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Achilles Tendinopathy

Achilles Tendinopathy

The Achilles tendon is a strong cord made of fibrous connective tissue that attaches the calf muscle to the calcaneus, or heel bone. The Achilles tendon is located at the lower end of the calf muscles, and it is the continuation of the gastrocnemius and soleus muscles. This tendon is one of the strongest tendons in the body and is essential for performing many occupational and recreational activities, especially athletic activities.

Condition Information

Achilles tendinopathy (a condition commonly—though erroneously—referred to as Achilles tendinitis) involves pain along the Achilles tendon. MRI studies reveal that this condition is characterized by collagen degeneration, not inflammation, in the affected area, as has been previously thought. This health problem can affect any part of the tendon, though it most commonly occurs at the point where the Achilles tendon attaches to the heel bone or less than 1 inch above this point. Shoes that continuously rub on the back of the heel may irritate the Achilles tendon and heel bone, causing a condition known as Haglunds Deformity or Pump Bump.

Pain experienced from this condition can only be relieved by addressing the underlying source of the problem: footwear. Most conventional running shoes are designed with more cushion at the heel, lifting the heel up. This decreases the Achillies tendon functional length, changing structural integrity and length-to-tension relationships of several posterior calf muscles. In addition, shoes that are too short in heel-to-toe length or shoes with a heel counter may rub and cause pain. Excessive motion of the heel bone during walking and other activities may also be a factor in this health problem. Examine the inside of the shoe’s heel counter to see if the material at the back of the heel is worn away.

Causes and Symptoms

Some of the most common causes of Achilles tendinopathy include:

  • Conventional footwear
  • Rapid increase in training volume and/or intensity among runners, walkers, and other athletes (i.e., excessive repetitive overload of the Achilles tendon)
  • Rapid transition from running shoes with heel elevation to racing flats or spikes
  • Tight calf muscles (especially the deep flexor muscles in the back of the lower leg)
  • Arthritis and bone spurs (more common among middle-aged individuals and seniors)
  • Certain antibiotics and corticosteroids
  • Age, gender, weight, foot shape, and gait

Achilles Tendinopathy caused by a rapid increase in training volume or intensity is called overuse Achilles tendinopathy. Transitioning too quickly from shoes with heel elevation (including running shoes and high heels) to shoes with little heel elevation may cause Achilles tendinopathy. This transition provokes the Achilles tendon to adapt and stretch up to 1 inch in length. Stretching forces along the Achilles tendon to pull at the insertion point, causing irritation and pain.

Often overlooked as a cause of Achilles tendinopathy is the role of footwear and foot position within the shoe. In particular, the position of the toes has a significant effect on the attachment area of the Achilles tendon. Toe spring—a toe and foot deforming feature built into most conventional footwear—can cause tensioning in the Achilles tendon and restrict blood flow to the back of the ankle, which is a major cause of tissue degeneration in this area.

Common signs and symptoms associated with Achilles in particular include:

  • Pain and stiffness along the Achilles tendon, typically worse in the morning and with activity
  • Extreme pain following exercise
  • Achilles tendon thickening
  • Bone spur formation
  • Observable changes in gait

Treatment

The first and most important step in the conservative and natural management of Achilles tendinopathy involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation, and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows the calf deep flexor muscles to engage more fully, off-loading the Achillies tendon. This foot and toe position helps optimize circulation in the foot tissues and encourages a balance in tissue tone between your toe flexor and extensor muscles/tendons.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. This is especially true for individuals accustomed to shoes with heel elevation. Additional treatments for Achilles tendinopathy include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Relative rest
  • Eccentric calf loading exercises of a “sensible” training program
  • Massage
  • Physical therapy
  • Hydrotherapy

Achilles tendinopathy is a serious health problem and should be treated immediately to help avoid complications. Achilles tendinopathy, if left untreated, may lead to prolonged pain and scar tissue formation. Scar tissue can decrease Achilles tendon flexibility and increases the likelihood of experiencing a complete rupture.

Arthritis

Arthritis

Arthritis is the general term used to describe joint pain. There are numerous types of arthritis that may manifest in your body. Arthritis, including arthritis in your foot and ankle joints, can occur at any age, though certain types of arthritis may be more common in older or younger individuals. There is no cure for this health problem, although there are many treatment options available. Treating arthritis in its early stages may better help manage symptoms, help to maintain a high quality of life, and avoid surgery or certain health complications.

Condition Information

Three principle types of arthritis may cause pain and other symptoms in your feet or ankles, including:

  • Osteoarthritis: A form of degenerative joint disease from wear and tear, causing cartilage to become worn and frayed. The most common type of arthritis affecting feet and ankles.
  • Rheumatoid Arthritis: An autoimmune condition, symptoms are commonly located in toes or forefoot.
  • Post-Traumatic Arthritis: May occur after an injury to the foot or ankle. Develops most frequently following a fracture or severe ligament sprain.

Causes and Symptoms

Foot and ankle arthritis may be caused by numerous factors, and the underlying cause of your arthritis depends on the specific type of arthritis you have. Factors that contribute to osteoarthritis include advanced age, bone deformity, muscle imbalances, obesity, sedentary living, and a family history of this condition. Other health problems—diabetes, Paget’s disease, underactive thyroid—may also increase the likelihood of developing osteoarthritis. Rheumatoid arthritis is an autoimmune condition whose true cause is unknown. Like other autoimmune conditions, rheumatoid arthritis is a health problem in which the immune system targets and attacks healthy joint tissues. Post-traumatic arthritis develops following direct trauma or injury to the impacted joint.

Common signs and symptoms associated with foot and ankle arthritis include:

  • Pain within involved joint
  • Joint tenderness and stiffness
  • Bone spurs
  • Swelling
  • Joint deformity and instability

Treatment

Foot and ankle arthritis cannot be cured, although many treatment methods, including conservative measures, may be beneficial in controlling symptoms. The first step in the conservative and natural management of any form of arthritis involves a departure from conventional footwear and towards naturally shaped footwear. Avoid toe spring, heel elevation, and tapering toe boxes when selecting footwear. Natural footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread. This foot and toe position helps optimize circulation and mobility in foot tissues, which encourages stiff and arthritic joints to warm and move with greater ease. Possible additional treatment techniques include:

Progressive changes to naturally shaped footwear

  • Correct Toes; to improve circulation, alignment, and flexibility of toes
  • Lifestyle changes like routine exercise, improved diet, restful sleep and weight loss.
  • Heating and Warming therapies
  • Acupuncture

For foot related arthritis care, speak with your podiatrist about all relevant treatment methods to help control your foot and ankle arthritis-related symptoms.

Athlete's Foot

Athlete's Foot

Athlete’s foot, also known as tinea pedis, is a fungal infection found on the skin of feet. In most cases, the fungal infection develops on the bottom of your foot and between your toes. Athlete’s foot is a common health problem and may last for a short or long time. This condition can be difficult to treat and may recur following treatment. It is commonly believed that athlete’s foot is contagious, and that infection occurs from touching an infected individual or from walking on damp floors in areas with heavy foot traffic, such as locker rooms or public showers. In truth, fungi live on a variety of surfaces including your skin. What makes a person become infected is a combination of factors including genetic predisposition, skin biome (presence of sustained moisture or heat) and systemic reduced immunity (the body’s inability to combat and fight the infection).

Condition Information

Athlete’s foot is common in people who wear constrictive shoes or boots. This type of closed-toe footwear causes feet to sweat and creates warm, damp environments in which fungi can grow. Individuals with sweatier feet, or those who remain in footwear for long periods of time (long workouts or 10-12 hours shifts in restrictive footwear) are more likely to suffer from fungal skin conditions such as athlete’s foot. In some cases, athlete’s foot may occasionally be caused by a bacteria instead of a fungus. Certain health problems—psoriasis, dermatitis—can also look like athlete’s foot, but will not resolve following treatment for athlete’s foot.

It is now widely accepted the skin fungal infections can lead to fungal infections of your toenails; a condition known as onychomycosis. Onychomycosis causes your toenails to become thick, discolored, incurvated, and painful. Diabetics should be particularly concerned with athlete’s foot, as the fungi-related skin damage associated with this health problem can allow bacteria to invade your skin and causes a life-threatening infection or lead to amputation.

Causes and Symptoms

Some of the most common causes of athlete’s foot include:

  • Wearing closed-toe shoes that compress or squeeze the toes, increasing friction and mild skin breakdown
  • Keeping feet wet for prolonged periods
  • Excessive sweating
  • Reduced immunity
  • Minor skin or nail wounds

Frequently experienced signs and symptoms associated with athlete’s foot include:

  • Itching, burning, or pain in affected areas
  • Cracks, blisters, or peeling areas, usually between toes
  • Redness and scaling on the bottoms of feet
  • Foot odor
  • Foot rash

Treatment

One of the most important factors in treating and preventing athlete’s foot is creating an environment that is light and dry, not dark, warm, and damp. Limiting exposure to enclosed footwear will aid in skin recovery; consider going barefoot more often or wearing sandals in place of closed-toe shoes as much as possible to create a foot environment in which fungi cannot thrive.UV is a potent aid in combating fungal infections. Wearing sandals exposes fungus to ultraviolet rays when you are in the sun.When enclosed footwear must be used, make sure shoes are naturally shaped to limit toe rubbing and constriction. The following measures will also decrease moisture buildup within footwear:

  • Use synthetic wicking socks, or wear socks made from natural fibers like wool or bamboo
  • Change socks often when in footwear for prolonged periods, or immediately following exercise
  • Discontinue and avoid cotton socks, as cotton fibers retain moisture
  • Use a shoe dryer to dry footwear after prolonged use

While oral anti-fungal medications are commonly prescribed for this condition, they are hard on the liver. Here are several other factors to consider for fungal treatment:

  • Application of over the counter topical medications. Apply medications nightly to dry/clean skin, under occlusion (cover with saran wrap/plastic to aid penetration of the substance into infected skin)
  • Work with a natural health care provider to boost immune system health to better combat fungal infections

Bunion

Bunion

A bunion, also known as Hallux Abductovalgus, is a foot condition in which the big toe (Hallux) and first metatarsal bone are displaced. This position exposes the head of the 1st metatarsal bone. The first metatarsal bone is the long bone located directly behind the big toe, extending to the mid-foot along the medial arch. The ‘bump’ of the bunion is not a growth of bone, but rather the exposed first metatarsal head, as the big toe shifts towards the 2nd toe. The resulting shift of the 1st metatarsal widens the ball-of-the-foot and destabilizes the midfoot. The bump or prominence of the displaced big toe and 1st metatarsal head may become reddened and enlarged when compressed in footwear. Pressure from footwear may irritate the skin or cause additional soft tissue enlargements as the body tries to protect the displaced bone.

Causes and Symptoms

Bunion formation only exists in cultures that wear conventionally shaped footwear with a tapered toe box, toe spring, and an elevated heel. This position pushes the big toe towards the second toe, and lifts the toe ends and heel above the ball of the foot (where the big toe and 1st metatarsal meet). Not all individuals whom wear conventionally shaped tapered toe-box footwear will develop bunion formation. Bunions are also not a genetic condition, rather individuals who wear conventionally shaped footwear and who possess the following characteristics are more likely to develop bunion formation:

  • Ligament laxity, allowing the big toe to be more impacted by poor alignment in conventional footwear
  • Possessing a wider than average foot-type, which predisposes the big toe to be greater impacted by footwear with a tapering toe box
  • Limb length inequalities
  • Arthritis
  • Toe trauma

Bunions are an often painful with symptoms that may worsen as the body tries to protect displaced bone with soft tissue or fluid around the base of the big toe. Some of the most frequently experienced signs and symptoms associated with bunions include:

  • Pain
  • Redness
  • Blistering
  • Callus Formation
  • Swelling
  • Nerve damage; numbness and/or sharp pains

Bunions may also cause pain within and below the first metatarsophalangeal, or MTP, joint. Bunion formation is the progressive dislocation at the 1st MTP joint, this relationship creates instability and may overload adjacent joints.

