Peripheral Neuropathy
Questions to Ask Yourself
- Do you feel numbness or strange sensations in your feet?
- Do you wake at night with the feeling of burning or pins and needles in your feet?
- Do your feet get blisters or red areas that you can't feel?
These can be symptoms of peripheral neuropathy. Peripheral neuropathy is a disease of the nerves in your feet. It may make you unable to sense pain. Lack of pain makes you more likely to injure yourself without knowing it. But you can learn ways to protect your feet from injury.
When Nerves Are Diseased
Nerves in your feet carry signals to your brain. Your brain reads those signals and interprets them as sensations. When nerves in your feet are diseased, signals may never reach the brain. Or, signals may be confused. The result may be a lack of feeling in your feet or other symptoms of peripheral neuropathy.
Symptoms Mask Pain
Symptoms of peripheral neuropathy begin in your toes. The symptoms slowly spread up your feet and legs as more nerve is affected. These symptoms may mask pain. Without pain, you may not notice a cut or even a bone fracture. Cuts may become infected. Fractures may heal poorly and lead to foot deformity.
Physical Exam
Your doctor will ask about your symptoms and check your reflexes. He or she will also check how well you sense pressure, vibration, and temperature. To do this, some simple tools will be touched against your feet.
Regular Foot Care
If you have foot numbness, you may not notice cutting yourself while trimming your nails. To prevent problems, your doctor may ask you to visit for nail and callus trimming. See your doctor for foot care as often as suggested.
Protecting Your Feet
Learn ways to protect your feet. Check your feet daily for wounds you may not have felt. Avoid burns by testing bath water with your elbow before stepping in. Also, to prevent injury, always wear shoes.
Check Your Feet Daily
Catch problems early by checking your feet every day for changes. Look at the top and bottom of your feet, your heels, and between your toes. It may help to use a mirror. If this is hard, ask someone to check for you. Call your doctor if you notice a wound, ingrown nail, or any changes in your feet. This includes increased heat, swelling, and redness.
Wear Proper Footwear
Always wear shoes and socks, even indoors. Ask your doctor how to choose the right shoe. After buying shoes, bring them to your doctor to be checked for fit. Take new shoes off every hour or so to check for red pressure areas on your feet.
Ganglions
A ganglion is a fluid-filled swelling of the lining of a joint or tendon. Although ganglions can form on any part of the foot, they most often appear on the ankle or top of the foot. Ganglions tend to change in size and usually grow slowly.
Causes of Ganglions
Repeated irritation can weaken the lining of a joint or tendon and lead to ganglions. People who wear boots are more vulnerable to ganglions, as this type of footwear puts stress on the foot and ankle. Bone spurs (bony outgrowths) may also cause ganglions by irritating the joints and tendons.
Symptoms of Ganglions
Ganglions often form with no symptoms. But if the ganglion puts pressure on the nerves in the overlying skin, it can cause tingling, numbness, or pain. Ganglions sometimes swell and their size can change with different activities or a change in weather.
How Are Ganglions Diagnosed?
Because ganglions are sometimes mistaken for tumors, it's important to have a complete examination and, possibly, tests to confirm the diagnosis.
Medical History: Your podiatrist asks you questions such as how long you've had the ganglion, what kind of symptoms you're feeling, if it has changed in size, or if its size varies according to your activities.
Physical Exam: During your evaluation, your podiatrist may do a translumination exam, shining a light through the swelling (usually, you can see through a ganglion, but not through a tumor). When your foot is palpated (pressed), a ganglion feels spongy and the fluid moves from side to side.
Tests: If a bone spur is suspected, x-rays may be needed. Fluid removal (needle aspiration) may be done to help determine the degree of swelling and to decrease pain. To confirm a ganglion, magnetic resonance imaging (MRI) may be done, which reveals images of soft tissue and bone. Sometimes, special dyes may be injected into the area to show the outline of the ganglion.
Treatment
Ganglions are often difficult to treat without surgery-but nonsurgical methods may be helpful in relieving some of your symptoms.
Non-Surgical Care
- Pads placed around the ganglion can ease pressure and friction.
- Fluid removal may also relieve symptoms, though ganglions may recur.
- Limiting movements or activities that increase pain may bring relief.
- Icing the ganglion for 15-20 minutes may temporarily relieve inflammation and pain.
- If your inflammation is severe, your podiatrist may treat your symptoms with medication.
Will I Need Surgery?
If a ganglion is causing ongoing or severe pain, your podiatrist may recommend surgery. The entire ganglion wall is removed during the procedure; some surrounding tissue may also be removed.
