Many Achilles tendon injuries occur slowly over time, beginning with mild tendonitis which feels like a slight stiffness or tight sensation at the back of the heel, due to inflammation around the Achilles tendon. If the condition is not allowed appropriate time to rest, chronic tendonitis can result. Chronic tendonitis of the Achilles tendon can often lead to a complete rupture of the Achilles tendon. Any injury of the Achilles tendon should be taken very seriously because of the importance of this anatomic structure to our ability to walk normally.
In adults, long-standing Achilles tendon pain that occurs at the back of the heel bone can be due to an enlargement of the heel bone itself causing pressure on the Achilles tendon and the overlying shoe. In many cases, chronic pain at the back of the heel can be due to formation of a bone spur within the attachment of the Achilles tendon. This occurs because the tendon is injured at its attachment to bone, and bone healing occurs resulting in calcification of the tendon material. Conservative therapy for this condition involves changes in shoe gear, custom molded orthotics, physical therapy, and anti-inflammatory medication. If conservative therapy fails, surgery is sometimes necessary to remove the spur, lengthen the Achilles tendon, and reattach it to the heel bone.
In children, there is a common condition called Calcaneal Apophysitis which involves inflammation of a growth plate at the back of the heel. This is a condition that frequently affects children between the ages of approximately 8 --12 years of age but can occur earlier or later. In some cases, an injury to the growth plate can result because of a fracture in the plate without any injury or trauma. Because of the importance of the growth plate in determining the overall shape of the heel bone, heel injuries in children should also promptly be identified, evaluated and treated.
Dr. Gavin utilizes diagnostic ultrasound and MRI to accurately assess and diagnose Achilles tendon conditions and Achilles spur formation. In many cases, conservative therapy with anti-inflammatory medication, rest, immobilization and physical therapy are all that is necessary to treat this condition. Most importantly, if a patient suffers Achilles tendon pain, the idea that you should "work through the pain" can sometimes result in a devastating and debilitating injury if the tendon ruptures completely. Dr. Gavin utilizes the latest in surgical techniques for repair of Achilles tendon ruptures including the latest reattachment techniques, as well as biological and synthetic graft material for severe ruptures with loss of tendon tissue.Click to view Image #1.Click to view Image #2.
Ankle pain is a very common condition that can result from many medical conditions or injuries. A partial list includes history of ankle sprain, arthritis, damage to the cartilage, a condition called impingement syndrome, pronation deformity or flat feet, limb length inequality, and metabolic conditions such as gouty arthritis. If you suffer from chronic ankle pain, accurate diagnosis and treatment is essential for long-term joint health.
X-rays, diagnostic ultrasound, and MRI study are some of the tools that Dr. Gavin uses to diagnose the cause of ankle pain. Patients with a history of an ankle sprain with chronic pain after the sprain may have suffered a torn ligament, damage to the cartilage in the joint, or may be suffering from scar tissue from the injury being pinched
inside the joint during activity.
Conservative treatment for ankle pain often consists of oral and topical anti inflammatory medication, ankle braces, physical therapy treatments, ultrasound-guided Cortizone injections, and custom molded orthotics.
In some cases, conservative therapy fails and surgery becomes necessary. Dr. Gavin has extensive training and experience in the area of arthroscopic surgery for the ankle and is proficient in most forms of ankle ligament repair, removal of impingement syndrome, and tendon transfer surgery to stabilize unstable ankles with a history of chronic ankle sprains. As with most conditions, the sooner the condition is accurately diagnosed and treatment is begun, the better. Continuing activity with a ruptured ankle ligament or unstable ankle can result in unnecessary and irreversible damage to the cartilage in the joint.Click to view Image #1.
Ankle Instability or Weak Ankles
Ankle instability is a condition that one can be born with, but can also result from an injury such as an ankle sprain. Often a simple ankle sprain, or "rolling the ankle" can result in only mild pain and swelling that resolves, but an underlying problem exists. Sprains involve stretching and often rupturing or tearing the ligaments on the outside of the ankle. If the ligaments do not heal properly, which often results if the injured ankle is not immobilized after the sprain, the ankle becomes weak and prone to repetitive sprains. Sometimes the repeat sprains are less painful than the initial injury; this can be deceiving. These repeat injuries can lead to rupturing more ligaments and tendons, and can also result in an ankle fracture. Furthermore, weakness in the ankle ligaments causes the joint surfaces of the ankle to contact improperly, resulting in rapid development of arthritis, which is irreversible. In short, the joint can easily be destroyed.
Conservative management for this condition involves physical therapy and use of a high quality fitted ankle brace. Surgery is available to repair the torn ligaments, and in some cases, a tendon transfer procedure is performed to recreate the ankle ligaments and prevent further sprains. The majority of these cases have successful outcomes.