Treatment

The first and most important step in the conservative and natural management of bunion formation involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation, and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all the toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes repositions the big toe into anatomic alignment.

Bunions often respond to conservative care measures and should always be treated by a qualified healthcare professional in a timely and appropriate manner. Conservative treatment for bunions usually involves the following:

In some cases, conservative measures including switching to appropriate footwear, may not have the desired effect. It’s possible for the big toe and 1st metatarsal to fuse in this displaced position following years or decades of malalignment. Once fusion of a joint develops, the above treatments will not accomplish full recovery. Seek consult with a Podiatrist to determine possible treatment options including surgical procedure known as a bunionectomy. Bunionectomy is a general term that describes a variety of bone and soft tissue procedures that are intended to realign the big toe and reduce the prominence at the base of the big toe. The procedures chosen are based on numerous factors, including:

  • Measured angular displacement of the involved joints
  • Severity of pain
  • The degree of joint dislocation and cartilage damage
  • Flexibility of soft tissues in the impacted area and adjacent joints

Bunion surgery is both an art and a science, and it should always be performed by a healthcare professional who understands the multifaceted mechanics of the 1st MTP and its surrounding structures. There are several forms of bunionectomy procedures, surgery typically involves more than just removal of the bump at the 1st MTP. Bunionectomy does not guarantee cure or even a beneficial health outcome. Surgical correction must be maintained with therapies that preserve anatomical Hallux alignment. Following surgery, it is of the utmost necessity to never return to conventionally shaped footwear with a tapered toe-box. High recurrence rate of Bunion following Bunionectomy is linked to poor footwear choices following surgery.

Bunionette (Tailor's Bunion)

Bunionette (Tailor's Bunion)

Bunionette refers to a structural deformity that can occur at the base of the 5th toe at the 5th metatarsophalangeal or MTP joint. This foot condition involves the displacement of both the 5th metatarsal bone and 5th toe, as the toes are compressed within conventionally constructed footwear. This position exposes the head of the 5th metatarsal bone. The ‘bump’ of the bunionette is not a growth of bone, but rather the exposed 5th metatarsal head, as the 5th toe shifts towards the 4th toe. The resulting shift of the 5th metatarsal widens the ball-of-the-foot. The bump or prominence of the displaced big toe and 1st metatarsal head may become reddened and enlarged when compressed in footwear. Pressure from footwear may irritate the skin or cause additional soft tissue enlargements as the body tries to protect the displaced bone.

Bunionettes are often misdiagnosed as tailor’s bunions. Tailor’s bunions are less commonly experienced, a condition originally impacting tailors who frequently sat cross legged on hard floors. This position lead to tenderness, soft tissue irritation, or callusing of the lateral 5th MTP. While both tailor’s bunion and bunionette experience similar soft tissue irritations, tailor’s bunion does not describe misalignment of the 5th toe and 5th metatarsal experienced with diagnosis of bunionette.

Causes and Symptoms

Bunionette formation only exists in cultures that wear conventionally shaped footwear with a tapered toe box, toe spring and an elevated heel. This position pushes the fifth toe towards the fourth toe, and lifts the toe ends and heel above the ball of the foot (where the toes and metatarsals join). Not all individuals who wear conventionally shaped tapered toe-box footwear will develop bunionette formation. Bunionettes are also not a genetic condition, rather individuals who wear conventionally shaped footwear and who possess the following characteristics are more likely to develop bunionette formation:

  • Ligament laxity, allowing the fifth toe to be more impacted by poor alignment in conventional footwear
  • Possessing a wider than average foot-type, which predisposes toes to be more impacted by footwear with a tapering toe box
  • Limb length inequalities
  • Arthritis
  • Toe trauma

Bunionettes are often painful. Symptoms that may worsen as the body tries to protect displaced bone with soft tissue or fluid around the base of the 5th toe. Some of the most frequently experienced signs and symptoms associated with bunionettes include:

  • Pain
  • Redness
  • Blistering
  • Callus Formation
  • Swelling
  • Nerve damage; numbness and/or sharp pains

Bunionettes may also cause pain within and below the fifth metatarsophalangeal, or 5th MTP, joint. Bunionette formation is the progressive dislocation at the 5th MTP joint, this relationship creates instability and may overload adjacent joints.

Treatment

The first and most important step in the conservative and natural management of bunionette formation involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all the toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes repositions the big toe into anatomic alignment.

Bunionettes often respond to conservative care measures and should always be treated by a qualified healthcare professional in a timely and appropriate manner. Conservative treatment for bunionettes usually involves the following:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Soft tissue exercises
  • Avoiding footwear that possess a tapering toe box

In some cases, conservative measures including switching to appropriate footwear, may not have the desired effect. It’s possible for the 5th toe and 5th metatarsal to fuse in this displaced position following years or decades of malalignment. Once fusion of a joint develops, the above treatments will not accomplish full recovery. Seek consult with a Podiatrist to determine possible treatment options.

It’s important to remember that surgery is both an art and a science, and it should always be performed by a healthcare professional who understands the multifaceted mechanics of the 5th MTP and its surrounding structures. Surgical correction must be maintained with therapies that preserve anatomical toe alignment. Following surgery, it is of the utmost necessity to never return to conventionally shaped footwear with a tapered toe-box. High recurrence rate of structural foot diagnoses is linked to poor footwear choices following surgery.

Bursitis (Infracalcaneal)

Bursitis (Infracalcaneal)

Bursae are fluid-filled sacs found throughout the body in areas exposed to friction and pressure. These sacs are designed to help reduce friction and prevent pain. Infracalcaneal Bursitis is inflammation of the bursa that sits below (inferior) to the calcaneus (heel bone). Excessive pressure, repetitive or prolonged movements are the most common causes of bursal inflammation. Traumatic injury may also contribute to infracalcaneal bursitis. Poor mechanics with repetitive motions may also create bursal sac formation anywhere in the body. This new bursal formation is called an adventitial bursa. Infracalcaneal bursitis is frequently misdiagnosed as plantar fasciosis. Infracalcaneal bursitis symptoms tend to be worsen with pressure and activity on the bursa, while plantar fascia symptoms tend to temporarily increase following periods of rest or inactivity.

Condition Information

Due to pain and impaired gait, infracalcaneal bursitis can significantly affect quality of life and the ability to perform activities of daily living. Inflammation of the bursal sac below the heel bone occurs due to abnormal stress to the bursa or excessive pressure for prolonged periods. Constant pressure and friction from footwear is a common cause of this health problem, thus treatments addressing infracalcaneal bursitis should include recommendations for healthful footwear.

Causes and Symptoms

Soft tissue structures of the foot and heel may breakdown when subjected to chronic stress associated with prolonged periods of weight-bearing activity on concrete, asphalt or other hard surfaces. Foot problems, including infracalcaneal bursitis, are often exacerbated by poorly designed footwear which increases pressure and impact along the heel. Bursal sacs are the body’s natural defense mechanism, intended to minimize overload to sensitive tissues, but sometimes the bursa itself becomes inflamed. A rapid increase in physical activity levels or thinning of the heel’s protective fat pad are factors that may contribute to infracalcaneal bursitis. Other possible causes of infracalcaneal bursitis include blunt force trauma, acute or chronic infection and arthritic conditions.

The following factors increase risk of experiencing infracalcaneal bursitis:

  • Poor gait mechanics
  • Sudden increases in forces on the heel
  • Heel striking when running
  • Participating in activities that involve repetitive jumping
  • History of bursitis

Common signs and symptoms associated with infracalcaneal bursitis include:

  • Pain directly under of the heel
  • Pain or discomfort that increases with prolonged weight-bearing activities
  • Pain and swelling under the heel
  • Redness under the heel

Treatment

The first and most important step in the conservative and natural management of infracalcaneal bursitis involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Infracalcaneal bursitis will recover with relative rest. Healing can be accelerated by temporarily avoiding strenuous weight-bearing activities that put stress on the heel bone. An integrated approach to this problem will also typically involve the following options:

  • Progressive changes to naturally shaped footwear
  • Use of a Heel Cup to reduce pressure, friction, and inflammation
  • Natural anti-inflammatory agents
  • Topical or oral medications

In rare cases more aggressive treatments, such as cortisone injections, may be required. Please consult your personal medical professional regarding specific treatment options.

Capsulitis

Capsulitis

Capsulitis is inflammation of a joint capsule. Joint capsules are formed by membrane layers filled with synovial fluid and surrounded by ligaments. Joint capsules improve joint function, balancing stability and mobility. Capsulitis occurs when friction, improper movement or excessive pressure is applied to a joint. Joint trauma or irritation can occur in any joint anywhere in the body. For the purpose of this specific condition in relation to the foot, Capsulitis refers to the metatarsophalangeal joint, or MTP joint, at the bases of each toe. Capsulitis is painful and can compromise joint stability, in rare cases leading to toe dislocation. Capsulitis is a condition that can manifest in people of all ages.

Condition Information

Joint capsules of the foot most likely to experience capsulitis typically involve the metatarsophalangeal joints, or MTP joints, at the ball of the foot. Each foot possesses five MTP joints that connect the toe bones, or phalanges, with the metatarsal bones. The most common MTP joint capsule to develop capsulitis is the 2nd MTP. Inflammation of this capsule is particularly common due to the fact that in most human feet the 2nd metatarsal is the longest metatarsal bone. Additionally, overloading of the 2nd MTP is in direct relation to big toe position; as the big toe is pushed towards the 2nd toe within conventionally shaped footwear, more pressure is added to the 2nd MTP.

Causes and Symptoms

Most podiatrists believe that capsulitis is caused by aberrant, or unusual, foot mechanics that involve excessive weight-bearing on the ball of the foot beneath the MTP toe joint. Certain factors may increase the likelihood of developing capsulitis, including:

  • Imbalance between extensors muscles on top of the foot and flexors muscles on the bottom of the foot
  • Regular use of footwear with an elevated heel and/or toe-spring such as conventional running shoes
  • Extreme bunion deformity
  • An unstable foot arch
  • Tight calf muscles

Conventional footwear may be the most common cause of capsulitis. Most athletic and dress shoes possess an elevated toe boxes and toe-spring. Toe-spring elevates the toes, increasing pressure at the ball of the foot under the MTP joints. Elevated heels lift the hind foot, dramatically shifting weight onto the ball of the foot and MTP joints. Tapering toe-boxes compress toes together, squeezing MTP joint capsules.

Signs and symptoms of capsulitis include:

  • Pain
  • Swelling
  • Redness of the skin
  • The sensation of walking on a stone or pebble
  • Callus formation along the impacted joint
  • Nerve irritation, resulting from fluid compressing along nerve fiber

Treatment

The first and most important step in the conservative and natural management of capsulitis involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation, and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread. Footwear lacking toe spring and elevated heels off-loads the ball of the foot and the MTP joints. This flat profile allows capsules of the MTP joints to heal within natural alignment, and prevents future irritation of this joint line.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. This is especially true for individuals accustomed to shoes with heel elevation or rigid toe spring. Capsulitis often responds to conservative, non-surgical treatments. This condition is best treated in its early stages to help improve affected joint’s stability, reduce pain and other symptoms and resolve the root cause of the problem. Additional treatments for capsulitis include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Exercises that balance the foot extensors and flexors like the Toe Extensor Stretch
  • Metatarsal Pads
  • Taping or splinting the toe into natural alignment or into slight plantar flexion
  • Anti-inflammatory agents: Supplements or medications can help reduce your pain and swelling

Corns & Calluses

Corns & Calluses

Corns and calluses are common skin problems that are characterized by a buildup of hard, thick skin. Corns and calluses are particularly common in areas subject to prolonged pressure or friction. Though not life-threatening, corns and calluses may cause pain when buildup of skin gets too thick or causes pressure on sensitive parts of the foot. Thick, hard skin can occur on any part of your foot.

