Total Care Podiatry

What is it?

Sesamoiditis is a common ailment that affects the forefoot, typically in young people who engage in physical activity like running or dancing. Its most common symptom is pain in the ball-of-the-foot, especially on the medial or inner side. The term is a general description for any irritation of the sesamoid bones, which are tiny bones within the tendons that run to the big toe. Like the kneecap, the sesamoids function as a pulley, increasing the leverage of the tendons controlling the toe. Every time you push off against the toe the sesamoids are involved, and eventually they can become irritated, even fractured. Because the bones are actually within the tendons, sesamoiditis is really a kind of tendinitis – the tendons around the bones become inflamed as well.

What causes it?

One of the major causes of sesamoiditis is increased activity. You’ve probably stepped up your activity level lately, which has forced you to put more pressure on the balls of your feet. Speedwork, hillwork, or even increased mileage can cause this. If you have a bony foot, you simply may not have enough fat on your foot to protect your tender sesamoids. Also, if you have a high arched foot, you will naturally run on the balls-of-your-feet, adding even more pressure. Sesamoiditis typically can be distinguished from other forefoot conditions by its gradual onset. The pain usually begins as a mild ache and increases gradually as the aggravating activity is continued. It may build to an intense throbbing. In most cases there is little or no bruising or redness.

How can it be treated?

Treatment for sesamoiditis is almost always noninvasive. Minor cases call for a strict period of rest, along with the use of a modified shoe or a shoe pad to reduce pressure on the affected area. In addition, the big toe may be bound with tape or athletic strapping to immobilize the joint as much as possible and allow for healing to occur. It is recommended to decrease or stop activity for awhile. This will give your sesamoids time to heal. You should apply ice to the area for 10 to 15 minutes after exercise, or after any activity that aggravates the area. While the injury is healing, women should wear flat shoes on a daily basis. If home remedies do not work, see your podiatrist for a correct diagnosis.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is Turf Toe?

Turf toe is a sprain to the ligaments around the big toe joint, which works primarily as a hinge to permit up and down motion. An excessive upward motion called hyperextension can — either over time or, if forceful enough, all at once — cause a sprain in the ligaments that surround the joint. The most common symptom of turf toe is pain at the base of one big toe that started suddenly as a result of an injury. There may also be swelling. Sometimes when the injury occurs, a “pop” can be felt. Usually the entire joint is involved, and toe movement is limited.

What causes Turf Toe?

Typically with turf toe, the injury is sudden. It is most commonly seen in athletes playing on artificial surfaces, which are harder than grass surfaces and to which cleats are more likely to stick. It can also happen on a grass surface, especially if the shoe being worn doesn’t provide adequate support for the foot. Often the injury occurs in athletes wearing flexible soccer-style shoes that let the foot bend too far forward.

How Is Turf Toe Treated?

The basic approach to treating turf toe is to give the injury ample time to heal, which means the foot will need to be rested. The big toe may be taped or strapped to the toe next to it to relieve the stress on it; the toe may be immobilized by putting the foot in a cast or special walking boot that keeps it from moving. The podiatrist may also ask you to use crutches so that no weight is placed on the injured joint.

It typically takes two to three weeks for the pain to subside. After the immobilization of the joint ends, some patients require physical therapy in order to re-establish range of motion, strength, and conditioning of the injured toe.

Your podiatrist can also work with you on correcting any problems in your gait that can lead to injury and on developing training techniques to help reduce the chance of injury.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What are they?

A bunion is a bony malalignment of the first and/or fifth toes. Bunions that form around the base of the fifth toe are commonly called a Tailor’s bunion. If it occurs at the base of the first toe it is called a Hallux Abducto Valgus deformity. This is where the first toe is angulated away from the midline of the body toward the other smaller toes.

What causes them?

Bunions are caused by the inability of the first or fifth toe joints to function as they normally should. This incorrect foot function may be the result of:

1. Abnormal foot mechanics that cause the foot to roll in excessively.
2. Impaired nerve stimulation of the muscles.
3. Inflammatory disease. (e.g. Rheumatoid Arthritis).
4. Surgical removal of the cartilage under the big toe joint.
5. Hereditary flexion deformities of the fifth metatarsal and toes.