Arthritis or Degenerative Joint Disease
There are multiple forms of arthritis that can affect the feet and ankles, the most common of which that strikes many people is known as Osteoarthritis or Degenerative Joint Disease. There are many more severe forms of arthritis that are either genetically inherited or involve and autoimmune disorder in which the body's immune system mistakenly attacks the joints in the body. Rheumatoid arthritis, scleroderma, and Systemic Lupus Erythematosus are examples of autoimmune disorders resulting in arthritis. Certain genetic or metabolic conditions such as diabetes which can cause a condition called Charcot arthropathy or psoriasis which can result in a condition called psoriatic arthritis often go undiagnosed and are first recognized in the feet. If you have a family history of arthritis and have begun to develop joint pain without a history of injury, your condition should be evaluated with the appropriate diagnostic testing. In many cases, x-rays and a simple blood test are all that is necessary to accurately diagnose arthritis.
Conservative treatment for arthritis often involves oral and topical anti inflammatory medication, custom molded orthotics, physical therapy, and Cortizone injections. Sometimes arthritis results in significant scar tissue or formation of bone spurs around the joints that are affected. In these cases, surgical removal of scar tissue or spurs can be helpful to alleviate pain but does not reverse the original arthritic condition. It is for this reason that early diagnosis and treatment is the key to preventing long-term damage and disability from arthritis.Click to view Image #1.Click to view Image #2.
Bone spurs involve an overgrowth of normal or arthritic bone around a joint or within connective tissue. They often form as part of another process, such as arthritis, tendonitis and plantar fasciitis, in which case a heel spur forms. Many spurs are painful, some are not. The treatment for bone spurs varies quite considerably and depends upon thier location and root cause. Often changing shoegear to alleviate pressure can help, but many cases require custom molded orthotics, medication, cortizone injections or physical therapy. In some cases, nothing helps and surgical removal of the spur becomes necessary. Because the cause of the spur can vary based on underlying pathology, surgery often is not as simple as removing the spur, but requires correction of the causative condition as well. Dr Gavin uses physical examination, patient and family history, xrays, ultrasound, MRI and CAT scans to accurately image bone spurs and any impingement or pressure caused on surrounding structures. Timely diagnosis and treatment is the key to success here; waiting too long can often make the outcome of treatment less certain because of the nature of underlying conditions doing irreversible damages to joints, tendons and ligaments.
Description -- the bunion deformity, also known medically as Hallux Abductovalgus involves a progressive angulation of the big toe joint which results in prominence of the first long bone at the base of the big toe. This appears as a large and often painful bump on the side of the big toe joint. Bunions are hereditary, often following family lines. The result of the deviation of the big toe joint is a progressive subluxation or partial dislocation of the big toe joint which can cause pain from the enlarged bump rubbing on the shoe as well as deep joint pain from damage which occurs to the cartilage inside of the joint. The damage that occurs to the cartilage from the bunion deformity is irreversible; medical technology to this day cannot directly replace the cartilage in smaller joints. Joint implant surgery is available, but it is best to prevent the damage to the cartilage caused by bunion deformity in the first place through early intervention.Click to view Image #1.Click to view Image #2.Click to view Image #3.Click to view Image #4.Click to view Image #5.Click to view Image #6.Click to view Image #7.
Painful Callouses / Callouses
Hard callouses under the forefoot are sometimes known as Intractable Plantar Keratoses and form either because of hammertoes or because one of the metatarsals or long bones in the forefoot is either longer or closer to the ground with respect to the others which results in excessive pressure on the skin and formation of a painful callous. These callouses can also be caused by a failure of the first long bone to conract the ground properly due to other conditions such as bunion deformities. Some people develop excessive calloused skin on their heels and balls of their feet. This condition is hereditary, and is known as hyperkeratosis. Treatment usually involves removal of the dead skin itself periodically, and topical enzyme treatment with a prescription medication to remove callouses and keep skin soft and supple.
Conservative treatment for plantar callouses involves periodic trimming of callouses, changes in shoe gear, and custom molded orthotics in order to reduce pressure on the area. Conservative therapy often fails for this condition and surgical intervention becomes necessary in the form of correction of any secondary condition that causes the callous such as bunion deformity, or specific procedures to address the bone causing the callous such as a removal of a portion of the bone or a procedure to reposition the bone and elevate it to the level of the other bones in the forefoot.Click to view Image #1.Click to view Image #2.
Cold Fingers / Toes - Raynauds Disease and Phenomenon
This condition involves a disorder in which exposure to cold, even briefly, results in the fingers or toes becoming cold, often resulting in bluish discoloration and pain. This results from a reactive constriction of the blood vessels called vasospasm- the blood vessels close off and tissues are deprived of vital oxygen and warmth. The Raynauds Phenomenon version is less severe than the disease. This disorder is inherited, occuring mostly in women. The key to treatment here is prevention- from cold exposure itself. Raynauds patients should always keep thier fingers and toes warm and avoid exposure to cold altogether. Rewarming of the fingers and toes once vasospasm occurs is essential. Some patients respond very well to low doses of blood pressure medication that works to reverse the vasospasm.
Diabetics suffer a myriad of foot problems that are too numerous to list here. Suffice it to say that CONTROL of your BLOOD SUGAR in the long term is the key to minimizing your risk for serious foot problems. Many diabetics suffer from poor circulation, nerve problems, and difficulty fighting infection. It is for this reason that Dr Gavin believes ALL diabetics should be evaluated by a podiatrist to assess whether they need ongoing treatment on a regular basis. ANY infection or open sore should be attended to immediately.