Condition Information

A corn is thickened skin on the top or sides of the toes, while a callus is thickened skin on the soles of the feet. Skin thickening is a protective reaction by your body to avoid painful blisters. Corns that manifest on the tops or ends of your toes are called heloma durum (hard corns), most commonly found on the first toe joint, or proximal interphalangeal joint, and the ends of your toes. Corns that develop between your toes are called heloma molle (soft corns), which frequently occur between any of your toes and are caused by shoes that pinch your forefoot. Soft corns are seen more often in people who wear shoes with tapering toe boxes. Tapering toe boxes force the normal roundness of your forefoot into an unnatural triangular shape. The skin beneath the metatarsal heads is among the most common locations for calluses. Calluses may also form around and/or under the heel. In rare instances, calluses may form in your foot arch. Arch calluses are usually associated with extreme foot deformities. Calluses that develop a core or seed inside of them are known as intractable plantar keratosis (IPK). IPK’s are generally located under the metatarsal heads, and are frequently misdiagnosed as plantar warts.

Causes and Symptoms

Pressure and friction from shoes or the ground provokes skin to develop hard or thick patches. Factors that may contribute to this health problem include:

  • Poor-fitting or conventionally constructed footwear
  • Poor-fitting of sock size or sock bunching
  • Prolonged physical activity
  • Athletic events that place significant stress on the feet

Common signs and symptoms associated with Corns and Calluses include:

  • Areas of thick and hardened skin
  • Flaky and dry skin
  • Waxy skin
  • A hardened, elevated skin bump
  • Pain or tenderness under skin

Treatment

The first and most important step in the conservative and natural management of Capsulitis involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread, reducing points of pressure and friction in the toe box. Obtaining and using appropriate footwear along with manual therapies that reduce skin thickening are among the most common and effective conservative strategies for treating corns and calluses. A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. Additional treatments for corns and calluses include:

  • Progressive changes to naturally shaped footwear
  • Reduce the thickness of corns or calluses with a pumice stone or Emery board.
  • Topical over-the-counter acid plasters to erode corns and calluses. Caution should be expressed, as acid is capable of damaging healthy tissue. Avoid using acid plasters if you have diabetes, nerve-related conditions and/or poor circulation.

See your podiatrist for treatment if manual reduction of your skin thickening and a proper shoe fit have not resolved your problem.

Crooked Toe

Crooked Toe

Crooked toe is an umbrella term to express a multitude of different toe conditions. Crooked toe classification depends on the location of the affected joint deviation. In most cases, realignment of crooked toe position can be achieved using conservative care techniques. Crooked toe deformities are always linked to compression and restrictive position placed on the toe from conventional footwear. In shoe-less populations, crooked toe deformities are extremely rare or completely absent. Crooked Toe are usually flexible in the initial stages but can become rigid over time if not treated appropriately.

Condition Information

Possible types of crooked toes include:

  • Hammertoe: A hammertoe is a crooked toe that is flexed down (plantarflexion) at the first toe joint, or proximal interphalangeal (PIP) joint. This position can lead to rubbing on the top of the PIP, or overloading of the bottom of the metatarsal-phalangeal (MTP) joint.
  • Claw Toe: A claw toe is a crooked toe that is flexed down (plantarflexion) at both the first toe joint, or proximal interphalangeal (PIP) joint, and the second toe joint, or distal interphalangeal (DIP) joint. This position can lead to rubbing on the top of both the PIP and DIP joints, or overloading of the bottom of the metatarsal-phalangeal (MTP) joint.
  • Mallet Toe: A mallet toe is a crooked toe that is flexed down (plantarflexion) at the second toe joint, or distal interphalangeal (DIP) joint only. Mallet toe formation overloads and increases pressure to the tip of the toe at the distal phalanx and along the toe nail.
  • Adductovarus Toe: Adductovarus toe is a crooked toe deformity where lesser small toes curl under adjacent toes and move inward towards the big toe. This toe problem most commonly occurs in the fourth and fifth toes, it is a direct result of wearing footwear with a tapering toe box.
  • Curly toe: Curly toe is a crooked toe that flexes out, or laterally from the second toe joint, or distal interphalangeal (DIP) joint. Particularly common in newborns, curly toes most often impact 2nd and 3rd toes.

Causes and Symptoms

Conventional footwear construction is the leading cause of crooked toes. Footwear that possesses heel elevation, rigid soles, tapering toe boxes and toe-spring forces toes out of natural alignment, encouraging muscle or tendon imbalances. In addition, crooked toes may also be associated with previous foot trauma, or certain genetic patterns.

Some of the most frequently experienced symptoms associated with crooked toes include:

  • Toe pain or irritation
  • Skin thickening, callus or corn formation
  • Inflammation and redness
  • Toe contracture and resulting joint stiffness or fusion

Treatment

The first and most important step in the conservative and natural management of crooked toes involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows natural positioning of each toe into appropriate alignment. This foot and toe position helps off-load areas of overloading and pressure; re-alignment of toes also balances tissue tension and coordination between the toe flexor and extensor muscles and tendons.

A slow, gradual transition to foot-healthy footwear and/or Correct Toes is necessary to ensure a successful outcome. The longer a crooked toe problem exists, the greater the likelihood it will become rigid or stiff, requiring more extensive and invasive treatments. Addressing crooked toe alignment when toes are mobile or ‘reducible’ is most effective with the following interventions:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Toe joint manipulation and exercises
  • Physical Therapy
  • Instrument-assisted soft tissue mobilization (Graston, Gua Sha, ASTYM)

It is suggested to discontinue the use of footwear that possess heel elevation when treating crooked toes. High-heeled shoes, including conventional running footwear, will hasten the progression of crooked toe.

With decades of crooked toe deformity, toes will stiffen and become immobile, or non-reducible. Many of the conservative therapies listed above will not impact a non-reducible crooked toe. For immobile crooked toes, seek care and evaluation at a Podiatrist or local foot specialist. For fused joints, toe surgery may be the only recommendation available. Following toe alignment surgery, all of the above conservative therapies will still be necessary; primarily, lifestyle changes to naturally shaped footwear are imperative. Surgery will not provide a complete correction of crooked toe deformity if the correction is not maintained within naturally shaped footwear. Ask a Podiatrist about the risks, benefits and limitations of toe surgery to help resolve crooked toe problems.

Diabetes

Diabetes

Diabetes is the inability to control or regulate blood sugar levels. Many complications may arise from elevated or erratic blood sugar levels. Prolonged elevated blood sugar levels impact nerve fibers, and can lead to a complication known as neuropathy—a condition involving nerve damage or dysfunction to nerves. Nerve fibers in the feet perform a multitude of important functions; they are particularly susceptible to diabetes-related damage.

Condition Information

There are two forms of diabetes, both of which can lead to a complication involving nerve damage. Diabetic neuropathy can cause significant foot health problems. Without nerve innervation into foot tissues, proprioception (the body’s ability to determine position in space) is limited. Sensation is also damaged with ongoing high blood sugar. Loss of sensation decreases the ability to feel damage to skin from hot surfaces, hot water or friction that could lead to skin blistering. Individuals with neuropathy also experience decreased sebum production, the oily substance that helps lubricate skin and hair. The production of sebum and therefore the moisture level of your feet is controlled by nerves. Once nerves are damaged, the ability to regulate blood flow to the foot is compromised. Loss of the ability to control blood flow may impact the ability to deliver minerals and nutrients to foot bones and musculature, rendering tissue and bones weak and brittle. Decreases in nerve innervation also leads to muscular atrophy of the ankle, foot and toes.

Causes and Symptoms

Certain factors may increase your likelihood of developing diabetes, including:

  • Excessive body weight
  • Sedentary lifestyle
  • Family history of diabetes
  • Ethnicity
  • Age
  • Elevated blood pressure

Common signs and symptoms associated with diabetes include:

  • Increased thirst, hunger, and urination
  • Weight loss
  • Fatigue
  • Vision changes
  • Frequent infections
  • Extremity sores that are slow to heal

Neuropathy is the most significant problem associated with diabetic feet, although immune deficiency, decreased circulation, and other problems may also accompany this health problem. Diabetic individuals are particularly susceptible to fungal and yeast infections of the feet, especially the toenails. Important signs of infection include:

  • Redness
  • Heat
  • Swelling
  • Drainage
  • Foul odor
  • Pain (although pain is not a reliable indicator in diabetics)

Treatment

Individuals with diabetes should discontinue use of conventional footwear, avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Tight-fitting shoes are one of the most common causes of blisters and ulcers in diabetics. In addition, numerous treatment methods may be helpful in controlling your diabetes and reducing your chances of developing diabetic neuropathy. Addressing diabetes may include any of the following interventions:

  • Lifestyle changes including adaptations to diet, hydration, and exercise
  • Management for high blood sugar levels
  • Avoid walking barefoot as loss of ‘protective threshold’ or ability to feel pain can be dangerous
  • Use of plastazote inserts to protect and cushion feet

If you are Diabetic it is encouraged to perform daily visual examination of feet to note any blisters, cracks, redness or swelling. For lifelong management, seek out in-person evaluations and regular examinations with a local Podiatrist or health professional.

Fibroma - Plantar

Fibroma - Plantar

A plantar fibroma is a knot or nodule of fibrous tissue that develops in the main foot arch. This nodule grows within the plantar fascia—a strong band of tissue on the underside of the foot from the heel to the toes. Plantar fibromas can develop in one or both feet, are non-cancerous (i.e., benign) and typically will not resolve without appropriate treatment.

Condition Information

Plantar fibromas are slow-growing masses of collagen and connective tissue. These benign (non-cancerous) masses usually themselves do not cause pain. However, as size increases, fibromas can put pressure on sensitive structures (such as nerves and blood vessels) which can cause pain. To avoid impacting or increasing pressure on a fibroma, it’s common to alter gait or compensate movement patterns. Changes in gait can put abnormal strain on your body’s joints and soft tissues throughout the limbs, pelvis and spine. Plantar fibroma development forms typically one solitary nodule, though multiple nodules are possible in the same foot. Growth is most common in the mid-arch region of the foot, though they can appear anywhere along the underside of your foot. Plantar fibromas can occur in people of any age and gender.

Causes and Symptoms

Researchers and physicians still debate a variety of primary underlying causes of plantar fibromas. It is generally understood that genetic predisposition to fibrotic diseases and an over-development of connective tissue leads to plantar fibroma development. Individuals that make connective tissue fast will repair minor plantar fascia problems with fibrous tissue. In individuals prone to over-development of connective tissue, rather than laying down connective tissue in slowly formed and organized parallel rows, fast repairing leads to a jumble of disorganized collagen and connective tissue fibers. Fast repairing mechanisms quickly leads to a build-up, or enlargement of repair tissue in a chaotic bundle. The plantar fibroma mass is formed as a reparative mechanism ‘gone awry’ to prior damage to the plantar fascia. Other possible contributing factors include:

  • Conventionally constructed footwear: Footwear that contains heel elevation and toe spring stretches the plantar fascia and leads to weaknesses and distended length in surrounding musculature. Fibromas may develop in response to a stretching and minor tearing in the plantar fascia, which the body desperately tries to mend.
  • Trauma: Damage to the plantar fascia may lead to a plantar fibroma. The formation of excess connective tissue can be the result of a robust healing response after overuse or traumatic injuries, such as a puncture wound.
  • Other health problems: Individuals who have certain conditions (such as diabetes, epilepsy, liver disease, and thyroid problems) are more likely to develop plantar fibromas.
  • Medications: Certain medications (primarily beta-blockers and anti-seizure drugs) may increase the likelihood of a plantar fibroma.

An MRI or biopsy can also help confirm or rule out a plantar fibroma.

Treatment

The first and most important step in the conservative and natural management of plantar fibromas involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows natural positioning of each toe into appropriate alignment. This foot and toe position helps off-load areas of stretching or overloading of the plantar fascia; re-alignment of toes also balances tissue tension and coordination between the toe flexor and extensor muscles and tendons, which support and protect the plantar fascia.

