Here are some common problems associated with the foot and a little information about each.

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Achilles Tendonitis
Arch Pain/Arch Strain
Arthritis
Bunions (Bunionettes)
Calluses
Claw Toes
Corns
The Diabetic Foot
Hammer Toes
Heel Pain
Heel Spur
Ingrown Toenails
Mallet Toes
Metatarsalgia
Morton's Neuroma
Morton's Toe
Diabetic Neuropathy
Overlapping Toe
Over Pronation (Flat Feet)
Plantar Fasciitis
Post-Tib Tendonitis
Pregnancy and Your Feet
Sesamoiditis

Achilles Tendonitis
Achilles tendonitis causes inflammation and degeneration of the achilles tendon. The achilles tendon is the large tendon located in the back of the leg that inserts into the heel. The pain caused by achilles tendonitis can develop gradually without a history of trauma. The pain can be a shooting pain, burning pain, or even an extremely piercing pain. Achilles tendonitis should not be left untreated due to the danger that the tendon can become weak and ruptured.

Achilles Tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases, even prolonged periods of standing can cause symptoms. It is a common problem often experienced by athletes, particularly distance runners. Achilles Tendonitis is difficult to treat in athletes because of their high level of activity and reluctance to stop or slow down their training.

Individuals who suffer from Achilles Tendonitis often complain that their first steps out of bed in the morning are extremely painful. Also, often the first steps taken after long periods of sitting are often quite painful. This pain often lessens with activity.

Several factors can cause Achilles Tendonitis:

  • Over-pronation—the most common cause—occurs in the walking process, when the arch collapses upon bearing weight, adding stress on the Achilles tendon,
  • Improper shoe selection,
  • Inadequate stretching prior to engaging in athletics,
  • A short achilles tendon,
  • Direct trauma (injury) to the tendon, and
  • Heel bone deformity. 

Athletes, particularly runners, should incorporate a thorough stretching program to properly warm-up the muscles. They should decrease the distance of their walk or run, apply ice after the activity, and avoid uphill climbs. Athletes should use an orthotic device, heel cup, or heel cradle for extra support.

A heel cup or heel cradle elevates the heel to reduce stress and pressure on the achilles tendon. The device should be made with lightweight, shock-absorbing materials. An orthotic device can be used to control over-pronation, support the longitudinal arch, and reduce stress on the achilles tendon.

If the problem persists, consult Dr. Alexander.

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Arch Pain/Arch Strain
Arch Pain (often referred to as Arch Strain) refers to an inflammation and/or burning sensation at the arch of the foot.

There are many different factors that can cause Arch Pain. A structural imbalance or an injury to the foot can often be the direct cause. However, most frequently, the cause is Plantar Fasciitis, a common condition.

The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Excessive stretching of the plantar fascia, usually due to over-pronation (flat feet), causes plantar fasciitis.

The inflammation caused by the plantar fascia being stretched away from the heel often leads to pain in the heel and arch areas. The pain is often extreme in the morning when an individual first gets out of bed or after a prolonged period of rest. 

If this condition is left untreated and strain on the longitudinal arch continues, a bony protrusion (heel spur) may develop. It is important to treat the condition promptly before it worsens.

This is a common foot condition that can be easily treated. If you suffer from Arch Pain, avoid high-heeled shoes (over 3”) whenever possible. Choose footwear with a reasonable heel, soft leather uppers, shock absorbing soles, and removable foot insoles. When the Arch Pain is pronation related (flat feet), an orthotic designed with a medial heel post and proper arch support is recommended for treating the pain. This type of orthotic will control over-pronation, support the arch, and provide the necessary relief.

If the problem persists, consult Dr. Alexander.

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Arthritis
Arthritis is a disease characterized by the inflammation of the cartilage and lining of the body's joints. Inflammation causes redness, warmth, pain and swelling. About 40 million Americans suffer from Arthritis. The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that, by 2020, about 60 million Americans will have Arthritis. Arthritis primarily afflicts people over the age of 50. Arthritis is a major cause of foot pain because each foot has 33 joints that can become affected by the disease.


Osteoarthritis
There are many different types of Arthritis. The most common is osteoarthritis. Osteoarthritis causes excessive strain and the wearing away of cartilage in the joints of the foot. Movement becomes quite difficult and painful. Pain and swelling worsens while standing or walking, and stiffness usually occurs after periods of rest.