Many people suffer from a condition called Pronation Deformity or flat feet. Flat feet can be painful to some, and not in others. The truth is that Pronation Deformity leads to MANY other foot problems, including heel pain, bone spurs, arthritis, tendonitis, bunions, hammertoes, corns, callouses and more. As with many foot problems, Prevention is they key to success. Many of the problems that develop as a result of flat feet occur because Pronation Deformity leads to an inherent instability in the feet. Just because your flat feet don't hurt now, that doesn't mean that they won't hurt or develop painful conditions in the future. If you have flat feet, you should be evaluated by a podiatrist to see whether orthotics, or custom molded arch supports would be helpful in your case. Because foot structure is genetically inherited, if you have flat feet there is a good chance that your children will as well. The earlier in life this condition is recognized and treated, the greater the chance that many of the problems it presents can be prevented.Click to view Image #1.Click to view Image #2.
Many foot injuries result in fractures that are either not diagnosed in time or at all.
There are 28 bones in each human foot. Many people make the mistake of believing that if they can walk on their foot, then it can't be broken. Nothing could be further from the truth. People can develop stress fractures with no history of injury or trauma in any of the bones in the foot and ankle. Stress fractures can manifest as occasional or constant pain with or without swelling. In many cases, stress fractures can be present that are not visible on routine x-rays taken at the emergency room. More intensive diagnostic study such as MRI or CT scan is sometimes necessary to find these hairline cracks. In most cases, stress fractures do not necessitate surgery but do require immobilization and sometimes use of a device called a bone growth stimulator to promote healing if the body's natural process has not healed a fracture within a reasonable amount of time.
Other foot injuries result from trauma and are obvious -- a bone is simply broken, and sometimes displaced. Most fractures of the toes do not require surgery but should be treated with immobilization and splinting to prevent displacement of the fracture. Fractures in the mid foot and rearfoot only need surgery if there is displacement of the bone fragments. Dr. Gavin is trained and proficient in the multiple fixation techniques necessary to repair most fractures of the foot and ankle, including those that necessitate bone grafts.Click to view Image #1.Click to view Image #2.
A ganglion cyst is a fluid filled sac that forms due to a weakening in the connective tissue layer around a joint or tendon. They commonly form on the front of the ankle or top of the foot, but can appear anywhere. The cyst fills with synovial fluid from inside the joint or tendon sheath. These cysts will often change in size and shape on a day to day basis. Often they become problematic when the cyst itself creates pressure on other structures, such as nerves and can become quite painful. Dr Gavin uses the latest techniques by evaluating the cyst with diagnostic ultrasound, and can often remove the fluid in a painless procedure performed in the office using ultrasonic guidance during a procedure called aspiration. These cysts have a high rate of recurrence and sometimes need to be removed surgically, a procedure that is done on an outpatient basis under sedation.Click to view Image #1.
Haglunds Deformity or "Pump Bump"
Haglunds deformity is an enlargement of the heel bone at the back of the heel that is often very painful because of irritation that occurs between the skin over the enlargement and the back of the shoe. It is often called a "Pump Bump" because it occurs commonly in women but can often occur in men as well. Along with the bony enlargement, bursitis (inflammation of a reactive sac of fluid over the area), and Achilles tendonitis can result. Conservative treatment consists of medication, shoegear modification, physical therapy and arch supports or orthotics. In some cases, conservative treatment is ineffective and surgery to remove the enlarged portion of the bone is necessary.Click to view Image #1.
Hallux Limitus or Painful Arthritic Big Toe Joint
Hallux limitus is a term used to describe a painful arthritic restriction of motion at the big toe joint. It can occur because of foot structure or as a result of trauma. In general, the cartilage in the joint deteriorates, and large painful spurs form at the top of the big toe joint restricting motion. Conservative management of hallux limitus or arthritic big toe joint can include changes in shoe gear, custom molded orthotic devices, physical therapy, and Cortizone injections. Hallux limitus is a progressive condition, and surgical intervention frequently becomes necessary. Surgery can range from a simple removal of Bone spurs in mild to moderate cases of hallux limitus to joint replacement or fusion of the big toe joint when the condition becomes severe. As with many arthritic conditions, the sooner the condition is recognized and treated, the better given the irreplaceable nature of the cartilage in our joints.Click to view Image #1.Click to view Image #2.
Hammertoe deformity is a term used to describe a condition of the lesser toes and sometimes the big toe in which the toes buckle upward often resulting in painful painful callouses on tops of the toes and underneath the forefoot. Over time, the toes change from being flexible to the deformity being rigid and inflexible. This often causes pain from pressure in shoe gear, as well as pain under the ball of the foot because of the effect of the hammertoe transferring pressure back to the ball of the foot. Conservative management of hammertoe deformity often includes changes in shoe gear, periodic trimming of corns and callouses, and use of custom molded orthotics to reduce contracture/deformity of the toes.