A slow, gradual transition to foot-healthy footwear and/or Correct Toes is necessary to ensure a successful outcome. Addressing plantar fibromas with conservative non-surgical care typically involves the following interventions:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Acupuncture
  • Collagen impacting topical medications
  • Physical Therapy to re-balance and off-load the plantar fascia
  • The Toe Extensor Stretch
  • Recessive cut-outs within footwear liners to off-load pressure to fibroma formation

When conservative therapies fail to reduce fibroma discomfort, individuals may turn to conventional medicine and surgical removal. It is important to recognize that surgical intervention for this condition is an act of trauma or invasion to the plantar fascia. While surgery will reduce current plantar fibroma growth, there is a near 100% re-growth rate following surgery— as the over-productive connective tissue growth mechanisms will try to ‘repair’ the damage from invasive surgery. Surgery also may include the following complications:

  • A flattening of the medial-longitudinal foot arch, as the plantar fascia is cut during the surgery
  • The development of hammertoes; as the toes will try to ‘grip’ to stabilize the arch following surgery
  • A high incidence of recurrence; once the plantar fascia is cut during surgery, repair mechanisms produce rapid formation of collagen and connective tissue formation at the sight of surgery, effectively recreating and regrowing the fibroma

Flat Feet

Flat Feet

Also known as pes valgus or pes planovalgus, flat feet lack normal arch structure. This position creates abnormal foot contact with the ground as the mid-foot falls. Generally painless, flat feet can be caused by a variety of factors including age-related degenerative changes, traumatic injuries and chronic malpositioning of feet within conventionally shaped footwear. As foot arches flatten, other lower extremity joints are affected, including hips, knees and ankles.

Condition Information

It is important to recognize that arch height, while critiqued on both ends of the height spectrum (generally by shoe companies and footwear salespeople), is NOT an indication of overall foot health. High, moderate, and low arch height is largely developmental and related to genetics. Low arches are not the same as or equal to flat feet, or pes planovalgus. Regardless of low arches, it is still possible to have healthy feet. A low arched foot that is strong will ‘outperform’ a moderate height arched foot. Focus on arch height as an indication for foot failure is innately flawed; rather, foot strength or weakness is a more accurate indicator to measure foot health.

Each foot contains three arches, the medial-longitudinal arch, lateral-longitudinal arch, and the transverse or metatarsal arch. Most footwear companies and some physicians are only concerned with the medial-longitudinal arch. Flat feet, or pes planovalgus, is the failure of all three arches, where the entire bottom surface of the foot contacts the ground as the foot is weighted.

Considered a normative stage in early development, arch structure is very limited at birth. Flat feet are common for infants and toddlers. With progressive movement lower leg musculature strengthens, lifting the medial-longitudinal arch up typically by the age of three. Flat feet may persist longer past toddler development if soft tissue or other genetic factors are present. If feet are insulated and protected in arch supporting braces, splints, orthotics or footwear, arch supporting muscles will atrophy or weaken. Weak foot and leg muscles can lead normal and healthy arches to fail, as they lack necessary strength. Conventionally constructed footwear also places strain on foot musculature and arch integrity.

Causes and Symptoms

Flat feet may be caused by numerous factors, possible causes of this foot condition include:

  • Use of footwear with tapered toe boxes and heel elevation
  • Neuromuscular disorders (e.g. cerebral palsy)
  • Certain genetic conditions causing extremely flexible soft tissues
  • Traumatic foot or ankle injuries
  • Tight Achilles tendons (also known as equinogenic flatfoot)
  • Rheumatoid arthritis (about 50 percent of people with RA will develop flat feet)
  • Carrying excessive body weight
  • Aging

Flat feet, in rare cases, can be associated with or caused by a condition called tarsal coalition. Tarsal coalitions involve unusual connections and fusions of the tarsal bones. Tarsal Coalitions can be congenital (from birth), or as the result of ankle and foot traumatic injury. Tarsal bones can be bound together in three different categories of coalition;

  1. Synostosis- bone-to-bone coalition
  2. Synchondrosis - cartilaginous coalition
  3. Syndesmosis - ligament coalition

The irregular joint connections and immobility of the hind-foot as associated with tarsal coalition will cause unusual movement of the mid-foot and other joints through the lower limbs. Tarsal coalition-related flat feet usually cause pain or discomfort.

Some of the most common signs and symptoms associated with flat feet include:

  • Foot pain
  • Decreased ability or inability to stand on your toes
  • Irregular callus formation along the medial-longitudinal arch
  • Swelling along the medial-longitudinal arch

Treatment

Flat feet treatment depends on the cause of your condition, the symptoms you are experiencing and the likelihood of your condition progressing. For flexible and mobile flat feet, the first and most important step in the conservative and natural management of flat feet is to encourage foot strengthening. This involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows natural positioning of each toe into appropriate alignment. This foot and toe position helps position the foot in a more advantageous position to promote strengthening; as muscles of the foot and lower leg strengthen, the foot arches will lift and shorten.

A slow, gradual transition to foot-healthy footwear and/or Correct Toes is necessary to ensure a successful outcome. Addressing flat feet with conservative non-surgical care typically involves the following interventions:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Physical Therapy to promote foot strengthening or Achilles flexibility

When conservative therapies fail to reduce flat foot signs and symptoms, or when the flat foot is immobile or fused, individuals may turn to conventional medicine and surgical removal. It is important to recognize that following surgical intervention the conservative steps listed above will still be necessary. Addressing flat feet with conventional podiatric care typically involves the following interventions:

  • Orthotics
  • Stiff, rigid and supportive footwear
  • Surgery to correct bone alignment within the mid and hind-foot

**Following Surgery, conservative therapies are still encouraged to maintain and improve upon surgical intervention:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Physical Therapy to promote foot strengthening or Achilles flexibility

Friction Blisters

Friction Blisters

Friction blisters are a common health problem. Friction from shoes or clothing repeatedly rubs against skin causing the outermost layers to separate from the inner layers. Lymph fluid fills the area between separated skin, causing local discomfort or pain.

Condition Information

Blistering of the skin may develop for numerous reasons. Factors that may contribute to skin blister formation include:

  • Burns: Prolonged sun exposure or contact with a hot surface
  • Irritants: Contact with certain chemicals, cosmetics, and other toxins
  • Drugs: Reactions to certain prescription medications
  • Health conditions: Autoimmune conditions and chronic skin disorders
  • Infection: Shingles, chickenpox, cold sores, impetigo, or fungus
  • Friction: The most common cause of skin blisters are caused by rubbing or pressure

Causes and Symptoms

Friction blisters occur as a direct result of one or more of the following factors:

  • Pressure
  • Shearing forces
  • Moisture
  • Heat

Some of the most commonly experienced signs and symptoms associated with friction blisters include:

  • Pain
  • Burning
  • Redness or discoloration
  • Nerve sensations and sensitivity
  • Raised skin
  • Weeping skin

Extensive and prolonged blistering can lead to skin infections. Immediately contact your doctor if you experience joint pain, reduced appetite or swollen lymph nodes following blister formation.

Treatment

Blister treatment depends on the cause of your condition and the symptoms you are experiencing. The first and most important step in the conservative and natural management of friction blisters is to limit rubbing, squeezing or pressure from points of contact within conventionally shaped footwear. This involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread. Spreading the toes into appropriate alignment decreases pressure and rubbing between and on the ends or sides of toes. This foot and toe position allows the foot to be in a more natural position which naturally decreased friction on the skin.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. Addressing friction blisters with conservative care typically involves the following interventions:

  • Progressive changes to naturally shaped footwear
  • Use synthetic wicking socks, or wear socks made from natural fibers like wool or bamboo
  • Change socks often when in footwear for prolonged periods or immediately following exercise
  • Discontinue and avoid cotton socks, as cotton fibers retain moisture
  • Using a double layer acrylic sock system
  • Application of topical drying powders or antiperspirants

Management of existing blister formation may include:

  • Application of tape or moleskin over the blister
  • New-Skin liquid or spray topicals
  • Various topical hydro gels

Fungal Toenail Infection

Fungal Toenail Infection

Also known as onychomycosis, fungal toenail infections occur when fungi invade underneath toe nail beds. Fungal toenail infections can be difficult to treat, and are typically associated with fungus living on the surrounding skin along the nail bed. It is commonly believed that fungal infections are contagious and that infection occurs from touching an infected individual or from walking on damp floors in areas with heavy foot traffic, such as locker rooms or public showers. In truth, fungi live on a variety of surfaces including your skin. What makes a person become infected is a combination of factors including genetic predisposition, skin biome (presence of sustained moisture or heat) and systemic reduced immunity (the body’s inability to combat and fight the infection).

Condition Information

Fungal toenail infections involves the lifting and discoloration of one or more toe nails. Fungi from the skin and from the surrounding immediate environment can invade and proliferate beneath the protective covering of the toenail. Initial infections begin with one or more small ‘shoots’ of fungi burrowing from the tip of the nail to the base of the nail. This can appear as a white or yellow streak under the nail’s surface. As fungi grows, it will expand outward from this initial streak, causing further discoloration to the nail bed, and in some cases, elevating the nail surface as the infection takes hold.

Fungal toenail infections impact individuals of all ages, but are most common among people 60 years of age and older. While not overly harmful, fungal toenail infections can be dangerous in the elderly or individuals with compromised immune systems. Fungal toenail infections occur with greater regularity in people with diabetes, or individuals with circulation problems. Men are more likely than women to develop fungal toenail infections.

Causes and Symptoms

Some of the most common causes of fungal toenail infections:

  • Wearing closed-toe shoes that compress or squeeze the toes, increasing friction and mild skin breakdown around the nail
  • Keeping feet wet for prolonged periods
  • Excessive sweating
  • Reduced immunity
  • Minor skin or nail wounds

Signs and symptoms that most commonly suggest a fungal toenail infections include:

  • Toenails that are white or yellow in color
  • Toenails that are brittle or crumbly at the ends
  • Thick toenails
  • Toenails that detach from the nail bed
  • Toenails that are curled or deformed
  • Debris located under your toenails
  • Decreased toenail shine or luster

Treatment

One of the most important factors in treating and preventing fungal toenail infections is creating an environment that is light and dry, not dark, warm, and damp. Limiting exposure to enclosed footwear will aid in skin recovery; consider going barefoot more often or wearing sandals in place of closed-toe shoes as much as possible to create a foot environment in which fungi cannot thrive. Wearing sandals exposes fungus to ultraviolet rays when you are in the sun, UV is a potent aid in combating fungal infections. When enclosed footwear must be used, make sure shoes are naturally shaped to limit toe rubbing and constriction. The following measures will also decrease moisture buildup within footwear:

  • Use synthetic wicking socks, or wear socks made from natural fibers like wool or bamboo
  • Change socks often when in footwear for prolonged periods, or immediately following exercise
  • Discontinue and avoid cotton socks, as cotton fibers retain moisture
  • Use a shoe dryer to dry footwear after prolonged use

While oral anti-fungal medications are commonly prescribed for this condition, they are hard on the liver. Here are several other factors to consider for fungal treatment:

  • Thinning, filing, trimming or debridement of thick or lifted nails
  • Application of over the counter topical medications. Apply medications nightly to dry/clean nail, under occlusion (cover with saran wrap/plastic to aid penetration of the substance into infected nail).
  • Work with a natural health care provider to boost immune system health to better combat fungal infections

Keep in mind that toenails grow about 1 millimeter per month. Full recovery takes up to 1 year as new healthy nails grows in slowly. Once nail health is restored, it’s crucial to maintain healthful habits to combat future fungal growth indefinitely. Maintenance will require prophylactic applications of topical antifungals to skin and nails on a bi-monthly basis. Appropriate naturally shaped footwear use and methods to maintain skin health will also be necessary for lifetime management of this condition.