Gout
Gout is another form of Arthritis that also leads to foot complications. Excess uric acid crystals collect in and around the joints of the big toe. The big toe joint is commonly the focal point due to the stress and pressure it experiences during walking and other weight bearing activities. This often leads to severe pain in the big toe. Men are more likely to develop gout than women.

Rheumatoid Arthritis
Another type of Arthritis is rheumatoid arthritis, which may develop at any age, with no known cause. Rheumatoid arthritis is the most crippling form of the disease and can cause severe deformities of the joints, with associated fatigue of the entire body. People who suffer from rheumatoid arthritis often develop severe forefoot problems, such as bunions, hammer toes, and claw toes, along with problems in the heel and ankle area, due to the erosion of the involved joints.

There are many causes of Arthritis. Heredity plays a major role. However, arthritic symptoms can develop due to many other factors. Some of these include bacterial and viral infections, prescription and illegal drugs, traumatic injuries, and bowel disorders such as ileitis and colitis.

If the problem persists, consult Dr. Alexander.

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Bunions
Bunions, referred to in the medical community as Hallux Valgus, are one of the most common forefoot problems. A Bunion is a prominent bump on the inside of the foot around the big toe joint. This bump is actually a bone protruding towards the inside of the foot. With the continued movement of the big toe towards the smaller toes, it is common to find the big toe resting under or over the second toe. This causes a common forefoot condition, overlapping toes. Some of the symptoms of Bunions include inflammation, swelling, and soreness on the side surface of the big toe. The discomfort commonly causes a patient to walk improperly.

Another type of Bunion is called a Tailor's Bunion, also known as a Bunionette. This forms on the outside of the foot towards the joint at the little toe. It is a smaller bump that forms due to the little toe moving inwards, towards the big toe.

Bunions are a common problem experienced more often by women. The deformity can develop from an abnormality in foot function or arthritis. Also, tight, narrow dress shoes with a constrictive toe box (toe area) can cause the foot to begin to take the shape of the shoe, leading to the formation of a Bunion. Women who have Bunions often wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes, causing the first metatarsal bone to further protrude on the side of the foot.

It is important for everyone to realize that wearing dress shoes and boots taper in the toe area can cause the Bunion to worsen, to the point where surgery is necessary.

In the early stages of the formation of a Bunion, soaking feet in warm water can provide temporary relief. The best way to alleviate pain associated with Bunions is to wear properly fitting shoes. Shoes designed with a high, wide toe box (toe area) are recommended for people suffering from forefoot disorders, such as Bunions. Shoes with rocker soles will unload pressure to the bunion area. Orthotics are also recommended for this condition to provide extra comfort, support, and protection.

Other conservative treatments include the use of forefoot products designed to accommodate and relieve bunions, such as bunion shields, bunion night splints, and bunion bandages. These conservative treatments can limit the progression of the bunion, relieve pain, and provide a healthy environment for the foot.

If the problem persists, consult Dr. Alexander.

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Calluses
Callus formation is caused by an accumulation of dead skin cells that harden and thicken over an area of the foot, the body's defense mechanism to protect the foot against excessive pressure and friction. Calluses are normally found on the ball-of-the-foot, the heel, and/or the inside of the big toe.

Some Calluses have a deep-seated core known as a nucleation. This type of Callus can be especially pressure-sensitive and is often referred to as Intractable Plantar Keratosis.

Calluses develop because of excessive pressure at a specific area of the foot. Some common causes of Callus formation are high-heeled dress shoes, shoes that are too small, obesity, abnormalities in the gait cycle (walking motion), flat feet, high arched feet, bony prominences, and the loss of the fat pad on the bottom of the foot.

Many people try to alleviate the pain caused by Calluses by cutting or trimming them with a razor blade or knife. This is wrong, as it is very dangerous and can worsen the condition, resulting in unnecessary injuries. Diabetics especially should never try this type of treatment.

To relieve the excessive pressure that leads to Callus formation, weight should be redistributed equally via the use of an orthotic. An effective orthotic transfers pressure away from the "hot spots" or high pressured areas to allow the Callus to heal. The orthotic should be made with materials that absorb shock and shear (friction) forces. Women should also refrain from wearing high-heeled shoes.

As always, surgery should be the very last option.

If the problem persists, consult Dr. Alexander.

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Claw Toes
A Claw Toe is a toe that is contracted at the PIP and DIP joints (middle and end joints in the toe) and can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe's joints to curl downwards. Claw Toes may occur in any toe, except the big toe. There is often discomfort at the top part of the toe that is rubbing against the shoe and at the end of the toe that is pressed against the bottom of the shoe.

