Amniotic Band Syndrome
Amniotic band syndrome (ABS) is an uncommon, congenital fetal abnormality that causes disfigured feet.
Some researchers believe that ABS is caused by early amniotic rupture, which leads to the formation of fibrous strands that entangle limbs and appendages.
Contact our office to discuss treatment options, which may include surgical excision of the fibrous band and any necrotic tissue.
Bunions (Hallux Valgus)
Bunions are misaligned big toe joints that can become swollen and tender, causing the first joint of the big toe to slant outward, and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. Surgery by a podiatric physician is frequently recommended to correct the problem.
Claw toe normally is caused by nerve damage from diseases like diabetes or alcoholism, which can weaken the muscles in your foot, according to the American Orthopaedic Foot and Ankle Society. Having claw toe means your toes “claw,” digging down into the soles of your shoes and creating painful calluses. Claw toe gets worse without treatment and may become a permanent deformity over time.
Common symptoms include:
- Toes bent upward from the joints at the ball of the foot.
- Toes bent downward at the middle joints toward the sole of your shoe.
- Corns on the top of the toe or under the ball of the foot.
Claw toe deformities are easier to repair when detected early, but they harden into place over time. Splint or tape is used to hold your toes in correct position.
Clubfoot is one of the most common non-life threatening major birth defects. It affects your child’s foot and ankle, twisting the heel and toes inward. It may look like the top of the foot is on the bottom. The clubfoot, calf and leg are smaller and shorter than normal. Clubfoot is not painful, is correctable and your baby is probably otherwise normal.
Approximately one in every 1,000 newborns has clubfoot. Of those, one in three have both feet clubbed. The exact cause is unknown.
Two out of three clubfoot babies are boys. Clubfoot is twice as likely if you, your spouse or your other children also have it. Less severe infant foot problems are common and are often incorrectly called clubfoot.
The goal of treating clubfoot is to make your newborn’s clubfoot (or feet) functional, painless and stable by the time he or she is ready to walk. Doctors start by gently stretching your child’s clubfoot toward the correct position. They put on a cast to hold it in place. One week later, they take off the cast and stretch your baby’s foot a little more, always working it toward the correct position. They apply a new cast, and one week later you come back and do it again.
This process (called serial casting) slowly moves the bones in the clubfoot into proper alignment. Doctors use X-rays to check the progress. Casting generally repeats for 6-12 weeks, and may take up to four months. About half the time, your child’s clubfoot straightens with casting. If it does, he or she will be fitted with special shoes or braces to keep the foot straight once corrected. These holding devices are usually needed until your child has been walking for up to a year or more.
Muscles often try to return to the clubfoot position. This is common when your child is 2-3 years old, but may continue up to age 7. Sometimes stretching, casting and bracing is not enough to correct your baby’s clubfoot. He or she may need surgery to adjust the tendons, ligaments and joints in the foot/ankle.
Dysplasia (Epiphysealis Hemimelica)
Dysplasia is a disorder affecting the bone joints. It is characterized by overgrowth of the cartilage on the end of one or more of the long bones (carpal or tarsal bones) in the hand or foot. Less often, the cartilage on other bones such as those in the ankle, knee or hip joint can be affected.
Usually only one limb is involved. The limbs may be unequal in length.
Small tumors called enchondromas can sometimes form in the bone beneath the toenail.
An enchondroma is a fairly common benign tumor, which is the most common bone tumor of the hands and feet. The tumor can involve large portions of the bones, causing thinning of the cortex. This can weaken the bone and cause it to break spontaneously. When enchondromas occur in the small bone in the end of the toe, they can cause pain that may mimic the pain of ingrown toenails. Ollier’s Disease, also known as enchondromatosis, frequently occurs in the small bones in the hands and toes (phalanges) and the long bones behind the phalanges called metatarsals. Maffucci’s Syndrome is a very rare form of enchondromatosis associated with multiple soft tissue hemangiomas. This tumor frequently occurs in the hands and feet, and has a greater tendency toward malignant transformation than Ollier’s Disease.
Flat Feet (over pronation)
Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. The arch develops in childhood, and by adulthood, most people have developed normal arches. Most feet are flexible and an arch appears when the person stands on his or her toes. Stiff, inflexible or painful flat feet may be associated with other conditions and require medical attention. Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).
Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated.
Painful progressive flatfoot, otherwise known as Tibialis Posterior Tendinitis, is caused by inflammation. The tendon becomes inflamed, stretched or suffers a partial or total tear. If left untreated, this condition may lead to severe disability and chronic pain. Some people are prone to this condition if they have flatfeet or an abnormal attachment of the tendon to the bones in the midfoot.
Nonsteroidal anti-inflammatory medications, ice, physical therapy, supportive taping and bracing, or orthotic devices are the common ways of treating painful progressive flatfoot. Consult with your physician before taking any medications. Surgical intervention involves repairing the torn or damaged tendon to restore normal function. To prevent re-injury, orthotic devices or show inserts may be recommended. In severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.