Hallux Limitus and Hallux Rigidus

Hallux Limitus and Hallux Rigidus

Hallux limitus and hallux rigidus are conditions that impact the mobility of the big toe - the hallux. The hallux joins the foot at the head of the 1st metatarsal, a long bone that extends along the inside of the foot. This juncture is called the 1st metatarsal-phalangeal (or 1st MTP) joint. The 1st MTP is a joint that is crucial for gait. Specifically, the 1st MTP provides propulsive force, helps control balance of the foot and body column and creates stability of the medial-longitudinal arch.

Healthy movement of the hallux should possess between 50 and 90 degrees of dorsiflexion, or movement of the toe up. Hallux limitus or hallux rigidus involve a limitation of the hallux moving into dorsiflexion. Movement limitation of the hallux will impact other joints, especially the hip. Gait changes and compensation patterns from hallux limitus and rigidus may cause pain and fatigue throughout the body.

Condition Description

Both hallux limitus or hallux rigidus involve a loss of motion for the hallux. Loss of motion can be caused by a variety of factors including loss of cartilage or growth of bone. Hallux limitus generally includes a limitation of hallux dorsiflexion under 50 degrees. Hallux rigidus is considered by many podiatrists to be the end stage of hallux limitus, or a state in which the limitation of hallux dorsiflexion is fully lost or severely restricted to under 10 degrees of motion. While hallux limitus benefits greatly from a variety of conservative therapy options, hallux rigidus may not respond to conservative strategies outlined in the following sections

Causes and Symptoms

Hallux limitus and hallux rigidus can be linked to a variety of factors. Possible causes include:

  • Prior history of trauma to the hallux, 1st metatarsal or 1st MTP joint
  • Prolonged use of conventionally constructed footwear that pushes the hallux out of natural, anatomical alignment
  • Faulty foot biomechanics
  • Genetics
  • Rheumatoid arthritis, gout or other inflammatory diseases

Hallux limitus or hallux rigidus may include a combination of the following signs and symptoms:

  • Pain and stiffness with movement of the hallux
  • Restriction of movement of the hallux into dorsiflexion
  • Pain when walking, running or squatting
  • Increase in pain and stiffness throughout cold or damp weather
  • Swelling and inflammation localized around the 1st MTP joint
  • Conscious or unconscious changes in gait

Treatment

The first and most important step in the conservative and natural management of hallux limitus or hallux rigidus involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows natural positioning of each toe into appropriate alignment. For cases of hallux limitus, this shift in position of the hallux can immediately increase hallux mobility in dorsiflexion by up to 15 degrees. The natural position of hallux alignment also improves muscular length-to-tension principles of the extensor hallucis muscle along the dorsal aspect or ‘top’ of the big toe and flexor hallucis muscle along the plantar aspect or ‘bottom’ of the big toe, allowing for greater ease of motion. Additionally, re-alignment of the hallux with natural footwear and Correct Toes impacts sesamoid alignment. The fibular and tibial sesamoids are floating bones that sit under the 1st MTP and act as a fulcrum similarly to the patella or knee-cap. The sesamoids are intertwined along with the flexor hallucis and adductor hallucis tendons; re-alignment of the hallux impacts the mobility of the sesamoids as controlled by their associated tendons.

A slow, gradual transition to foot-healthy footwear and/or Correct Toes is necessary to ensure a successful outcome. It is also important to consider recovery of hallux limitus similarly to any osteoarthritic condition. Osteoarthritis responds well to progressive and controlled movement, and responds best when warm. Addressing hallux limitus with conservative non-surgical care typically involves the following interventions:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Slow and progressive movement within natural 1st MTP joint alignment
  • Heat
  • Physical Therapy
  • Therapeutic Ultrasound
  • The Toe Extensor Stretch and Bunion Stretch.
  • Topical pain relievers: natural pain relievers may help reduce swelling, pain and inflammation.

The extent to which the non-surgical treatment options listed above can alleviate Hallux Limitus depends on the ability for initial manual movement of the hallux. For hallux rigidus, conservative approaches may not lead to meaningful changes in symptoms. Traditional non-surgical treatments available for hallux rigidus involve ‘off-loading’, protecting and cushioning the hallux and 1st MTP. Protection of a joint with osteoarthritis, or limiting the movement of the hallux will not provide a cure, it will merely manage symptoms. Addressing hallux rigidus with traditional non-surgical care typically involves the following interventions:

  • Use of footwear that is rigid, inflexible or stiff
  • Use of inserts or arch supports
  • Orthotics or Carbon plates that include a ‘Morton’s Extension’

Hammertoes

Hammertoes

Hammertoes are a type of crooked toe that involve a unnatural contracture, or bending of a toe. In most cases, realignment of hammertoe position can be achieved using conservative care techniques. Hammertoe deformities are always linked to compression of toe position, caused by restriction placed on the toe within conventional footwear. In shoe-less populations, hammertoe deformities are extremely rare or completely absent. Hammertoe are usually flexible in the initial stages, but can become rigid over time if not treated appropriately.

Condition Information

A hammertoe is both flexed slightly up into dorsiflexion at the metatarsal-phalangeal (MTP) joint and also flexed down into plantarflexion at the first toe joint, or proximal interphalangeal (PIP) joint. This position can lead to rubbing on the top of the PIP, or overloading of the bottom of the MTP joint. The development of hammertoe formation is slow, typically occurring over years and decades. With initial contracture of the tendons that lead into the toe, new hammertoe development will be flexible at the MTP and PIP joints. As the toe remains in hammertoe position for years, the angled position of the toe joints will stiffen and eventually become rigid. Rigid hammertoes may not respond to conservative strategies outlined in the following sections.

Causes and Symptoms

Conventionally constructed footwear has a significant impact to the development of hammertoes. Footwear that contains heel elevation is particularly problematic. Most dress shoes, athletic shoes and reputable ‘therapeutic’ brands of footwear, like Dansko clogs, all include an elevated heel. Typical running shoes are constructed with a 8-12mm rise of additional cushion in the heel. Heel elevation of any degree will change the angle of the MTP joints, subtly forcing the toes into dorsiflexion. This position is exacerbated with the addition of Toe Spring. Toe Spring, or the added lifted rocker at the front of shoes, is a feature added to many styles of footwear including rigid clogs and running shoes. Toe spring furthers toe dorsiflexion at the MTP joint. These two shoe features impact the length-to-tension principles of both the extensor tendons on the tops of toes and the flexor tendons on the bottoms of the toes. Hammertoes are a result of the chronic nature of stretching and compressing of these muscles as they respond to elevated heels and toe spring within conventionally constructed footwear.

Ball-of-foot pain is one of the most common symptoms associated with hammertoes. Other common signs and symptoms of hammertoes include:

  • Rubbing or pain on the top of the proximal pnterphalangeal (PIP) joint from footwear pressure
  • Callus formation along the PIP joint
  • Redness and swelling along the PIP joint
  • Progressive loss of joint range of motion at the PIP joint
  • Overloading of pressure at the metatarsal-phalangeal (MTP) joint
  • Distal fat-pad migration, as the ball-of-foot cushioning is pulled forward into the sulcus of the foot as toes curl and elevate.

Treatment

The first and most important step in the conservative and natural management of hammertoes involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows natural positioning of each toe into appropriate alignment. Correct Toes can also aid the recovery of mobile hammertoes by placing force over the PIP joint to encourage the toe to lengthen and lay flat. Overall, this foot and toe position helps off-load areas of overloading and pressure; re-alignment of toes also balances tissue tension and coordination between the toe flexor and extensor muscles and tendons.

A slow, gradual transition to foot-healthy footwear and/or Correct Toes is necessary to ensure a successful outcome. The longer a hammertoe problem exists, the greater the likelihood it will become rigid or stiff, requiring more extensive and invasive treatments. Addressing hammertoe alignment when toes are mobile or ‘reducible’ is most effective with the following interventions:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Toe joint manipulation and exercises
  • Physical Therapy
  • Instrument-assisted soft tissue mobilization (Graston, Gua Sha, ASTYM)

It is suggested to discontinue the use of footwear that possess heel elevation when treating hammertoes. Footwear with heel elevation, including conventional running footwear, will hasten the progression of hammertoes.

With hammertoes that persist for decades, toes will eventually stiffen and become immobile or non-reducible. Many of the conservative therapies listed above will not impact a non-reducible hammertoes. For immobile hammertoes, seek care and evaluation at a Podiatrist or local foot specialist. For fused joints within hammertoes, toe surgery may be the only recommendation available. Following toe alignment surgery, all of the above conservative therapies will still be necessary; primarily, lifestyle changes to naturally shaped footwear are imperative. Surgery will not provide a complete correction of hammertoe deformity if the correction is not maintained within naturally shaped footwear. Ask a Podiatrist about the risks, benefits and limitations of toe surgery to help resolve hammertoe problems.

Ingrown Toenails

Ingrown Toenails

Ingrown toenails are a common problem that can develop if the edge of a toenail grows down into the surrounding skin. Ingrown toenails can cause significant pain or discomfort, redness and swelling around the nail. In severe cases, infection may spread and impact tissues systemically. Ingrown toenails can occur in any toe; they frequently impact children and individuals who wear poorly fitting footwear.

Information

Ingrown nails are common in individuals with nails that are either too thin or unusually thick. Thin nails can have sharp edges that will more easily pierce through surrounding skin. Thick nails are more resilient and can press against surrounding skin, forcing the skin to experience unnatural pressure.

Causes and Symptoms

Pressure and friction along the nail and surrounding skin is the greatest cause of ingrown nails. Conventionally shaped toe boxes do not allow our toes to remain in natural alignment, forcing toes to press against each other and touch the inner material of the toe box. External pressure from improperly fitted or shaped footwear subjects toes and toenails to mild and consistent pressure. Throughout years, this pressure can change the shape, thickness and architecture of nails, increasing likelihood of nails being compressed into the skin surrounding the nail. Additionally, certain foot or toe deformities can also place stress on your toes and cause ingrown toenails.

The following signs or symptoms are common when experiencing an ingrown toenail:

  • Pain and tenderness
  • Redness
  • Swelling
  • Infection

Treatment

The first and most important step in the conservative and natural management of ingrown toenails involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear as these features all increase pressure along the toes and toenails. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows offloading of pressure and reduction of pressure along toenails. This reduces the risk of nails pressing and rubbing along skin, decreasing likelihood of nails becoming ingrown.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. Additional treatments for ingrown nails include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Regular trimming and thinning of nails

Ingrown toenails may occasionally be so progressed as to warrant more invasive medical care from a trained healthcare professional or podiatrist. Medical treatments for ingrown toenails may include a partial or full toenail removal (matrixectomy). Diabetics or individuals with impaired lower extremity circulation should be vigilant in monitoring the health and condition of their toenails.

Metatarsalgia

Metatarsalgia

Metatarsalgia is an “umbrella” term for forefoot or ball-of-foot pain, it is a dated, unscientific term. Many conditions or diagnoses fall under the term metatarsalgia. This diagnosis is a generalized method to state where pain is originating, but provides no information about the cause or source of the condition. Because metatarsalgia lacks true definition of the etiology of the condition, no defined treatment plan can be obtained for cure. Metatarsalgia is a symptom, not a condition. Due to the lack in specificity of metatarsalgia, individuals can only resort to symptom management rather than cure.

A more effective way to manage and cure forefoot pain is to reassess for a true diagnosis or cause of forefoot pain. Possible causes of forefoot pain include:

  • Capsulitis
  • Neuroma
  • Sesamoiditis
  • Bunion or bunionette
  • Crooked toe conditions like hammertoe
  • Arthritis

Neuroma

Neuroma

Neuroma is a term for an enlarged nerve. Neuromas can occur on any nerve in the body. Foot nerves between the metatarsals are the most likely nerves within the foot to experience a thickening or neuroma. These intermetatarsal nerves of the foot are numbered by the interspace they lay within, 1st interspace along the medial (inside) of the foot, and progressing out to the 4th interspace closer to the lateral (outside) of the foot. The most common intermetatarsal nerve to suffer from neuroma is the 3rd intermetatarsal nerve or Morton’s nerve. Morton’s neuroma specifically relates to an enlargement of the Morton’s or 3rd intermetatarsal nerve. All other foot nerve enlargements of the 1st, 2nd and 4th intermetatarsal nerves are simply referred to as a neuroma.