Claw toes are classified by the mobility of the toe joints. There are two types—flexible and rigid.

In a flexible Claw Toe, the joint has the ability to move. This type of Claw Toe can be straightened manually.

A rigid Claw Toe does not have that same ability to move. Movement is very limited and can be painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, possibly causing pain and the development of corns and calluses.

Claw Toes result from a muscle imbalance which causes ligaments and tendons to become unnaturally tight, making the joints curl downwards. Arthritis can also lead to many different forefoot deformities, including Claw Toes.

Changing the type of footwear is a very important step in the treatment of Claw Toes. When choosing a shoe, make sure the toe box (toe area) is high and broad and can accommodate the Claw Toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes.

Other conservative treatments include using forefoot products designed to relieve Claw Toes, such as toe crests and hammer toe splints. These devices will help hold down the Claw Toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.

If the problem persists, consult Dr. Alexander.

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Corns
Corns, like calluses, develop from an accumulation of dead skin cells on the foot, forming thick, hardened areas. They contain a cone-shaped core, with a point that can press on a nerve below, causing pain. Corns are very common ailments that usually form on the tops, sides, and tips of the toes. Corns can become inflamed due to constant friction and pressure from footwear. Corns that form between the toes are sometimes referred to as soft corns.

Some of the common causes of Corn development are tight fitting footwear, high-heeled footwear, tight fitting stockings and socks, deformed toes, and the foot sliding forward in a shoe that is too loose. Soft Corns result from bony prominences and are located between the toes. They become soft due to perspiration in the forefoot area.

Complications that can arise from Corns include bursitis and foot ulcers.

There are very simple ways to prevent and treat Corns:

  • Wear properly fitted footwear, with extra room in the toe box (toe area).
  • Avoid shoes that are too tight or too loose.
  • Use an orthotic or shoe insert made with materials that will absorb shock and shear forces.
  • Avoid tight socks and stockings, to provide a healthier environment for the foot.

Steer away from corn removing solutions and medicated pads, as they can sometimes increase irritation and discomfort. Diabetics and all others with poor circulation should never use any chemical agents to remove corns.

If the problem persists, consult Dr. Alexander.

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The Diabetic Foot

Diabetes is a serious disease that is caused by lack of insulin production in the body or the inability of the body's insulin to perform its normal functions. Insulin is a substance produced by the pancreas that helps transform food into energy.

Diabetes affects approximately 16 million Americans and is classified into two different types—Type 1 and Type 2. Type 1 is usually associated with juvenile diabetes and is often inherited. Type 2, commonly referred to as adult onset diabetes, is characterized by elevated blood sugars, often in people who are overweight or have poor diets.

Diabetes has many complications. It disrupts the vascular system, affecting many areas of the body, such as the eyes, kidneys, legs, and feet. Diabetics must pay special attention to their feet.

Neuropathy
Of the sixteen million Americans with Diabetes, 25% will develop foot problems related to the disease. Diabetic foot conditions develop from a combination of causes, including poor circulation and neuropathy. Diabetic Neuropathy can cause insensitivity or an inability to feel pain, heat, and cold. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores of which they may not be aware due to this insensitivity. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet.

Diabetics must take all precautions to prevent foot related injuries. Due to the consequences of neuropathy, daily foot observation and inspection is critical. When a diabetic patient takes the necessary preventative measures, the risks of serious foot conditions are greatly reduced.

Poor Circulation
Diabetes often leads to peripheral vascular disease that inhibits blood circulation. With this condition, there is a narrowing of the arteries that frequently leads to significantly decreased circulation in the lower part of the legs and the feet. Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, causing injuries to heal poorly. Poor circulation can also lead to dryness of the foot. Preventing foot complications is more critical for the diabetic patient because poor circulation impairs the healing process and can lead to ulcers, infection, and other serious foot conditions.

Diabetics need to be particularly alert to any foot problems. It is very important for diabetics with neuropathy to take necessary precautions to prevent injury and keep their feet healthy. If you have diabetes and are experiencing a foot problem, immediately consult Dr. Alexander.

