Common Foot Conditions and Their Symptoms
Ronald J Klein, DPM is committed to providing every patient with healthy feet. On this page, you will find some of the most common foot conditions that patients face.
Select a category to learn more:
Flat Feet/Over-Pronation
As an arch collapses, the foot flattens and lengthens, and the soft tissue stretches. As the middle of the foot sags, the weakness in the middle of the foot puts abnormal stresses on the joints of the foot and they function at unnatural angles. As the joints are now more lax and flexible, the foot rolls in on the flatter arch. Following the motion of the foot, the lower leg now internally rotates, counter-resisted by external rotation of the upper leg. These motions beginning with a flattening of the arch leads to pronation.
Flat-footedness can be hereditary or acquired as a result of injury, exertion, or musculoskeletal disorders.
Over-pronation as a result of weaker arches is best treated with orthotics. Left untreated, flat feet and pronation can lead to bunions, hammer toes, neuromas as well as ankle, knee, hip and low back pain.
Metatarsalgia Foot Pain
Metatarsalgia is a general tern to denote pain in the ball of the feet, occurring with excessive pressure over a long period of time. It can be caused by high impact sports, thin soles or high heeled shoes, or a thinning of the fat pad across the ball of the feet. This thinning can occur with age or also seen in diabetics.
Treatment involves offloading the pressure at the affected area. This is done with an orthotic with a metatarsal built in to redistribute pressure, as well as gel pads and shoes with better support to ease the symptoms.
Plantar Fasciitis/Heel Pain
The plantar fascia is a thick fibrous support band that attaches at the heel and extends forward to the base of the toes. It acts as a stabilizer and maintains the integrity of the arch. Pain occurs when the inflexible plantar fascia is forced to elongate more than it is capable. It then pulls away from its attachment from the heel resulting in inflammation.
The problem originates from a relatively stationary heel bone and a forefoot that over-pronates with each step the patient takes, thereby twisting the plantar fascia.
Pain is most pronounced with initial weight bearing with the first steps in the morning or after sitting for a period of time. Pain also increases when a patient stands for extended periods.
Predisposing factors that may lead to plantar fasciitis include:
- Flat pronated feet
- High arched rigid feet
- Inapptopriate shoe wear
- Increasing age
Plantar Fasciitis may be treated using:
- Rest
- Ice
- Stretching exercises
Patella Femoral Syndrome (Knee Pain)
Pain behind the knee cap (patella) accounts for 50% of all overuse injuries. This syndrome is caused by irritation of the underside of the patella as it does not tract properly in the femoral groove. Pronation and its subsequent internal tibial torsion, force the patella to track outside the femoral groove. This difficulty is most often seen in people with wide hips, those who are knock-kneed, or in people who pronate.
Treatment involves ice, anti-inflammatories, and orthotics. Orthotics will control the internal tibial torsion associated with pronation and better support the arches. Sports to avoid include volleyball, basketball, downhill running, and racquet sports.
Athlete's Foot
Athlete's foot (tinea pedis) is caused by a fungus that flourishes in a warm, moist, dark environment. You don't need to be an athlete, and it affects people more as they age.
The area most susceptible is between the toes and on the soles. It presents as reddish skin that fissures and peels, burns and itches.
It is best to avoid walking barefooted in areas such as change rooms, swimming pool decks and common shower areas. Always wear shower or deck shoes. Secondly, it is best to keep the feet as dry as possible. Wear cotton or wool socks, or double layer socks that wick the moisture away. Shoes should also be made of natural materials that breathe. Allow shoes to dry by not wearing the same shoe two days in a row. Also use cedar shoe trees. Be sure to dry feet well after bathing. When getting dressed, put socks on first, even before underwear. This will prevent the fungus from spreading to the groin, which is also a warm, dark, moist environment.
- Sometimes the toenails can become infected by the fungus, causing them to become thick and yellow.
- Treatment involves prescription of anti-fungal creams, or pills if the infection is more severe.
- Sometimes a secondary bacterial infection can occur and antibiotics will be prescribed.
Shin Splints
Pain on the front of the lower leg is known as anterior shin splints. Posterior shin splints also occur, but less frequently. It is a chronic soft tissue pain on the front of the tibia bone and occurs with repetitive movements, thereby not allowing the tissue to heal. Tender areas are felt along the shin bone.