Condition Information

Medical terms, including neuroma, can often be understood by breaking down the term into component parts. “Neur” or “neuro” means nerve, and “oma” means swelling or tumor. Simply put, a neuroma is a swelling or enlargement of a nerve. The word “tumor” should be avoided when referring to a neuroma, as this word may be construed to mean cancerous or malignant. Neuromas are benign, or non-cancerous, and often respond to conservative care methods.

Causes and Symptoms

Nerves are soft tissue and respond similarly to other soft tissues of the body when inflicted with pressure or friction. For example, when skin on the hand is exposed to new friction or pressure from weight lifting or gardening, skin will form redness (irritation) or ‘hot spots’. If the stimulus from weights or tools rubbing on the skin is experienced regularly, eventually the skin thickens as a protective mechanism from the routinely exposed friction and pressure. This skin thickening provides protection, and increases durability of the skin. When the stimulus of weight lifting or gardening ceases, skin calluses will remain temporarily. Eventually without the friction or pressure stimulus over weeks or months, calluses will soften and skin thickness will return to normal.

Nerve tissue behaves similarly to skin when exposed to friction and pressure. As nerves have the same capacity to thicken and protect itself. However, as nerves thicken within the intermetatarsal spaces, nerve tissue can impact other soft tissues or against the metatarsal bones. This added intermetatarsal pressure can further exacerbate the problem, leading to additional thickening and enlargement of the nerve. When intermetatarsal nerves become too large they may begin to contact the metatarsals on either side of the nerve. Impact of the nerve along the metatarsal can lead to a ‘click’ or ‘pop’ sensation as the nerve slides past the bone. Medical professionals can also test for positive signs of neuroma by performing the Mulder’s Test. The Mulder’s Test involves squeezing the forefoot to compress the metatarsal bones while pressing the intermetatarsal nerve through the metatarsal interspace. A true neuroma must have a positive Mulder’s ‘click’ or ‘pop’. Intermetatarsal nerve symptoms without a positive Mulder’s test are referred to as intermetatarsal neuritis.

Footwear shape and rigidity both contribute to the development of intermetatarsal neuroma. Toe spring and tapering toe boxes lift and compress toes, stretching and compressing intermetatarsal nerves. Other factors that may contribute to Morton’s neuroma include:

  • Narrow or poorly sized footwear
  • Structural forefoot or toe problems
  • Poor gait biomechanics

Common signs and symptoms of neuroma include:

  • Ball-of-foot pain including burning, stinging, stabbing or shooting
  • Foot or toe cramping
  • Foot or toe numbness
  • The sensation that you are walking on a lump, pebble or stone

Treatment

The first and most important step in the conservative and natural management of neuroma involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. A shoe that possesses toe spring will increase stress on intermetatarsal nerves and increase your likelihood of developing a neuroma. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes encourages spreading and space around each intermetatarsal nerve. Decreasing pressure on intermetatarsal nerves offloads nerve compression and irritation. Additionally, the natural position of toes helps optimize circulation in the foot tissues.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. Treatments for neuroma include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Exercises that balance the foot extensors and flexors like the Toe Extensor Stretch
  • Metatarsal pads
  • Heat
  • Hydrotherapy

Peripheral Arterial Disease

Peripheral Arterial Disease

Peripheral arterial disease, or PAD, is a health problem in which plaque—a combination of calcium, fibrous tissue, fat and cholesterol—accumulates within the artery wall. Plaques associated with PAD occur in arteries within peripheral body tissues or close to the surface of the skin throughout the body, most commonly along the stomach, head and extremities. Accumulation of plaque decreases artery volume, limiting blood flow delivery to specific areas throughout the periphery of the body. Plaque hardens with time, further reducing blood flow. PAD is a common circulatory problem.

Condition Information 

Compromised blood flow to lower extremities has a variety of implications, including pain, numbness or increasing likelihood of developing an infection. Systemic complications of PAD include risk of heart attack, coronary heart disease, transient ischemic attack, stroke and gangrene. Smoking, diabetes, obesity, advanced age, family history of PAD and increased protein levels are all factors that significantly increase risk of developing PAD. PAD symptoms are often mistaken for other health problems, resulting in delayed diagnosis of PAD.

Causes and Symptoms

The primary cause of PAD is due to atherosclerosis, or plaque deposits within artery walls. Additional causes of PAD include:

  • Blood vessel inflammation
  • Limb injury
  • Anatomical abnormalities
  • Radiation exposure

The most significant symptoms associated with PAD include:

  • Pain
  • Numbness
  • Inflammation
  • Aching and heaviness of leg tissue
  • Intermittent leg, buttock, thigh, calf or foot cramping
  • Blue tint to skin
  • Decreased temperature along impacted tissue
  • Diminished or absent pulses within extremities
  • Healing (or non-healing) foot wounds
  • Decreased toenail or leg hair growth
  • Erectile dysfunction in men

Treatment

PAD symptoms of the leg, foot and ankle may benefit from a variety of treatment methods. Conservative measures may be beneficial at controlling symptoms. The first step in the conservative and natural management of any form of PAD involves a departure from conventional footwear and towards naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Natural footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread. This foot and toe position helps optimize circulation and mobility in foot tissues, which encourages movement or disbursement of static fluid. Possible additional treatment techniques include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes; to improve circulation, alignment and flexibility of toes. (Contraindicated for individuals who are experiencing numbness).
  • Lifestyle changes like routine exercise, improved diet, restful sleep and weight loss
  • Heating and warming therapies
  • Acupuncture

PAD is a health condition that should always be managed by a healthcare professional. Conventional treatments for PAD may include:

  • Prescription medication
  • Surgery (bypass grafting, angioplasty, etc.)
  • Cessation of smoking
  • Blood pressure reduction
  • Attaining healthy blood sugar levels
  • Increasing physical activity levels

Plantar Fasciosis

Plantar Fasciosis

Until the early 2000’s, plantar fasciosis was known as plantar fasciitis, a condition commonly described with an inflammatory nature. As Dr. Harvey Lemont, DPM states in his 2003 study of plantar fasciitis, “Although authors writing on the subject describe inflammation as being present in plantar fasciitis, they provide no objective, clinical or histologic evidence to support their claims.” Dr. Lemont took 50 MRI confirmed, traction heel spur plantar fasciitis cases and extracted tissue samples. He found that inflammation was not present in any case, but rather observed “marked thickening and fibrosis of the plantar fascia at its origin… In all the samples reviewed, there was no evidence of inflammation histologically” (Lemont). Dr. Lemont concluded that the plantar fascia tissue samples extracted from his study were in fact a build-up of necrotic, fibrotic cells. He has since fathered the term for plantar fasciosis. Plantar fasciosis is frequent to both athletic and inactive populations.

Condition Information

The plantar fascia is a band of tissue extending from the plantar surface of the calcaneus that fans into a medial, central and three lateral cords that attach on the distal aspects of the metatarsals. Spanning a great portion of the foot, and with origin and insertion points located on bony landmarks, the plantar fascia performs as a ligament. The plantar fascia functions to stabilize the foot, assist in gait at toe off and absorb impact.

Following a lifetime of rigid footwear or orthotic use, plantar foot muscles will weaken and atrophy. When a weak foot is forced to exert any load or movement, the plantar fascia will strain. The plantar fascia pulls at its bony attachments, unsupported by surrounding muscles. Heel spur formation (additional bone formation growth) is common where the plantar fascia connects to the bone along the calcaneal origination. Pain can be alleviated if the plantar fascia is placed in a relaxed position with toes plantarflexed, this offloads the stress of the plantar fascia pulling at the origination point. The condition can be reversed when the foot is forced to strengthen.

Causes and Symptoms

Modern footwear with an elevated heel, tapered toe box and toe spring hold the foot in an unnatural position. This position can be found across all footwear, including running shoes. Footwear that holds the hallux adducted and dorsiflexed, the medial plantar fascia band becomes stretched and tight, impeding blood flow through the tibialis posterior artery. In other words, our foot’s position within footwear decreases blood supply to the plantar fascia, allowing tissue to lose nutrients while being held in a stretched unnatural position.

Other recognized contributing factors to this health problem may include any of the following:

  • Shortened or hypertonic calf musculature
  • Weak foot plantarflexers
  • Arthritis
  • Poor foot biomechanics
  • Corticosteroid injections

Plantar fascia pain occurs most commonly located at the proximal, medial plantar fascia origin. Pain is most notable following periods of rest or inactivity, known to podiatrists as post-static dyskinesia or PSD. Other common signs and symptoms of plantar fasciosis include:

  • Tenderness along the bottom of the inside (medial) heel
  • Gait compensation or limping

Treatments

The first and most important step in the conservative and natural management of plantar fasciosis involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows the calf deep flexor muscles to lengthen and engage more fully, offloading stress on the plantar fascia. Natural foot and toe position helps optimize circulation in the foot tissues, encouraging removing of fasciotic accumulation and delivery of oxygen to plantar fascia tissue.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. This is especially true for individuals accustomed to shoes with heel elevation. Additional treatments for plantar fasciosis include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Progressive barefoot walking to encourage plantar foot muscular flexing and strength adaptations
  • Foot exercises that encourage progressive loading of plantar foot muscular
  • Massage or acupuncture
  • Physical therapy
  • Heat
  • Hydrotherapy

Treatments specified to ‘cure’ plantar fasciitis are misguided and outdated. Many current recommendations for the treatment of plantar fasciitis are also misguided and reveal an inadequate understanding of the etiology of the condition. The following therapies should be discontinued, as they are either not helpful or delay recovery of plantar fasciosis:

  • Stretching the plantar fascia, including:
    • Discontinue stretching the toes up into dorsiflexion
    • Discontinue use of footwear (including exercise footwear) that lifts the heel up
  • NSAID’s
  • Ice
  • Strasburg Sock ©
  • Night splints or boots
  • Orthotics
  • Activity cessation and immobilization

As the mentality shifts in regards to treatment of plantar fasciosis, treatment times and length of injury are declining. For further details about plantar fasciosis, check out “Treatment of Plantar Fasciosis,” written by Dr. Glenn Ingram, ND and our own Dr. Ray McClanahan, DPM.

Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction

Posterior tibial tendon dysfunction (PTTD) involves injury to the tendon of the tibialis posterior muscle which originates along the back (posterior) of the lower leg and travels down to the inner (medial) ankle. The tibialis posterior has several insertions on each tarsal bone of the foot, with the primary branch inserting at the navicular. Tibialis posterior controls ankle inversion, a motion that tilts the medial foot up. Additionally, tibialis posterior prevents the medial longitudinal arch from falling, mitigating excessive pronation.

PTTD is relatively uncommon, involving sustained and focal injury or micro-trauma to the posterior tibial tendon. This chronic musculoskeletal problem will impact the strength of the tibialis posterior muscle, resulting in excess medial longitudinal arch mobility and decreased medial longitudinal arch height.

Condition Information

PTTD is also known as acquired flat foot, as the condition involves the acquired injury or failure of the tibialis posterior muscle, which stabilizes the medial longitudinal arch. PTTD typically occurs unilaterally (one foot), and rarely occurs bilaterally (both feet). This condition is often progressive and requires immediate treatment to prevent complications.

PTTD causes a maximally pronated, flattened and collapsed foot. PTTD alters the shape of the foot, increasing mid-foot width and decreasing instep height, a foot shape that may be difficult to fit in shoes. A PTTD-affected foot often becomes a progressively more difficult problem to treat the flatter and more deformed the foot becomes. A test to confirm PTTD involves standing on the affected foot and failing to raise up onto toes.