Hammertoe deformity is often a progressive condition, the earlier conservative management with custom molded orthotics is instituted, the lower the likelihood that surgery will become necessary. In cases where conservative treatment fails, surgery involves removing and remodeling a portion of the joint in the toe, lengthening tendons and often requires use of surgical pins to maintain the toe in position while healing takes place.Click to view Image #1.Click to view Image #2.Click to view Image #3.
Heel Pain in Children
Heel pain in children is often related to activity level and participation in sports. The most common cause is a condition called Calcaneal Apophysitis, which is a condition that involves an injury to or inflammation of a growth center in the heel bone. Apophysitits is most common in boys aged 8-12, but can affect girls as well as older and younger kids. Keep in mind, it is the most common cause, but certainly not the only one. Heel pain can also result from fractures, achilles tendon and ligament injuries, infection, and even tumors. Some cases of Apophysitis can be quite severe, involving a fracture of the growth plate of the heel bone. Most cases of Apophysitis can be treated with rest, anti inflammatory medication, ice, and arch supports which are essential in preventing the condition from coming back.
Heel Pain / Plantar Fasciitis / Heel Spurs
Plantar Fasciitis is a very common condition involving pain on the bottom of the heel associated with activity. Pain is frequently worst upon arising in the morning and after rest. The condition develops because of a strain and repetitive injury to a ligament on the bottom of the heel called the plantar fascia which connects the heel bone to the toe joints. This ligament serves to suspend the bodies weight when walking. Lack of arch support, poor shoe gear, prolonged standing and walking, sports activities, and spending significant amounts of time on hard concrete surfaces are contributing factors.
Self treatment can involve ice, anti-inflammatory medications such as Advil or ibuprofen, and off-the-shelf arch supports. Unfortunately, most of the off-the-shelf arch supports available do not provide adequate support and are not custom-fit and are therefore not very effective in treating this condition. Conservative treatment can involve ice, prescription anti-inflammatory medication either topical or oral, strapping or taping of the foot, custom molded arch supports, physical therapy, use of a night splint to stretch the fascia while sleeping, and Cortizone injections. Dr. Gavin uses the latest in state-of-the-art technology to diagnose and treat heel pain, diagnostic ultrasound is available in both locations and is used to assess the condition and if necessary to perform ultrasonic guided Cortizone injections.
In some cases, conservative therapy fails and surgical intervention becomes necessary. Dr. Gavin uses the latest techniques including ESWT or Extracorporeal Shockwave Therapy. This involves using the same type of high intensity focused ultrasound that's used to breakup kidney stones in the body without surgery for treatment of heel pain. There's no cutting, and no time off following the procedure. Another very effective surgical procedure is EPF or the Endoscopic Plantar Fasciotomy. This involves introducing a small fiber-optic camera into the heel through a small incision, and using the same micro surgical instruments that are used in carpal tunnel surgery to lengthen the fascia and alleviate pain causing plantar fasciitis. This procedure requires minimal time off and is often effective where multiple conservative treatments have failed..Click to view Image #1.Click to view Image #2.Click to view Image #3.Click to view Image #4.
Ingrown toenails are often caused by hereditary structure of the nail, but can become more symptomatic because of physical activity level or pressure from shoe gear. Other ingrown toenail problems can come from distortion of the toe nail itself from infectious processes like fungal infection of the toenail. Conservative treatment involves avoiding shoes that create excessive pressure on the nails, and appropriate trimming to reduce and remove the ingrown portion of the nail. Chronic problems with ingrown toenails are very easily addressed with a simple procedure done in the office which involves removing the ingrown portion of the nail, using a laser or chemical to destroy the ingrown portion of the nail root much like a dentist performing a root canal. This results in permanent removal of the ingrown portion of the nail -- The patient grows a nail, with a straight edge instead of the painful ingrown part.Click to view Image #1.
IN-TOE or PIGEON TOED or Metatarsus Adductus
In- toed gait, also known as being "Pigeon Toed", is often a sign of a deformity known as Metatarsus Adductus, especially when found in children. In this condition, the feet point inward, towards each other resulting in problems with walking and running because the patient literally trips over thier own feet. This condition has many causes, and is best often treated in childhood with bracing, stretching in physical therapy, and use of custom molded orthotics or arch supports designed to train the patients feet to walk with better alignment.
Limb Length Inequality
A rather surprising number of people have this condition where one leg is longer or shorter than the other, because of a multitude of factors. The problem can occur in the long bones of the leg, or in the joints of the foot, ankle, knee, or hip. Many people who have limb length discrepancy or inequality are unaware of the condition. Limb length inequality can result in a tilt or angulation to the pelvis which then results in curvature in the spine, shoulders, and neck. The discomfort from this condition can range from foot problems, knee problems, hip pain, lower back pain and a long list of conditions in the back and neck. Most often the body will compensate for the condition by altering hip and foot function in order to try and equalize the inequality by lengthening the short side to reach the ground and shortening the long side to stabilize the body in motion. Limb length inequality is often first recognized by podiatrists, physical therapists and chiropractors during a routine examination and treatment. The condition often responds favorably to conservative treatment with custom molded orthotics in mild to moderate cases, severe cases usually require fabrication of an entire lift under the sole of the shoe on one side to compensate for the inequality. If you are told you have this condition or are aware of its existence on your own, custom molded arch supports should be used consistently to prevent problems from recurring because of compensation for the condition.