One of the main causes of anterior shin splints is pronation, which causes internal tibia torsion. Other causes include improper stretching, lack of a warm up, muscle imbalances, old/worn-out shoes (should be replaced at 1,500 km intervals), hard surfaces or banked tracks. Tight posterior muscles will put added stresses on the front leg muscles. Sudden increased mileage or speed can also cause inflammation.
Treatment involves addressing the pronatory gait with orthotics. Never run through pain. Avoid hill running and decrease your mileage. Work on stretching and flexibility, as well as the use of ice.
Ingrown Toenails
An ingrown toenail occurs when the side of the nail grows into the skin. It is most often found in the great toe. It can be the result of poorly cut nails, improperly tight shoes or swollen feet or most often, due to heredity. Often times, there may be redness, swelling or discharge. The shape, thickness and texture of the nail can also change with aging. Fungal infections and acute injuries to the nail can also lead to ingrown toenails.
Treatment may involve something as simple as removing a small portion of the offending border of nail. The patient is then prescribed soaks and antibiotics. However, if this does not resolve the problem, the offending border of nail may need to be removed under a local anesthetic, with or without cauterization of the nail bed.
Patients with diabetes, poor circulation or on chemotherapy can experience changes in the nails.
The best prevention to ingrown nails is to avoid ill-fitting shoes, keep feet dry and clean, and cut nails square across, not rounded or too short.
Acute vs. Chronic Injuries (Traumatic vs. Overuse Injuries)
An acute injury is one whose symptoms appear suddenly and worsen quickly, while a chronic injury develops gradually and worsens over a much longer period of time. It is not uncommon for acute injuries to become chronic in nature if not addressed early on.
An acute injury, although appearing rapidly, will usually disappear over time. There is usually a known physical cause. This may include a burn, a stubbing of the toe or a sprain of the ankle, or a fracture. Acute injuries occur more frequently than those of a chronic nature. And they usually require the intervention of a professional.
A chronic injury occurs over a long period of time. Over-training can result in a chronic condition, that often has its origins in anatomical or mechanical problems. For example, a flat foot will lead to pronation that can then cause patella-femoral knee pain, that if left untreated, will become chronic. The patient should reduce mileage, evaluate shoes, and terrain, begin a stretching program and address the mechanics of foot and leg functionality.
Cracks and Fissures
Skin that is too dry can result in breaks in the skin. This leads to skin that cannot stretch to meet the loads placed on it and, which causes cracks due to the pressure. The skin becomes rough and flaky. Other causes include harsh soap, standing for long periods, winter cold weather, being over-weight and wearing improper shoes. Cracks and fissures can also be seen, but in rarer cases, due to excessive moisture in the feet, which can also lead to a fungal infection and fissures between the toes.
Without treatment, these cracks can spread and deepen, leaving an area that is prone to infection. It is certainly not without pain upon weight-bearing.
If the skin is too dry, treatment involves debriding three excessive dead skin on the heels by your podiatrist. Regular soaking at home, using a pumice stone, and moisturizer creams are recommended. Avoid walking barefooted or in shoes without socks.
If the skin is too moist and fissuring and itchiness occurs between the toes, carefully drying the feet is important, especially between the toes. Do not moisturize between the toes. Always wear natural fiber socks and see your podiatrist for a prescription for an anti-fungal medication.
Always wear shoes made of natural materials.
Hammer Toes, Mallet Toes and Claw Toes
These are the 3 most common problems seen in the toes, and occur in different areas of the toe. All three occur in the longest toe, usually the 2nd toe. They are aggravated by shoes that are too tight, as well as heels that are too tight or too short that cause the toe to rub against the front of the shoe. All three involve a bending of the toe in different locations.
Muscle imbalance can cause some tendons to pull unevenly. Arthritis can also lead to these problems.
A mallet toe occurs with a bending downward of the joint of the toe closest to the nail. This will cause pressure and a corn to develop at the end of the toe.
A hammer toe occurs when the middle joint of the toe is bent. This will cause the toe to rub against the top of the shoe and will also cause pressure and a corn to develop.
A claw toe occurs when the base of the toe is bent upward putting excessive pressure on the head of the metatarsal bone, causing pressure and a callus on the ball of the foot.
Treatment:
1. Ensure shoes have a lower heel or more room in the toe box.
2. A callus file or pumice stone will debride the com or callus (do not use if diabetic or if you have poor circulation.
3. Pads or splints will decrease pressure and attempt to realign the toe.
Exercises:
1. Place a marble on the floor and try to pick it up with your toes.
2. A second exercise is to place an elastic band around the toes and then try to spread the toes against resistance.