Causes and Symptoms

Chronic overuse and/or misuse of the posterior tibial tendon while participating in certain activities such as stair climbing, hiking, walking and running may contribute to PTTD-related symptoms. PTTD may also be caused by a tendon abnormality. Possible risk factors for PTTD include:

  • Diabetes
  • Elevated blood pressure
  • Previous trauma (e.g. certain types of ankle fracture)
  • Rheumatoid arthritis, psoriasis and other inflammatory conditions
  • Steroid injections

PTTD causes numerous signs and symptoms, including:

  • Mid-foot tenderness
  • Medial-longitudinal arch collapse
  • Pain and swelling on the inside aspect of your ankle
  • Foot and ankle weakness
  • Inability to lift heel and balance on your toes
  • Pain that gradually develops on the outer aspect of your foot or ankle

Treatments

The first and most important step in the conservative and natural management of PTTD involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes creates a more stable 1st ray alignment helping lift and balance the medial longitudinal arch, offloading the tibialis posterior muscle. Natural footwear shape allows for additional space around a widened mid-foot, decreasing compression and rubbing on sensitive tissues.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. This is especially true for individuals accustomed to shoes with heel elevation. Depending on the severity of present tendon dysfunction, a variety of treatments may be involved in the maintenance or recovery of PTTD. Taping procedures have been proven effective to temporarily splint the foot, ankle and lower leg in an inverted position, offloading the tibialis posterior tendon and optimizing recovery.

Additional treatments for PTTD include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Progressive barefoot walking to encourage plantar foot muscular flexing and strength adaptations
  • Foot exercises that encourage progressive loading of plantar foot muscular
  • Massage or acupuncture
  • Physical therapy
  • Heat
  • Hydrotherapy

Conventional western medicine treatments may also recommend immobilization as a treatment for PTTD. Immobilization may decrease symptoms of midfoot and arch pain; however, long duration immobilization further contributes to atrophy and additional muscle weakness. Conventional treatment may also include steroid injections to reduce symptoms. While likely to reduce pain, injectable steroids are not recommended to treat PTTD, as they may contribute to complete rupture of the tibialis posterior tendon.

PTTD requires immediate attention if the medial longitudinal arch collapses. Failure to seek immediate care may limit treatment options for PTTD. Advanced cases of PTTD following arch collapse may require surgical procedures to rebuild the midfoot and arch. Examples of surgical options for PTTD include:

  • Arthrodesis
  • Tendon transfer
  • Osteotomy
  • Tenosynovectomy
  • Lateral column lengthening

Raynaud's Syndrome

Raynaud's Syndrome

Raynaud's syndrome is a circulatory condition sometimes referred to as a Raynaud’s disease or Raynaud’s phenomenon. Raynaud's syndrome is characterized by brief bouts of vasospasm, or the sudden narrowing of blood vessels. As blood vessels narrow, blood flow decreases to the areas beyond the constriction. Arterial vasospasm is most likely to occur within the extremities, specifically throughout the fingers or toes. In rare cases, this condition may impact blood flow to the nose, ears, nipples and lips.

Due to decreased blood flow associated with Raynaud's syndrome, affected areas may discolor, initially turning white. With sustained loss of blood flow, the deoxygenated state will cause tissue to turn blue. Once vessels relax and the spasm subsides normal blood flow will return, forcing the skin to turn red. Return of blood flow may also cause additional sensations such as throbbing, tingling, burning or numbness. In severe cases Raynaud's syndrome may cause sores or tissue death. Known triggers of Raynaud's syndrome include cold weather and stress; however, the true underlying cause of Raynaud's syndrome is unknown.

Information

Raynaud's syndrome has two principle types: primary and secondary. Primary Raynaud's syndrome is more common, occurring without the presence of any other underlying health problem that could induce vasospasm. Primary Raynaud's syndrome typically develops early in life. Secondary Raynaud's syndrome is less common and is associated with an additional underlying medical condition. Secondary Raynaud's syndrome is usually more serious and typically develops by 40 years old. Approximately 5% of people in the United States have some form of Raynaud’s.

Causes and Symptoms

Raynaud's syndrome attacks can be triggered by either cold temperatures or elevated stress levels. Symptoms may be experienced in only one or two fingers or toes, or broadly across several areas. Relatively mild or brief temperature alterations such as removing an item from the freezer can provoke symptoms of Raynaud's syndrome. Episodes of Raynaud's syndrome may last in duration of under a minute to multiple hours. Most episodes of vasospasm suffer no lasting tissue damage, though severe or prolonged versions may lead to gangrene or tissue death.

Conditions that may contribute to secondary Raynaud's syndrome include:

  • Scleroderma
  • Lupus
  • Rheumatoid arthritis
  • Sjogren’s syndrome
  • Arterial diseases (e.g., Buerger’s disease)
  • Carpal tunnel syndrome
  • Smoking
  • Certain injuries (e.g., wrist fractures, frostbite, etc.)
  • Specific medications
  • Chemical exposure
  • Thyroid gland disorders

Another possible cause of secondary Raynaud's syndrome is due to overuse injuries. For example, contact with vibrating equipment for prolonged periods can lead to secondary Raynaud's syndrome known as vibration white finger.

Signs and symptoms of Raynaud's syndrome depend on several factors, including frequency, duration and severity of vasospasms. Some of the most common signs and symptoms include:

  • Cold fingers and toes
  • Skin color changes of white, blue and red
  • Sensation changes of numbness, stinging or pins and needles

Treatment

Raynaud's syndrome symptoms of the foot and toes may benefit from a variety of treatment methods. One of the most important factors in managing Raynaud's syndrome is limiting exposure to common triggers such as cold temperature, or finding outlets to mitigate and manage stress. Maintaining adequate circulation within footwear is critically important, as most conventional footwear will constrict the forefoot and toes which limits blood flow. Ideal footwear will not compress skin, and will allow toes to lay flat and spread into natural alignment. Conservative measures, such as footwear changes, may be beneficial at controlling symptoms. The first step in the conservative and natural management of any form of Raynaud's syndrome involves a departure from conventional footwear and towards naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Natural footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread. This foot and toe position helps optimize circulation in foot tissues. Possible treatment techniques include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes; to improve circulation, alignment and flexibility of toes (Contraindicated for individuals who are experiencing numbness)
  • Lifestyle changes to promote relaxation and stress management like routine exercise, improved diet and restful sleep
  • Heating and warming therapies
  • Limiting caffeine intake
  • Acupuncture

Techniques to halt or limit the severity of a Raynaud's syndrome episode may include any of the following warming strategies:

  • Relocate to a place of greater warmth
  • Gentle finger and toe movement
  • Run warm (not hot) water over affected area

Raynaud's syndrome is a health condition that may best be managed by a healthcare professional. Conventional treatments for Raynaud's syndrome may include:

  • Prescription medication
  • Topical ointments or creams
  • Cessation of smoking
  • Attaining healthy blood sugar levels
  • Increasing physical activity levels

Sesamoiditis

Sesamoiditis

Sesamoid bones are small, typically ‘floating’ bones found throughout our body. The patella, or kneecap, is the largest and most commonly known sesamoid bone. Sesamoid bones act as pulleys, decreasing force needed to create a specific movement. For our purposes, sesamoiditis refers to the irritation, imbalance or malalignment of the two small sesamoid bones located on the plantar (bottom) aspect of the 1st metatarsal-phalangeal joint, or 1st MTP where the hallux (big toe) joins the foot. Known as the tibial and fibular sesamoids, these small bones are approximately the size of a kernel of corn.

Condition Information

The tibial and fibular sesamoids provide a smooth surface for flexor tendons to slide, improving the ability of tendons to transfer force from the lower leg muscles to the hallux. Tendons from both the adductor hallucis and flexor hallucis muscles encompass and insert on the sesamoids. Each sesamoid slides along within its own groove on the plantar aspect of the 1st metatarsal. The projection of bone that separates the tibial and fibular sesamoid grooves is called the crista. As the adductor hallucis and flexor hallucis contract and move the hallux, the sesamoids move linearly within their respective grooves. When hallux alignment is compromised, such as within narrow toe box  footwear or conventionally designed footwear, the hallux becomes deviated towards the second toe. This position will pull the sesamoids with the hallux and the adductor hallucis and flexor hallucis tendons, repositioning the tibial sesamoid below the crista of the 1st metatarsal, and repositioning the fibular sesamoid within the 1st interspace between the 1st and 2nd metatarsals. The resulting sesamoid alignment leaves these small bones vulnerable to improper loading and impact. Sesamoid bones, like all other bones, can break, and the tendons that pass over these structures can suffer soft tissue irritation and inflammation. Sesamoiditis is the term used to describe this soft tissue irritation and inflammation.

In rare cases, the tibial or fibular sesamoids can each form in more than one piece. Known as bipartite sesamoid, the sesamoid bones would be composed of two rounded and typically equally sized pieces. Bipartite sesamoid can occur in either the tibial or fibular sesamoids, and can occur in one or both feet. Bipartite sesamoids routinely are misdiagnosed as sesamoid fracture. Fractured sesamoids can occur, and typically involves blunt impact or trauma. Resulting fragments from sesamoid fracture are typically jagged in presentation and often result in two unequally sized pieces, rather than the smooth sided and equally proportioned bipartite sesamoids.

Causes and Symptoms

Sesamoiditis can be linked to poor sesamoid alignment due to hallux deviation within conventionally shaped footwear. As the hallux is pushed towards the second toe, the adductor hallucis and flexor hallucis muscles pull the sesamoid bones out of their receptive grooves, displacing the tibial sesamoid under the crista of the 1st metatarsal, and displacing the fibular sesamoid to the 1st interspace. Normal ambulation or activity with poorly aligned sesamoids leaves these bones vulnerable to impact and repetitive stress. Conventional footwear plays an important role in aggravating sesamoids and their surrounding structures. Footwear with a tapered toe box, toe spring and an elevated heel will force sesamoids out of natural alignment and increase load along the ball of the foot, where the sesamoids are found. Sesamoiditis related pain is usually intermittent, increasing when wearing certain shoes or participating in certain activities.

Some of the most common signs and symptoms associated with sesamoiditis include:

  • Pain under the 1st MTP
  • Swelling
  • Bruising
  • Impaired hallux mobility

Treatment

The first and most important step in the conservative and natural management of sesamoiditis involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of your toes and allows all the toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes repositions the big toe. Sesamoiditis often responds to conservative care measures and should always be treated by a qualified healthcare professional in a timely and appropriate manner. Conservative treatment may also involve any of the following interventions:

Conventional treatments that can contribute to symptom reduction, but do not address cure may include:

  • Anti-inflammatory medication
  • Cortisone or steroid injections

Sever's Disease

Sever's Disease

Sever’s Disease, also known as calcaneal apophysitis, is a common heel problem affecting children. This temporary and painful disorder impacts the calcaneus, or heel bone. Children impacted by Sever’s disease suffer no long term complications. Similar to the knee disorder Osgood-Schlatter disease, Sever’s disease involves microtrauma, inflammation and edema. Specifically, Sever’s disease concerns the calcaneal growth plate, which can experience tension from the Achilles insertion pulling the retrocalcaneal portion of bone away from the calcaneal body. Conventionally designed footwear with rigid soles, a narrow toe box, toe spring and elevated heel is a contributing factor in the onset of this condition.

Condition Information

Sever’s disease is particularly prevalent among active children. Onset of Sever’s disease in girls typically occurs from ages 8-13, and in boys from ages 10-15. Sever’s disease symptoms can be initiated or exacerbated while the child is experiencing a growth spurt. Sever’s disease causes heel pain, typically worse with impact and activity as the calcaneal growth plate experiences force. Once structural maturity occurs, the growth plate fuses and pain resolves. Sever’s disease usually self-resolves within six months of onset; however, duration of symptoms is dependent on structural maturity and fusing of the growth plates.