After Surgery
You may feel pain, swelling, numbness, or tingling for several weeks following surgery. You'll probably be able to walk soon afterward, though your foot may need to be wrapped or in a cast. Be sure to see your podiatrist if you notice any problems in the future. Although surgery is usually successful, there is a chance that the ganglion will recur.
Corns & Calluses
A corn or callus is a thickening of the outer layer of skin on your foot. Corns usually grow on top of the foot, often at a toe joint. Calluses spread on the bottom of the foot or on the outer edge of a toe or the heel.
Corns and calluses are your body's response to friction or pressure against the skin. If your foot rubs inside your shoe, the affected area of skin thickens. Or if a bone is not in the normal position, skin caught between bone and shoe or bone and ground builds up. In either case, the outer layer of skin thickens to protect the foot from unusual pressure. In many cases, corns and calluses look bad but are not harmful. However, more severe corns and calluses may become infected, destroy healthy tissue, or affect foot movement. But with your doctor's help, corns and calluses can be controlled.
Corns
Corns can range from a slight thickening of skin to a painful, hard bump. They often form on top of buckled toe joints (hammer toes). If your toes curl under, corns may grow on the tips of the toes. You may also get a corn on the end of a toe if it rubs against your shoe. Corns can also grow between toes, often between the first and second toes.
Calluses
A callus may spread across the ball of your foot. This type of callus is usually due to a problem with a metatarsal (the long bone at the base of a toe, near the ball of the foot). A pinch callus may grow along the outer edge of the heel or the big toe. Some calluses press up into the foot instead of spreading on the outside. A callus may form a central core or plug of tissue where pressure is greatest.
Exam
Your doctor will check your feet for skin changes, such as red areas, blisters, and warts. He or she will also look for corns and calluses. If you have a buckled toe joint, your doctor may test its flexibility. He or she may also look for a misaligned bone or collapsed joint. An x-ray may be taken to pinpoint a suspected bone problem.
Treating Corns & Calluses
If your corns or calluses are mild, reducing friction may help. Different shoes, moleskin patches, or soft pads may be all the treatment you need. In more severe cases, treating tissue buildup may require your doctor's care. Sometimes orthoses (custom-made shoe inserts) are prescribed to reduce friction and pressure.
Change Shoes
If you have corns, your doctor may suggest wearing shoes that have more toe room. This way, buckled joints are less likely to be pinched against the top of the shoe. If you have calluses, wearing a cushioned insole, arch support, or heel counter can help reduce friction.
Visit Your Doctor
In some cases, your doctor may trim away the outer layers of skin that make up the corn or callus. For a painful corn, medication may be injected beneath the built-up tissue.
Wear Orthoses
Orthoses are specially made to meet the needs of your feet. They cushion calluses or divert pressure away from these problem areas. Worn as directed, orthoses help limit existing problems and prevent new ones from forming.
If You Need Surgery
If a bone or joint is out of place, certain parts of your foot may be under too much pressure. This can cause severe corns and calluses. In such cases, surgery is often the best way to correct the problem.
Outpatient Procedures
In most cases, surgery to improve bone position is an outpatient procedure. Your doctor may shave or cut away excess bone. Sometimes tendons or ligaments are cut to reduce tension on a bone or joint. Your doctor will talk with you about the
procedure that is best suited to your needs.
Flat Feet
What Are Flat Feet?
The arch of your foot is its main supportive structure. If this arch loses strength, the bony framework begins to collapse, causing your foot to flatten. Like a sagging bridge, the weakness in the middle strains the joints at both ends of your foot.
Causes of Flat Feet
There are many causes of flat feet. Some people are born with them. Others acquire flat feet as a result of arthritis, trauma, or musculoskeletal disorders. Overuse or repeated pounding on hard surfaces can also weaken the foot's arch.
Symptoms
Discomfort from flat feet often doesn't appear for years. At some point, pain may be felt and walking may become awkward as increasing strain is put on your feet and calves.
Related Problems
The excess strain from flat feet can cause other foot problems, such as hammertoes, bunions, heel spurs, arch strain, corns, neuromas, and sagging joints. Flat feet can also affect other parts of the body, causing fatigue, pain, or stiffness in the ankles, knees, hips, and lower back.
Exam
To determine the best treatment for your problem, Dr. Eric J. Paul will review your medical history, such as any medical problems you may have had in the past. He asks about the length and frequency of your symptoms, the types of activities you do, and any pain or problems you may have in other parts of your body. We do a complete examination of your foot, including a gait analysis to observe the movement and stability of your legs and feet as you walk.
