves. Pressure from poorly fitting shoes or an abnormal bone structure can also lead to this condition. Symptoms may include sensations of thickness, burning, numbness, tingling, or pain in the ball of the foot. Treatments generally include wearing corrective shoes or orthotics and/or receiving cortisone injections. In severe cases, surgical removal of the growth may be necessary.

Morton's neuroma is a thickening of tissues around the nerve that leads to the toes. Morton's neuroma usually develops between the third and fourth toes in response to irritation, such as that caused by wearing high-heeled or narrow shoes, or from trauma. Symptoms may include a burning pain that radiates from the ball of the foot to the toes or numbness in the toes. Conservative treatments usually resolve the pain or progressions of the condition, and range from wearing roomier, lower-heeled footwear or using orthotics to reduce the pressure on the nerve, to injections of corticosteroid medication to reduce swelling and inflammation.

Plantar Fasciitis

Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.

Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy. Note: Please consult your physician before taking any medications.

Poor Circulation

Chilblains are caused by the skin's abnormal reaction to cold. Circulation is a determining factor for chilblains; people with poor circulation in the feet are more susceptible.

Chilblains are characterized by small itchy, red swellings on the skin, which become increasingly painful, swell, and dry out, leaving cracks in the skin and exposing the foot to the risk of infection. They occur on the extremities—the toes (particularly the smaller ones), fingers, the face (especially the nose), and the ear lobes. They can also occur on areas of the feet exposed to pressure, such as on a bunion or where the second toe is squeezed by tight shoes. Symptoms include burning and itching, swelling or redness, breaks in the skin, and ulcers.

Treatment includes keeping the body, legs, and feet warm, especially for individuals who have poor circulation and/or limited mobility.

Calamine lotion will take away most of the skin discomfort. If chilblains become ulcerated, application of an antiseptic dressing is the recommended form of treatment.

SWIFT Wart Treatment

Are you tired of dealing with pesky warts? We at Kelley Podiatry are very excited to announce that we have a brand new and effective treatment for surface based skin lesions, primarily warts.

Plantar warts; a common and stubborn Viral Infection

“Plantar” means “Of the sole” in Latin. Unlike other types of warts, plantar warts are typically quite painful as the pressure from walking and standing forces them to grow into your skin. Like all warts, Plantar warts are caused by the human papillomavirus (HPV) virus, specifically types 1, 2, 4, 60, and 63. Underneath the skin, the wart can have finger-like roots that reach down and grow, making them very difficult to treat effectively from the surface.

What is Swift?

Swift is a cutting edge, FDA Cleared technology that has proven to be highly effective in the removal of plantar warts. It delivers low dose microwave energy through a specialized probe that targets and effectively treats the underlying HPV virus by stimulating a natural immune response in the body. We like to say that we’re addressing the root cause; not the symptom.

What to Expect

Swift protocol involves between 3 and 4 treatments, spaced 4 weeks apart; aligning with the body’s natural immune cycle. Each treatment lasts only 5-10 minutes and is what we call a “sock off - sock on” treatment: Limited debridement, no breaking of the skin, no bandages. No home treatment is required between treatments and patients are able to resume daily activities immediately post treatment.

How effective is Swift?

Due to Swift harnessing the power of the patient’s immune system to target the root cause of the wart (HPV), efficacy is significantly higher compared to other treatment methods. For more information on Swift and how it compares to traditional methods, visit https://www.warttreatmentinfo.com/

Does it hurt?

While pain is variable and patient/lesion specific, most patients typically feel some level of discomfort as infected tissue temperatures are rapidly elevated over a 2 second dose of energy. The pain immediately subsides following cessation of energy delivery and there is very limited post procedural pain, in fact some report an immediate reduction in pain levels. All patients are about to continue on with day-to-day activities immediately following treatment.