Causes and Symptoms

Rate of tissue growth in adolescents is a huge contributing factor for Sever’s disease. Specifically if there is a mismatch in speed of the calcaneus growing faster than the lower leg muscles inserting via the Achilles or calcaneal tendon. The difference of growth rate between the bone and muscles stretches underdeveloped musculature, decreasing tendon flexibility and increasing pressure on the calcaneal growth plate. Repetitive stress from the calcaneal tendon on its insertion can lead to tenderness, swelling and pain.

Activities that involve running or jumping place significant stress on the calcaneal tendon, contributing to the onset of Sever’s disease. Conventionally constructed footwear also contributes to Sever’s disease, specifically the elevated heel and tapered toe-box in athletic shoes. Elevated heeled athletic shoes decrease functional length of posterior leg musculature, contributing to contracted gastrocnemius, soleus and calcaneal tendon length. Tapered toe-box athletic shoes squeeze and lift toes together, decreasing functional abilities of the deeper posterior flexors, such as flexor hallucis longus and flexor digitorum, further contributing on the reliance and pressure on the calcaneal tendon. Additionally, poorly constructed or fitted conventional athletic footwear can rub against the back of heel, increasing irritation to the calcaneal tendon insertion.

The following factors may increase the likelihood of Sever’s Disease:

  • Wearing conventionally constructed footwear with a narrow toe-box or elevated heel
  • Leg length inequality
  • Obesity or carrying excess bodyweight
  • Rapid growth spurts

Some of the most common signs and symptoms associated with Sever’s disease include:

  • Retrocalcaneal heel pain or tenderness, unilateral or bilateral
  • Increased symptoms during or following activity
  • Heel pain following periods of rest or inactivity, i.e. post static dyskinesia (PSD)
  • Increased symptoms when the heel is squeezed
  • Localized heel swelling or redness
  • Limping
  • Tight calf muscles
  • Decreased ankle range of motion

Treatment

The first and most important step in the conservative and natural management of Sever’s disease involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of your toes and allows all the toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes repositions the big toe. Sever’s disease often fully recovers without intervention once skeletal maturity is reached; however, conservative treatment of Sever’s disease will decrease the impacts of tight lower-leg musculature during periods of adolescent growth. Treatments may involve any of the following interventions:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Physical therapy
  • Heat
  • Hydrotherapy

Sever’s disease is not expected to cause long-term problems. Certain conservative care measures may be implemented to address symptom management, including:

  • Avoiding activities that provoke pain or discomfort
  • Compression garments or wraps
  • Use backless footwear or sandals
  • Certain oral or topical medications

For medical interventions or medications, please contact your personal healthcare provider.

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome, also known as tibial nerve dysfunction occurs when the posterior tibial nerve becomes entrapped or compressed. Disturbance to the posterior tibial nerve can cause a variety of symptoms including various severity of compression neuropathy such as numbness, tingling and cramping.

Condition Information

The tarsal tunnel is a space on the medial (inner) ankle formed by a ligamentous structure called the flexor retinaculum. The flexor retinaculum spans from the medial malleolus (inner ankle bone) to the calcaneus (heel bone) forming the ‘ceiling’ or protective passageway called the tarsal tunnel. The tarsal tunnel contains arteries, veins, nerves and tendons leading from the lower leg to the foot. Compression of any of these tarsal tunnel structures can cause foot problems.

Causes and Symptoms

The underlying cause of tarsal tunnel syndrome can be difficult to determine without invasive procedures, biopsies or imaging. Causes of tarsal tunnel syndrome may include anything that increases pressure in your tarsal tunnel space including:

  • Edema
  • Cyst formation
  • Tendon sheath inflammation
  • Bone spurs
  • Varicose veins
  • Direct trauma to the tarsal tunnel
  • Poor biomechanics

Most conventional footwear contributes and causes excessive pronation, as the heel and toes are elevated and toes are compressed. This position destabilizes the midfoot, allowing the subtalar joint increased mobility. The posterior tibial nerve can become stretched or compressed as the subtalar joint acquires excess movement. Conventional footwear may also possess rigid or thick materials that may bind, squeeze or rub the posterior tibial nerve.

Some of the most common signs and symptoms associated with tarsal tunnel syndrome include:

  • Foot, ankle and toe muscle weakness
  • Foot pain
  • Localized burning, numbness or other neuralgia sensations

Treatment

The first and most important step in the conservative and natural management of tarsal tunnel syndrome involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows stability and balance to the subtalar joint, decreasing common biomechanical issues like excessive pronation. This foot and toe position also helps optimize circulation for all lower limb muscle compartments, helping nourish nerve tissue.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. This is especially true for individuals accustomed to shoes with heel elevation. Additional treatments for tarsal tunnel syndrome include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Heat
  • Temporary relative rest
  • Massage
  • Physical therapy
  • Hydrotherapy

Physician supervision may be beneficial for specific additional treatment recommendations for this health problem.

Tibial Fasciitis (Shin Splints)

Tibial Fasciitis (Shin Splints)

Tibial fasciitis, also known as medial tibial stress syndrome, is a lower extremity health problem involving pain along the inner edge of the shinbone, or tibia. ‘Shin Splints’ is an non-specific umbrella term for a variety of lower leg pathologies. Tibial fasciitis involves irregular movement of the periosteum, the dense layer of connective tissue that encases bone. Tibial fasciitis commonly manifests during or following vigorous physical activity. Activity can force muscles to pull in unusual ways, creating excess motion of the periosteum. The periosteum is vascularized and innervated with nerves, friction, rotation and torque along this membrane can be painful.

Condition Information

Tibial fasciitis is frequently experienced during athletic activities that involve jumping, pounding or impact on the lower limbs. Most athletes experience tibial fasciitis to some degree of severity at some point during their lives. Certain risk factors increase the likelihood of developing tibial fasciitis including poor biomechanics, foot arch rigidity and training errors. The underlying cause of tibial fasciitis may determine specific location of symptoms along the tibia.

Causes and Symptoms

Tibial fasciitis is more of a symptom of an underlying musculoskeletal or movement problem than a true medical condition. Possible causes of tibial fasciitis include:

  • Overuse or poor training habits
  • Erratic training routine
  • Sudden changes to intensity, duration or frequency of workouts
  • Compensatory movements during exercise
  • Excess or inadequate arch mobility

Even within an ideal training environment and movement pattern, tibial fasciitis can still occur. Prevalence of tibial fasciitis can be associated with conventionally constructed athletic footwear that possesses an elevated heel, toe spring, rigid sole and a tapered toe box. Both the elevated heel and toe spring features of common athletic shoes will contract lower leg musculature, shortening the anterior, posterior and lateral compartments. Paired with a tapered toe box that destabilizes the midfoot, all lower limb muscles are forced to function outside of their ideal anatomic alignments and length-to-tension ratios. Additionally, rigid soled footwear, insoles and orthotics prevent the natural motion of the three foot arches. In a normal to mobile foot, decreasing arch mobility hinders muscle contraction leads to atrophy of foot muscles. This limits the ability of the arches to absorb impact and produce energy for the next step. Lower limb muscles along the tibia that insert and act upon the foot will still contract, but the foot will be unable to respond or move within its rigid environment. This results in more force acting upon the tibia as muscles try to contract and move, creating sheering and torque.

Treatment

The first and most important step in the conservative and natural management of tibial fasciitis involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread (an action that can be further enabled with the use of Correct Toes). Spreading the toes with the use of Correct Toes allows the calf deep flexor muscles and anterior extensors to engage more fully and be balanced in length-to-tension relationships. This foot and toe position helps optimize circulation for all lower limb muscle compartments.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. This is especially true for individuals accustomed to shoes with heel elevation. Additional treatments for tibial fasciitis include:

  • Progressive changes to naturally shaped footwear
  • Correct Toes
  • Re-evaluation and adoption of a proper training program
  • Temporary relative rest
  • Massage
  • Physical therapy specific to lower leg muscle strengthening
  • Hydrotherapy

Warts (Plantar)

Warts (Plantar)

Plantar wart, also known as verruca plantaris, is caused by the human papillomavirus, or HPV. This strain of HPV only impacts skin on the bottom of the foot. This virus can only gain entry to living on plantar skin through small cuts or breaks in the skin on the bottom of the foot. If the skin barrier is intact, exposure to this strain of HPV does not guarantee the development of a plantar wart.

Condition Information

Plantar warts are living organisms, they require oxygen and blood flow to persist. Plantar warts will utilize the host’s own blood supply, functioning as a parasite. The blood supply feeding the wart leads to the appearance of small dark spots or black dots within the body of the wart, called wart seeds. The host’s body will try to rebuild tissue surrounding the wart’s site, creating buildup of thick, irregular skin circling or covering the plantar wart.

Plantar wart formation is frequently misdiagnosed as callus formation, and visa versa. Distinction between wart and callus can easily be determined based on location along the plantar surface of the foot. Warts cannot live under focal weight-bearing areas of the plantar foot and are more likely to occur along the arches, sulcus or along and between toes. Focal callus formation will only occur in areas of pressure or rubbing, typically under the MTP joints or directly at points under or along bony landmarks of the foot and toes. Calluses are not a viral infection and will not have capillary blood flow intervention.

Causes and Symptoms

The HPV virus is the cause of plantar warts. Over 100 types of HPV exist, although only several types have been linked to plantar wart formation. Plantar warts manifest in people of all ages, although people with compromised immune function are more likely to develop this health problem.

Possible signs and symptoms associated with plantar warts include:

  • Focal growth or groupings of darkened or callus skin patches along the bottom of the foot
  • Irregularity of skin texture and thickness
  • Localized pain, worsening with pressure
  • Small, clotted blood vessels that look like black pinpoints
  • Tenderness with weight-bearing activities

Treatment

The first and most important step in the conservative and natural management of plantar warts is to limit rubbing, squeezing or pressure from points of contact within conventionally shaped footwear. Poorly fitted or conventionally shaped footwear leads to toes rubbing together, increases skin moisture levels and creates areas of friction or pressure. These conditions lead to skin break down and degradation, factors that allow the skin barrier to be less resilient to exterior bugs. Soft, moist or raw skin is more susceptible to the plantar wart virus. Transitioning to healthful footwear involves a departure from conventional footwear and toward naturally shaped footwear. Avoid toe spring, heel elevation and tapering toe boxes when selecting footwear. Naturally shaped footwear possesses a toe box that is widest at the ends of the toes and allows all toes to spread. Spreading the toes decreases pressure and rubbing between and on the ends or sides of toes. This foot and toe position allows the foot to be in a more natural position which naturally decreases friction on the skin. A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome.

Additionally, plantar wart treatment depends on the severity of symptoms being experienced. If warts are not in a tender or painful area, and the wart is not spreading to other areas, elected deferral of treatment or not treating the wart is a possibility. Plantar warts typically resolve without treatment within two years. Addressing overall skin health and plantar warts with conservative care typically involves the following interventions:

  • Progressive changes to naturally shaped footwear to aid skin health
  • Use synthetic wicking socks, or wear socks made from natural fibers like wool or bamboo
  • Change socks often when in footwear for prolonged periods, or immediately following exercise
  • Discontinue and avoid cotton socks, as cotton fibers retain moisture
  • Use a double layer acrylic sock system
  • Application of topical drying powders or antiperspirants

Management of existing plantar wart formation may include:

  • Topical prescription or over-the-counter acid preparations, such as salicylic acid
  • Application of occlusive tape over the wart, specifically duct tape
  • Laser therapy
  • Debridement of excess topical callus or wart tissue from a medical provider

Misdiagnosis and inappropriate treatment methods by an unqualified individual may lead to unnecessary scarring, spread of your virus to other sites and prolonged pain and disability. Physician supervision may be beneficial for specific additional treatment recommendations for this health problem.