Lumps in the Arch and Plantar Fibroma
Painful lumps in the bottom of the arch are often caused by a condition called Plantar Fibromatosis, which involves the formation of hard bumps on the bottom of the foot. Any Lump or bump that doesnt appear normal can possibly represent a tumor or cancerous growth, and should be evaluated by a Doctor.
Plantar Fibromas themselves are not cancerous, they are benign but can be quite painful. Conservative therapy offered by Dr Gavin at The Foot & Ankle Institute usually starts with orthotics; custom molded arch supports with a groove or pocket built in to remove pressure from the area. Fibromas sometimes cause pain regardless and need to be removed surgically.
Toe nail fungus or Onychomycosis unfortunately has become a very common condition whereby a fungal organism known as a dermatophyte causes a deep-seated infection in the toenails and/or fingernails. Dermatophyte infections are often caused by the same fungal organisms that cause athletes foot infections. Many patients suffer from fungal infections of their toenails as a result of using instruments or nail clippers that someone else has used that already has the infection. If you frequently undergo pedicures, be sure to ask your nail technician about their sterilization techniques.
Unfortunately, many patients end up contracting fungal infection of their toenails at nail salons.
The condition starts as an area of discoloration involving the distal tip of a toenail or toenails. The discoloration is often white or yellow to brown in color, and spreads from the tip of the nail on backwards, and can spread from nail in two nail. Because of the potential for spread, if it is important to disinfect one's shoes with anti fungal spray on a regular basis if a diagnosis of athletes foot or toe nail fungus has been made.
There are many over-the-counter remedies available as well as home remedies, and most are ineffective for treating toe nail fungus because the medications do not penetrate the nail plate to kill the fungus where it lives. In essence, the fungus survives by eating away at the proteins in your nail.
Dr. Gavin uses prescription topical treatments and oral anti fungal treatments with removal of the infected portions of the nail as well as a new revolutionary method to treat this condition with a quick painless procedure using state of the art technology performed in the office. See the information in the laser treatments section for more information. Topical treatment with prescription medication are not always effective and require twice daily application of medication for at least 12 months. Oral anti fungal medication is also sometimes effective but also takes 12 months to work, and certain precautions need to be taken because this medication is eliminated from the body by the liver and therefore should not be given to patients who take other medications that are cleared by that pathway or have an elevation in their liver enzymes. In some cases, liver damage can occur. Dr. Gavin tests all patients that are considering oral anti fungal medication. As with many conditions, early diagnosis and treatment is essential to prevent the infection from spreading to multiple nails.
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Neuritis / Neuroma
A neuroma is a condition of the foot in which a nerve becomes compressed between two of the long bones in the forefoot resulting in trauma to the nerve and pain. Over time the nerve becomes entrapped in multiple layers of scar tissue and often becomes enlarged to many times its normal size. This condition can manifest with a wide array of sensations including tingling, burning, cold sensations, sharp shooting pains, and numbness. Patients with this condition often complain of feeling as if there's something in their shoe or they're stepping on a marble.The most common presentation involves sharp shooting pains between the third and fourth toes and pain under the ball of the foot, but because the nerve involved has branches from two major nerves in the foot, sharp shooting pain and electrical sensations can spread through the entire bottom of the foot.
Conservative treatment for neuromas usually involves taping/padding the foot, topical and oral anti inflammatory medication, physical therapy, Cortizone injections and custom molded arch supports. When conservative therapy fails, surgery sometimes becomes necessary. Neuroma surgery involves removing a segment of nerve with the entire neuroma through an incision on the top of the foot. This results in numbness between the affected toes, which is unavoidable but often much better than the pain from compression of the nerve.Click to view Image #1.
Pain in the Ball of the foot
There are 28 bones in the human foot, 21 of them in the forefoot or from the middle of your arch forward. Pain associated with the big toe joint can be caused by bunions, arthritis,tendonitis, gout, nerve entrapment, capsulitis or inflammation of the joint, sesamoiditis or inflammation of two small bones in the big toe joint, and many other things. Pain under the base of the smaller toes can result from hammertoes, pinched nerves, tendonitis,stress fracture, capsulitis, metatarsalgia or pain in the long bones of the forefoot, and many other causes. Pain with burning sensations in the toes is often caused by an entrapment of an enlarged or inflamed nerve called a Morton's Neuroma.
This is but a short list of the many conditions that can cause pain in the ball of the foot. Many of these problems can easily be treated with conservative or non surgical treatment: Changes in shoegear, Strapping/taping/padding of the foot, medications- both topical and oral, physical therapy, custom molded arch supports or orthotics, and cortizone injections. Some cases fail to respond to conservative treatment and necessitate surgical intervention. As with many foot problems, early diagnosis and treatment is the key to success. Waiting for something to get better while it may actually be getting worse can result in more damage to the structures involved, decreasing your chances for a positive outcome.