Gordon Syndrome is an extremely rare disorder that belongs to a group of genetic disorders known as the Distal Arthrogryposes. These disorders typically involve stiffness and impaired mobility of certain joints of the lower arms and legs (distal extremities) including the knees, elbows, wrists, and/or ankles.
These joints tend to be permanently fixed in a bent or flexed position. Gordon Syndrome is characterized by the permanent fixation of several fingers in a flexed position, abnormal bending inward of the foot, and, less often, incomplete closure of the roof of the mouth (also called cleft palate). In some cases, additional abnormalities may also be present. The range and severity of symptoms may vary from case to case. Gordon Syndrome is thought to be an inherited condition.
Haglund Deformity (also known as “pump bump” or “retrocalcaneal bursitis”) is a painful enlargement of the back of the heel bone that becomes irritated by shoes.
It normally appears as a red, painful, and swollen area in the back of the heel bone. Women tend to develop the condition more than men because of the irritation from rigid heel counters of shoes rubbing up and down on the back of the heel bone.
Changing shoes, soaking feet, and anti-inflammatory medications often mitigate the symptoms of this problem. Consult your physician before taking any medication.
Hallux Rigidis (stiff big toe)
When you have a stiff big toe, walking can become painful and difficult.
An unmovable big toe (Hallux Rigidus) often is the most common form of arthritis in your foot.
“Wear-and-tear” injuries also can wear down the articular cartilage, causing raw bone ends to rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk.
Symptoms may include:
- A bump, like a bunion or callus, that develops on the top of the foot.
- Pain in the joint when you are active, especially as you push-off on the toes when you walk.
- Stiffness in the big toe and an inability to bend it up or down.
- Swelling around the joint.
Pain relievers and anti-inflammatory medications are often prescribed to reduce swelling and ease the pain. Applying ice packs or taking contrast baths (which use alternating cold and hot water to reduce inflammation) may also help reduce inflammation and control symptoms for a short period of time.
A stiff-soled shoe with a rocker or roller bottom design and possibly even a steel shank or metal brace in the sole can alleviate the symptoms. This type of shoe supports the foot when you walk and reduces the amount of bend in the big toe.
When damage is mild or moderate, a surgical procedure may be performed to remove the bone spurs, as well as a portion of the foot bone, to allow the toe more room to bend.
Hallux Limitus (Stiff Big Toe Joint)
Hallux Limitus is a condition that results in stiffness of the big toe joint
It is normally caused by an abnormal alignment of the long bone behind the big toe joint called the first metatarsal bone. Left untreated, Hallux Limitus can cause other joint problems, calluses, and diabetic foot ulcers.
Painful bone spurs also can develop on the top of the big toe joint.
Anti-inflammatory medications, cortisone injections and/or functional orthotics are some of the common treatments for stiff big toe. Consult your physician before taking any medications.
Surgery may be prescribed if spurring around the joint becomes severe.
Hallux Varus is a condition in which the big toe points away from the second toe.
It often is one complication from bunion surgery. The condition has been linked to a number of other causes, including congenital deformity, tight or short abductor hallucis tendons, trauma or injury, absence or surgical removal of the fibular sesamoid.
Treatment may focus on stretching the abductor hallucis tendon through a specific kind of stretching exercise. Other options include toe splints and surgery, in which a small incision is made on the side of the toe. The toe is then splinted in a neutral or straight position.
Hammertoe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, resembling a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.
Causes of hammertoe include improperly fitting shoes and muscle imbalance.
Treatment for the condition typically involves shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions or non-medicated corn pads may also relieve symptoms.
Jackson Weiss Syndrome
Jackson-Weiss Syndrome (JWS) is a rare genetic disorder characterized by foot abnormalities. Symtoms include abnormally broad big toes and/or malformation or fusion of certain bones within the feet.
Mallet toes are often caused by bone and muscle imbalances that become exaggerated in people with active lifestyles.
Arthritis can also lead to mallet toes. Mallet toes can cause extreme discomfort, and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.
Treatment is designed to relieve pressure, reduce friction, and transfer forces from the sensitive areas. Shoes with a high and broad toe box (toe area) are recommended for people suffering from mallet toes. This prevents further irritation on the toe area from developing.
Other conservative treatments include forefoot supports such as, gel toe caps, gel toe shields and toe crests. Gel forefoot supports provide immediate comfort and relief from common forefoot disorders, without drying the skin.
Foot pain in the “ball of your foot,” the area between your arch and the toes, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this mid-portion of the foot.
Also known as “dropped metatarsal heads,” metatarsalgia can cause abnormal weight distribution due to over pronation.
Metatarsalgia causes one of metatarsal joints to become painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia can also be caused by arthritis, foot injury (sports, car accidents, repeated stress), hard surfaces (cement or tile floors) and specific footwear (rigid soled work boots). Inappropriate shoes will only aggravate the condition.
A simple change of shoes may solve the problem. In more severe cases, full-length custom-molded foot orthoses may need to be prescribed.