Testing
If your problem is severe and your podiatrist suspects a bone problem, x-rays may be needed. If other problems are suspected, magnetic resonance imaging (MRI) or computerized tomography (CT) may be done, which reveals cross-sectional images of soft tissue and bone.
Treatment of Flat Feet
If flat feet are diagnosed at an early age, chances are good that nonsurgical treatment, such as strapping, custom shoe inserts (orthotics), or medication can help the problem.
Nonsurgical Care
- Strapping: Taping your feet may help by temporarily maintaining the proper position of your feet.
- Orthotics: Custom orthotics can readjust the weightbearing position of your feet. Soft, semi-flexible, or rigid inserts may be used, depending on your weight and physical activity.
- Medication: You may be given anti-inflammatory medication to temporarily relieve pain caused by flat feet.
- Surgery: If your flat feet cause chronic pain, surgery may be needed to correct the alignment of the bones in your feet, or to support or reinforce the tendon structures in your feet. Learn More About Surgery
What Can I Do About Flat Feet?
To help ease the pain of flat feet, try the following as part of your daily routine. If you have continuing problems, be sure to see your podiatrist.
- Shoes: Be sure your shoes are supportive and comfortable, with enough space in the toe box for toes to wiggle. Women should wear low-heeled shoes, not pumps.
- Stretching: To stretch your soles and tendons, try this: Lean on something stationary, with one leg in front of the other and both heels flat. Bend the front knee. Hold for 10 seconds. Bend your back knee, bringing the heel up. Hold for 10 seconds. Do this 5 times with each leg.
- Soaking and Massage: Warm-water soaks or ice massages can help relieve pain. But if you have diabetes or a circulation problem, talk with your podiatrist first.
Neuroma
What Are Neuromas?
Commonly called a Morton's neuroma, this problem begins when the outer coating of a nerve in your foot thickens. This thickening is usually caused by irritation that results when two bones repeatedly rub together (often due to ill-fitting shoes or abnormal bone movement). The area between the third and fourth toes is the most commonly affected; the area between the second and third toes is another common irritation point. Nerve problems due to diabetes or alcoholism may also cause neuroma-like symptoms.
Symptoms
The pain from neuromas may start gradually, causing burning, tingling, cramping, or numbness. Symptoms often occur after you've been walking or standing for a period of time. It might feel like you're stepping on a lamp cord. You may need to take your shoe off and rub your foot. In some cases, the pain radiates from the tip of the toes to the ankle. To help diagnose your problem and determine the best treatment for your neuroma, your podiatrist looks at your medical history, thoroughly examines your foot, and performs any necessary tests.
Medical History and Physical Exam
Your podiatrist talks with you about your symptoms, the frequency of your pain, and any past medical history that could involve nerve problems. Then your podiatrist examines your foot carefully, palpating (pressing) the areas around the neuroma to determine the extent of your pain.
X-rays may be used to help identify a possible neuroma, or to rule out other causes of the pain. Ultrasound, which uses sound waves to show internal soft tissue, may also be performed. Another diagnostic test, which can also relieve pain, involves blocking the nerve by injecting anesthesia around it. Occasionally, magnetic resonance imaging (MRI) may be done to reveal cross-sectional images of soft tissue and bone.
Nonsurgical Care
Orthotics: Custom shoe inserts adjust the structural support of your foot, helping to prevent irritation to the nerve. Ultrasound Therapy Sound waves may help reduce swelling around the neuroma.
Medication: Cortisone injections or other medication can relieve pain and swelling in the nerve's outer coating. Shoe Changes Pads can cushion and support the parts of your foot that are vulnerable. Roomy, supportive shoes can make a world of difference.
Treatment of Neuromas?
After your evaluation, your podiatrist will talk with you about the most appropriate care for your neuroma. Nonsurgical treatment methods may include orthotics, medication, ultrasound or shoe adjustments.
Will I Need Surgery?
If nonsurgical care does not help, surgery may be necessary to remove the neuroma. A local anesthetic may be used for this procedure. The surgery may be done in your podiatrist's office, a surgical center, or a hospital.
After Surgery
Following your surgery, you may feel numbness (possibly permanent) in the area where the nerve was removed. Your podiatrist will tell you how soon you can be on your feet. Usually, you can return to normal activities within three to six weeks. Learn More About Surgery
What Can I Do About Neuromas?
Shoes can make all the difference. Be sure they're supportive-and roomy enough for your toes to wiggle. Avoid certain movements, such as squatting and knee-bending, which can irritate the nerve. See your podiatrist if your symptoms continue or other foot problems arise.