Plantar warts are caused by a viral infection of the skin as a result of human papilloma virus. The virus is spread by direct contact, usually when a person steps on the bare floor, shower floor, or swimming pool where someone else has stepped that has the virus. The virus enters the skin cells and utilizes the nucleus of the cell to reproduce -- it redirects the function of our cells to make more viral cells. Plantar warts also fool the body into growing blood vessels into the area in order to feed the infectious process, much like a parasite. Over-the-counter treatments include topical acid and liquid nitrogen products which are usually only effective with smaller warts. Because the infection often goes very deep into the skin layers, more aggressive treatment is necessary.
Conservative treatment for plantar warts can include liquid nitrogen treatment, and use of topical prescription medications, and use of topical acid/chemical compounds in the office. This treatment is performed with weekly visits, and avoids the necessity for surgery therefore no scar tissue is produced in ridding the body of the infection. Prescription medications are available that can successfully eradicate the virus with little or no discomfort. These medications work by specifically targeting the process the virus uses to reproduce, instead of traditional acid compounds that cause chemical burns, but can be used in conjunction with acid compounds for a combined effect in cases of more deep seated or resistant infections. In some cases, conservative therapy fails and surgical treatment becomes necessary. Dr. Gavin prefers laser treatment for those cases that failed conservative therapy. Laser surgery requires less time off and produces less scar tissue than other conventional methods such as sharp cutting procedures.Click to view Image #1.Click to view Image #2.
Sesamoiditis or Pain Under the Big Toe Joint
The sesamoid bones are two small bones located under the big toe joint in the foot; they are named after sesame seeds, for thier similar shape. These small bones perform an integral role in the weight bearing structure of the big toe joint. We actually walk on these bones, located underneath the first metatarsal or first long bone at the base of the big toe. In essence, they prevent the tendons that flex the big toe from damage throughout a lifetime of walking, jumping, and running. The sesamoids themselves are prone to many different painful conditions including swelling, or sesamoiditis and other conditions such as arthritis, gout, fractures, disclocation, displacement from bunion deformity, and loss of circulation- called avascular necrosis- to name a few. Because the sesamoids are subjected to immense pressure with every step we take, when there is an injury or problem with them, it can be quite painful.
Many conditions that affect the sesamoids can easily be treated with conservative measures such as padding, custom molded arch supports or orthotics, medication, physical therapy, and cortisone injections. Dr Gavin at the Foot & Ankle Institute uses the latest diagnostic techniques including diagnostic ultrasound, CAT scan and MRI to evaluate sesamoid problems. In some cases, conservative therapy fails and surgery is needed to reshape or remove a problematic sesamoid bone. To this day, medicine has not come up with a way to replace these vital structures. If you are having problems with pain under your big toe joint, avoid tight fitting shoes or shoes with hard soles- athletic shoes are best. If the problem persists, evaluation with xrays and ultrasound should be performed.Click to view Image #1.
Many runners experience pain on the front of their shins from running. This condition most often occurs because of overuse of a specific set of muscles on the front of the leg that are responsible for supporting the arch during a specific portion of each step we take. This condition is most often very easily treated with conservative treatment consisting of rest, avoidance of impact activity for a period of time, anti-inflammatory medication, supportive taping of the foot, physical therapy, and finally custom molded arch supports. Arch supports are usually the best way to treat this condition, but are also essential in preventing this condition from recurring, and should be used on a permanent basis even if symptoms have resolved completely.Click to view Image #1.
ABNORMAL MOLES, SORES, and LESIONS
Any abnormal mole, sore, lesion or area of the skin that becomes discolored, changes in size, becomes painful, or bleeds without injury could be a sign of skin cancer and therefore should be evaluated by a podiatrist.
Athletes Foot is a fungal infection of the skin caused by an organism called a dermatophyte. Once known as ringworm, the fungus enters the layers of the skin and survives by metabolizing proteins within our skin structure. Unfortunately, many of the over-the-counter remedies for this condition are ineffective because the organism causing the infection has developed a resistance to the active ingredient. There are many topical prescription strength medications available for treating this condition, and in some cases prescription oral anti fungal medication becomes necessary to combat the infection. Beyond treating the initial infection, it is often important to prevent reinfection by disinfecting shoe gear that was worn during the active infection, and reducing the moisture content in the skin to decrease the likelihood of further problems. This often involves use of prescription strength drying agents especially for those with sweaty feet.
HYPERHIDROSIS or Hyperactive Sweat Glands
Hyperhidrosis is a very common condition involving increased activity of the eccrine or oil-producing sweat glands in the soles of our feet. Most of us use some type of antiperspirant or deodorant under our arms on a daily basis. The same type of chemistry that causes underarm odor can and often does affect human foot. One home remedy that often works is to use an antiperspirant on the soles of the feet at bedtime each night, Mitchum brand has the highest concentration of active ingredient. Many cases require prescription strength medications which is available and is often successful at alleviating this problem.