When you should come to see us

It’s important to visit a podiatrist if you suspect or feel that you have a plantar wart and are seeking removal. The longer you wait to seek treatment, the more likely the wart is to persist. Here are some common symptoms to look out for:

• You may get the feeling of “painful pebbles” in your shoes.
• You may experience pain when you compress the sides of the wart.
• You may see a circular flat spot on the skin with a depressed area in the middle.
• They may appear “yellowed” with a crust; small black dots can be an easy give away.
• The lesion on your foot is painful, bleeding, or has changed color.
• Treatments you have tried do not work, and the wart reoccurs or multiplies.
• Discomfort that prevents you from doing regular activities.
• Poor sensation in your feet.
• You are unsure if the lesion is a wart.

What to do Next?

If you would like to (a) get rid of your warts and/or (b) explore Swift Treatment, please book a consultation with us either online https://www.kelleypodiatry.com/request-appointment/ or by calling us on (800) 554-5124. One of our specialists will be happy to help.

Warts

Most foot warts are harmless, even though they may be painful. They are often mistaken for corns or calluses, which are layers of dead skin that build up to protect an area which is being continuously irritated. A wart, however, is caused by a viral infection which invades the skin through small or invisible cuts and abrasions. Foot warts are generally raised and fleshy and can appear anywhere on the foot or toes. Occasionally, warts can spontaneously disappear after a short time, and then, just as frequently, they recur in the same location. If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of warts. Children, especially teenagers, tend to be more susceptible to warts than adults.

Plantar warts, also known as verrucas, appear on the soles of the feet and are one of several soft tissue conditions that can be quite painful. Unlike other foot warts, plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries. They are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. Plantar warts are often contracted by walking barefoot on dirty surfaces or littered ground. The virus that causes plantar warts thrives in warm, moist environments, making infection a common occurrence in public pools and locker rooms.

Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading. Plantar warts that develop on the weight-bearing areas of the foot (the ball or heel of the foot) can cause a sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

To prevent the spread of warts, follow these tips:

• Avoid direct contact with warts, both from other persons or from other parts of the body.
• Avoid walking barefoot, except on sandy beaches.
• Change your shoes and socks daily.
• Check your children's feet periodically.
• Keep your feet clean and dry.

It is important to note that warts can be very resistant to treatment and have a tendency to reoccur. Over-the-counter foot wart treatments are usually ineffective because their use can inadvertently destroy surrounding healthy tissue. Please contact our office for help in effectively treating warts. Our practice is expertly trained in recommending the best treatment for each patient, ranging from medications, freezing (cryotherapy) or in the most severe cases, surgical removal.

Wounds

Ulcers are skin wounds that are slow to heal. In the foot, as prominent metatarsal heads on the plantar (bottom of the foot)are subjected to increased pressure, the skin begins to become callused. When subjected to shearing forces, there is a separation between the layers on this callused skin, which fills with fluid and becomes contaminated and infected. The result is a foot ulcer.

Ulcers are classified in four stages, according to how deeply they penetrate the layers of skin they have broken through.

The four stages of ulcers are:

• Stage 1—Characterized by reddening wounds over bony areas. The redness on the skin does not go away when pressure is relieved.
• Stage 2—Characterized by blisters, peeling, or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin.
• Stage 3—Characterized by broken skin and sometimes bloody drainage. There is a full thickness skin loss involving subcutaneous tissue (the tissue between the skin and the muscle.)
• Stage 4—Characterized by breaks in the skin involving skin, muscle, tendon, and bone and are often associated with a bone infection (osteomyelitis).

The are also four major causes of foot ulcers:

• Neuropathic—Related to the nerves and characterized by a loss of sensation in the feet.
• Arterial—Related to poor blood circulation to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel, and top of the foot. It can very easily become infected.
• Venous—Related to compromised veins. These ulcers are often seen around the inside of the ankle and are slow to heal.
• Decubitus—Derived from excessive and prolonged pressure on one area of the foot. The most common type of decubitus ulcer of the feet is bed sores on the backs of the heels of people confined to bed for long periods of time.

Foot ulcers are a common problem for diabetics. Contact casts are sometimes applied to the diabetic foot to relieve the bony prominent areas of pressure, allowing ulcers to heal.