Osteomyelitis (Bone Infections)
Bone infections, called osteomyelitis, generally require surgery to remove the infected bone. These infections are very difficult to cure with oral or intra-venous antibiotics without also removing the infected bone. The presence of bone infection can be diagnosed with special tests such as bone scans and MRIs.
Overlapping or Underlapping Toes
Underlapping toes usually involve the fourth and fifth toes. (A special form of underlapping toes is called congenital curly toes.)
The cause of underlapping toes is generally unknown. They may be caused by an imbalance in muscle strength of the small muscles of the foot.
If deformed toes are flexible, a simple release of the tendon in the bottom of the toe will allow for them to straighten. If the deformity is rigid, surgery may be needed to remove a small portion of the bone in the toe.
Overlapping toes are characterized by one toe lying on top of an adjacent toe. The fifth toe is the most affected. Overlapping toes may develop in the unborn fetus.
Passive stretching and adhesive taping is most commonly used to correct overlapping toes in infants, but the deformity usually recurs.
Such deformities can sometimes be surgically corrected by releasing the tendon and soft tissues about the joint at the base of the fifth toe. In some extreme cases, a pin may be surgically inserted to hold the toe in a straighten position. The pin, which exits the tip of the toe, may be left in place for up to three weeks.
Peroneal Tendon Dislocation/Dysfunction
Peroneal tendons are two tendons whose muscles originate on the outside of the calves. These two muscles allow you to roll to the outside of the foot while standing.
Also called “stirrup” tendons because they help hold up the arch of the foot, the muscles are held in place by a band of tissue. Injury to these tendons can cause them to stretch or even tear. When this happens, they can dislocate.
Snow skiing, football, basketball, and soccer are the most common sports activities that can result in peroneal tendon dislocation. Ankle sprains have also known to lead to the condition.
Patients usually have top use crutches after such an injury, in order to allow the strain to heal. Sometimes, a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice also supplement treatment. Consult your physician before taking any medications.
Surgery can be prescribed with moderate to severe injuries that cause the tendon to be torn or severely stretched to a point that it easily dislocates.
Posterior Tibial Tendon Dysfunction
The posterior tibial tendon starts in the calf, stretches down behind the inside of the ankle and attaches to bones in the middle of the foot. This tendon helps hold your arch up and provides support as you step off on your toes when walking. If it becomes inflamed, over-stretched or torn, you may experience pain on the inner ankle and gradually lose the inner arch on the bottom of your foot, leading to flatfoot.
Signs and symptoms of posterior tibial tendon dysfunction include:
- Gradually developing pain on the outer side of the ankle or foot.
- Loss of the arch and the development of a flatfoot.
- Pain and swelling on the inside of the ankle.
- Tenderness over the midfoot, especially when under stress during activity.
- Weakness and an inability to stand on the toes.
Diabetics, overweight, and hypertensive people are particularly at risk.
Left untreated, posterior tibial tendon dysfunction could lead to arthritis in the hindfoot. Pain could increases and spread to the outer side of the ankle.
Treatment includes rest, over-the-counter nonsteroidal anti-inflammatory drugs, and immobilization of the foot for 6 to 8 weeks with a rigid below-knee cast or boot to prevent overuse. Consult your physician before taking any medications.
Sometimes known as the “ball bearings of the foot,” the sesamoids are two small bones found beneath the first metatarsal bones. They can inflame or rupture under the stress of exercise. Sesamoiditis can be relieved with proper shoe selection and orthotic devices, or shoe inserts.
Bone spurs are a very common foot problem. Spurs in the feet most often occur in the heel and near the toes.
Growths of bone on the underside, forepart of the heel bone, heel spurs occur when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. With proper warm-up and the use of appropriate athletic shoes, strain to the ligament can be reduced.
Painful bone spurs also can develop on the top of the big toe joint.
Anti-inflammatory medications, cortisone injections and/or special shoes or inserts are some of the common treatments for stiff big toe. Consult your physician before taking any medication.
Surgery may be prescribed if spurring around the joint becomes severe.
A tarsal coalition is a bone condition that causes decreased motion or absence of motion in one or more of the joints in the foot. The lack of motion or absence of motion is due to abnormal bone, cartilage or fibrous tissue growth across a joint. When excess bone has grown across a joint, there is usually little or no motion in that joint. Cartilage or fibrous tissue growth can restrict motion of the affected joint to varying degrees, causing pain in the affected joint or in surrounding joints.
The bones found at the top of the arch, the heel, and the ankle are referred to as the tarsal bones. A tarsal coalition is an abnormal connection between two of the tarsal bones in the back of the foot or the arch. This abnormal connection between two bones is most commonly an inherited trait and passed down from generation to generation.
Symptoms usually include an aching sensation deep in the foot near the ankle or arch, accompanied by muscle spasms on the outside of the affected leg. Non-surgical treatment includes special shoes or inserts, physical therapy and anti-inflammatory medication. Consult your physician before taking any medication.
Surgery sometimes is performed to allow for more normal motion between the bones, or to fuse the affected joint or surrounding joints.