Hyperkeratosis is also a very common condition affecting the feet in which significant dead skin builds up on the soles of the feet usually under the heel and forefoot. Frequent use of over-the-counter moisturizing lotion's as well as exfoliation or removal of dead skin at home can be helpful, but many cases require further treatment. Treatment usually involves removal of the heavier skin in the office which is frequently performed by Dr. Gavin during a routine office visit. This is followed by use of prescription strength proteolytic enzyme therapy which involves using a cream that dissolves or removes the dead skin build up with daily use.
FOREIGN BODY / SLIVERS
Foreign bodies or inclusion cysts are extremely common conditions affecting the human foot. Often slivers, Staples, needles and all manner of Metallic, glass or wooden objects end up getting stepped on an embedded in the bottom of our feet. If you have something stuck in your foot, and cannot easily grasp it and remove it, it is often best to avoid trying to "dig" it out as you can easily push the object in deeper and make it more difficult to find, also increasing the likelihood of infection and abscess formation. Removal of Foreign bodies is a very frequent procedure performed by Dr. Gavin in the office, and very seldom requires anything more than office visit and local anesthetic. If you have stepped on something and removed it yourself, but are unsure if anything is remaining in your foot, remember that any signs of infection are likely indications that a portion of the foreign body remains and needs to be removed.
Psoriasis is a genetic skin disorder that involves the formation of dry skin scales that are often very itchy. There are many types of prescrition medications that can alleviate the symptoms of psoriasis, but to this day, it cannot yet be cured.
Many sprain injuries of the foot and ankle are improperly treated after initial evaluation in the emergency room. The word sprain means to stretch or tear a ligament. In many cases, ankle sprains are evaluated initially and when no broken bones are found, patients are told to wear an air cast or ace bandage for a few weeks, then return to activity. The result is that the torn ligament never heals properly, and the patient goes on to have problems with chronic pain and instability. Our ligaments are responsible for holding our bones together at our joints, and when they are sprained or torn, joint function can be severely compromised resulting in permanent and progressive damage to the cartilage. Instability of the joint can also result, leaving the patient prone to repetitive sprains. In actuality, torn ligaments in the foot and ankle usually take between six -- eight weeks to heal, and in many cases should be completely immobilized during the healing process so that the body can repair the damage and restore strength and integrity to the structures.
Accurate diagnosis and treatment is essential early in the healing process. Dr. Gavin utilizes diagnostic ultrasound, x-rays, and MRI to accurately diagnose and treat these conditions. The majority of sprains can be healed through conservative or non surgical treatment if the injury is recognized and treatment rendered in timely fashion soon after the injury. In some cases, multiple ligaments are torn or instability results from improper care after a severe sprain. In these cases, surgical repair of the ligaments may be necessary, and in some cases tendon transfer or graft surgery becomes necessary. Dr. Gavin utilizes both primary repair techniques to repair the anatomy in its natural state, and also uses both synthetic and biological graft materials to repair and or replace damaged ligament structures when necessary.
Perhaps one of the most common problems Dr Gavin deals with on a daily basis are simple sports injuries, sprains, overuse injuries and "weekend warrior" pain. Often these problems start out mild, but can turn into real problems if left undiagnosed and untreated. Simple ligament strains and tendonitis can lead to more serious injuries or even rupture of the injured structures because athletes with the "No Pain, No Gain" mantra keep adding injury to an already compromised structure simply by doing what they've always done- exercising!
TWO RULES OF THUMB that Dr Gavin believes you should NOT follow:
I CAN WALK ON IT, SO IT MUST NOT BE BROKEN....
THE EMERGENCY ROOM TOOK XRAYS AND SAID NOTHING WAS BROKEN, SO I MUST BE OK...
Dr Gavin has seen literally HUNDREDS of cases where people have walked into his offices on a broken bone. Many times, stress fractures occur that cannot be seen on Xrays at the time of injury. In fact, they are often not visible until a full two weeks later when the bone begins to try healing itself. Continuing to walk with a stress fracture can result in failure of the healing process or the bone may fully fracture. In these cases, a simple cast of walking boot could have remedied the situation, but surgery ends up being the final result.
In many cases, the ER Doctor is right, and there are no broken bones. There may be, in fact, torn ligaments, muscles, or tendons. Failure to seek treatment in a timely fashion can often lead to permanent injury and disability. "Take some Motrin and wear an Ace bandage for 3 weeks." is a terrible way to treat these injuries. Soft tissue studies such as Diagnostic Ultrasound and MRI can be invaluable in the proper identification and treatment of your injury. If its been two weeks, and you're still in pain or can't bear weight; schedule an appointment.
Excessively sweaty or stinky feet can result from Hyperhidrosis- hyperactive sweat glands, or Bromohidrosis, which is essentially the same condition with a bad smell coming from bacteria that colonize the feet and shoes. Hyperhidrosis is a very common condition involving increased activity of the eccrine or oil-producing sweat glands in the soles of our feet. Most of us use some type of antiperspirant or deodorant under our arms on a daily basis. The same type of chemistry that causes underarm odor can and often does affect human foot. One home remedy that often works is to use an antiperspirant on the soles of the feet at bedtime each night, Mitchum brand has the highest concentration of active ingredient. Many cases require prescription strength medications which is available and is often successful at alleviating this problem.