The symptoms associated with bunions vary from person to person. They commonly include pain, swelling and redness. Not all bunions become painful, whereas in some people, certain arthritic conditions can cause severe bunion pain.

How are they treated?

1. Strengthening exercises of the specific foot muscles.
2. Stretching of the specific muscles with the aid of a night splint.
3. Footwear therapy.
4. Joint mobilization may utilized in some situations.
5. Orthoses which will assist in realigning the feet into a better functioning position and help to prevent the excessive abnormal movement through the feet.
6. Surgery is used only when other treatment fails.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is it?

Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. Metatarsalgia is often referred to as a symptom, rather than as a specific disease.

What causes them?

Common causes of metatarsalgia include:

• metatarsophalangeal synovitis
• avascular necrosis
• sesamoiditis
• inflammatory arthritis
• Morton’s neuroma
• Prominent metatarsal heads
• Hypermobile foot joints
• Excessive pronation
• Forefoot equinus

Each is diagnosed separately, often with the aid of X-rays and diagnostic ultrasound. Diagnosis is the key to ensuring the treatment matches the actual condition

How are they treated?

Once the cause of the metatarsalgia is known the appropriate treatment can be given. These may include:

• Trailing Felt padding to offload high pressure areas, which when successful will be replaced with an insole of some type.

• Orthotic devices to aid the foot to function correctly thus normalising the forces.

• Short-term relief may be from the removal of callus or corns under the metatarsal area.

• Footwear advice and footwear modifications

• Splinting all movement to completely rest the tissues

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

What is it?

A neuroma refers to the thickening or enlargement of nerve tissue, which is often caused by irritation or compression of the nerve. This compression causes swelling in the nerve and can lead to permanent nerve damage.

A Joplin’s Neuroma is an entrapment of the nerve travelling along the bottom and inside area of the big toe.

A Morton’s Neuroma causes pain in the ball of the foot that shoots out to the 3^rd and 4^th toes. The 2^nd and 3^rd toes can also be affected. The pain is typically worse when standing an walking and relieved by rest. Discomfort may be felt as a burning pain, deep achy pain, constant burning, radiating pain, electrical pain, or numbness. Others may describe the sensation of feeling as though their sock is bunched up under the ball of their foot or feeling like they’re walking on a lump or a ball.

What causes them?

A Joplin’s Neuroma may be caused by abnormal pronation, or may be associated with a bunion formation.

The exact cause of a Morton’s neuroma isn’t always known, although a number of problems can contribute to the formation of a neuroma.

High heels, particularly those over 5cm (2″), or shoes with constricting, pointed, or tight toe boxes can cause compression (for this reason, women tend to suffer from a Morton’s neuroma more often than men).

Conditions such as a high-arched or flat foot, bunions and hammer toes can lead to a neuroma being formed. These foot types can lead to instability around the toe joints, which can cause the beginnings of a neuroma.

Other causes include sporting activities, such as running or racquet sports, which can involve repetitive irritation to the ball of the foot.

How are they treated?

The treatment options for a Morton’s neuroma can differ according to how long you’ve had the condition and its severity. Identifying the neuroma in its early stages will help to avoid surgery.

The most important action is correct diagnosis ususally requiring a diagnostic ultrasound to differentiate a neuroma from other conditions that can produce similar symptoms.

Early treatments will concentrate on trying to relieve and reduce pressure on the area around the neuroma. This may consist of:

1. A simple change in the style of shoes you normally wear. Wide-toed shoes may be recommended.
2. Padding to provide support for the arch of the foot may be advised to take pressure away from the nerve.
3. Anti-inflammatory drugs (NSAIDs) and a course of steroid injections can help ease acute pain and inflammation.
4. Orthotics will help the foot to function so that the pressure is in the correct structure at the proper timinds, relieve abnormal stress on the affected area.
5. If the neuroma is small, cortisone injections or repeated injections of alcohol can also be beneficial.

In more severe cases, where early treatment options haven’t worked, surgical options may be considered. Surgery to remove the inflamed and enlarged nerve often takes up to 30 minutes and can be performed on an outpatient basis.Recovery generally takes less than four weeks and surgery is successful in 80% of cases.

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.