Swelling in the feet and ankles can be caused by a number of problems, a partial list is: Arthritis, Gout, Infection, Vascular Disease, Varicose Veins, Congestive Heart Failure, High Blood Pressure, and Blood Clots.
Chronic swelling or Edema in the feet and ankles can result in many problems and should not go untreated. Most often, chronic swelling can lead to a more serious and permanent condition called Lymphedema. Having chronic swelling that is uncontrolled can lead to the skin becoming very thin and fragile, resulting in the development of sores called Stasis Ulcers. These subborn sores often drain fluid constantly and are common places where infection begins. They are difficult, but not impossible to heal. Healing them often requires antibiotic therapy and use of specially formulated medicinal bandages. Once healed, strict control of the swelling that caused them is the key to preventing thier recurrence. Control of that swelling in the first place is the key to preventing them from occurring at all. Swelling is controlled through diet, medication, use of a treatment device called a sequential pressure pump and use of specially made socks called compression stockings.
Tailors Bunions or Bunionettes
The Tailors Bunion deformity involves an enlargement on the side of the foot at the base of the pinky toe. This condition is the result of enlargement or prominence of the 5th metatarsal or 5th long bone in the foot. This occurs because the bone is enlarged, bent, or the angle between the 4th and 5th bones is increased. This is often accompanied by a hammertoe of the 5th toe and the 5th toe lies on top of or underneath the 4th toe. Many patients with Tailors Bunions have redness over the prominence from rubbing on shoes. A bursa, or reactive sac of inflammation can accompany it, increasing pressure and pain. In some cases, the nerve on the side of the foot becomes entrapped causing excruciating pain. Like the Bunion deformity, Tailors Bunions involve a deviation of the joint surface which can lead to arthritis and permanent damage to the cartilage. Conservative management involves changes in shoegear, modification of existing shoegear, padding, injections and custom molded orthotics. In cases that fail conservative therapy, surgery is available to remove the bump of bone or reposition the 5th long bone if necessary. Surgery to correct the hammertoe is often also performed if necessary. Dr Gavin uses state of the art surgical techniques so that walking is often permitted after surgery, but must be in a protective walking boot.Click to view Image #1.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome involves a compression of the tibial nerve in the back of the ankle/inside of the heel area. The tarsal tunnel is defined as a fibrous structure on the inside of the ankle behind the ankle bone made up of strong connective tissue compartments that are occupied by the flexor tendon to the big toe, the flexor tendon to the lesser toes, the posterior tibial tendon which is responsible for providing the majority of support to the arch in our foot, as well as the largest artery and nerve in the human foot. Similar to carpal tunnel syndrome, patients with tarsal tunnel syndrome often suffer from problems with tingling, numbness, burning sensations and pain on the bottom of their feet. The condition is often related to activity, and worsens with prolonged standing and walking.
Timely diagnosis with appropriate diagnostic testing is essential in many cases to prevent permanent nerve damage. The compression of the tibial nerve can sometimes come from swelling around tendons, soft tissue masses or fluid filled cysts, varicose veins, or a structural problem where the tarsal tunnel is narrowed resulting in pinching of the nerve against the tendons that it shares space with in the tarsal tunnel. Conservative treatment for tarsal tunnel syndrome also topical for oral anti inflammatory medication, strapping/taping of the foot, physical therapy treatments, custom molded orthotics, and ultrasonic guided cortizone injections. In some cases, conservative therapy fails and surgical intervention if becomes necessary which involves release or widening of the tarsal tunnel and removal of any mass or cyst that is compressing the nerve.
It is essential when dealing with numbness in the feet to determine whether the numbness is due to a metabolic disorder, a compression of the nerve higher up in the body in the hip or lower back, or due to a localized compression of the nerve in the tarsal tunnel itself. Dr. Gavin utilizes an entire range of diagnostic testing in order to properly assess and evaluate conditions causing numbness in the feet. Testing often consists of blood tests, neurological testing to evaluate function of the nerves, diagnostic ultrasound, and MRI.
Many of the problems that affect the human foot are more common in women. This is in part due to genetic factors but is certainly made worse by the types of shoegear women wear. A partial list of these conditions is: Bunions, Tailors bunions, Hammertoes, Neuromas, Achilles Tendonitis, Haglunds Deformity, Plantar Fasciitis.
While many of these conditions are genetic and structural, the degree to which they cause problems can be reduced by two things:
Choosing proper shoegear for dress attire isn't always easy, especially with foot pain. Dr Gavin reccommends you first get fitted with dress orthotics, then worry about which shoes will work. Symptoms associated with toe problems can often be alleviated by simply avoiding narrow, pointy shoes that put pressure on these areas. High heeled shoes aren't the best thing for you, but if you choose shoes with heels 2" or lower, you can minimize the risks.