Footcare & Diabetes
Proper footcare is especially critical for diabetics because diabetics are prone to foot problems such as:

  • Loss of feeling in their feet.
  • Changes in the shape of their feet.
  • Foot ulcers or sores that do not heal. 
    Simple daily footcare can prevent serious problems. According to the National Institute of Health, the following simple everyday steps will help prevent serious complications from diabetes:
  • Take Care of Your Diabetes
    Make healthy lifestyle choices to keep your blood sugar close to normal. Work with your health care team to create a diabetes plan that fits your lifestyle.
  • Check Your Feet Every Day
    You may have foot problems of which you may not be aware. Check your feet for cuts, sores, red spots, swelling, or infected toenails. Checking your feet should become part of your daily routine. If you have trouble bending over to see your feet, use a plastic mirror to help or ask a family member to help. Be sure to call your doctor immediately if a cut, sore, blister, or bruise on your foot does not exhibit signs of healing after one day.
  • Wash Your Feet Every Day
    Wash your feet in warm, NOT HOT, water. Do not soak your feet because your skin will get dry. Before bathing or showering, test the water with your hands or a thermometer to make sure it is not too hot. Dry your feet well. Be sure to dry between your toes, and use talcum powder to keep the skin dry between the toes.
  • Keep the Skin Soft and Smooth
    Rub a thin coat of skin lotion or cream on the tops and bottoms of the feet. Do not put lotion between your toes, because this might cause fungal infection.
  • Trim your Toenails Each Week or When Needed
    Trim your toenails with clippers after you wash and dry your feet. Trim the toenails straight across and smooth them with an emery board or nail file. DO NOT cut into the corners of the nail or rip off hangnails. If your nails are thick or yellowed, DO NOT cut your own nails; have a podiatrist trim them.
  • Wear Shoes and Socks At All Times
    Wear shoes and socks at all times. Do not walk barefoot, not even indoors. It is extremely easy to step on something and hurt your feet. Always wear seamless socks, stockings, or nylons with your shoes to help avoid the possibility of blisters and sores. Be sure to choose seamless socks that are made of materials that wick moisture away from your feet and absorb shock and shear. Always check the insides of your shoes before putting them on, to make sure the lining is smooth and there are no foreign objects in the shoe, such as pebbles. Wear shoes that fit well and protect your feet.
  • Protect Your Feet From Hot and Cold
    Always wear shoes at the beach or on hot pavement. Put sunscreen on the tops of your feet for protection from the sun. Keep your feet away from radiators or open fires. DO NOT use hot water bottles or heating pads on your feet. If your feet are cold, wear seamless socks at night. Lined boots are good to keep your feet warm in the winter. Choose socks carefully. DO NOT wear socks with seams or bumpy areas. Choose padded socks to protect your feet and make walking more comfortable. In cold weather, check your feet often to keep your feet warm to avoid frostbite.
  • Keep the Blood Flowing to Your Feet
    Elevate your feet when you are sitting. Wiggle your toes for five minutes, two or three times a day. Move your ankles up and down, in and out, to improve blood flow in your feet and legs.
  • DO NOT cross your legs for long periods of time. 
  • DO NOT wear tight socks, elastic, or rubber bands, or garters around your legs.
  • DO NOT wear restrictive footwear or foot products. Foot products that can cut off circulation to the feet, such as products with elastic, should not be worn by diabetics. 
  • DO NOT smoke. Smoking reduces blood flow to your feet.
    · If you have high blood pressure or high cholesterol, work with your health care team to lower it.
  • Be More Active
    Ask your doctor for an exercise program that is right for you. Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet. Avoid all activities that are hard on the feet, such as running and jumping. Always include a short warm-up and cool-down period. Wear protective walking or athletic shoes that fit well and offer good support.
  • Communicate With Your Doctor
    Ask your doctor to check the sense of feeling and pulses in your feet at least once a year. Ask your doctor to tell you immediately if you have serious foot problems.

If the problem persists, consult Dr. Alexander.

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Hammer Toes
A Hammer Toe is a toe that is contracted at the PIP joint (middle joint in the toe), potentially leading to severe pressure and pain. Ligaments and tendons that have tightened cause the toe's joints to curl downwards. Hammer Toes may occur in any toe except the big toe. There is often discomfort at the top part of the toe due to rubbing against the shoe.

Hammer Toes are classified based on the mobility of the toe joints. There are two types, flexible and rigid. In a flexible Hammer Toe, the joint has the ability to move. This type of Hammer Toe can be straightened manually. A rigid Hammer Toe does not have that same ability to move, as movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted, leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses. Follow this link to learn more about Hammer Toe products.

Hammer Toes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight, resulting in the joint curling downward. Arthritis can also lead to many different forefoot deformities, including Hammer Toes.

Changing the type of footwear worn is a very important step in the treatment of Hammer Toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the Hammer Toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes.

Other conservative treatments include using forefoot products designed to relieve Hammer Toes, such as hammer toe crests and hammer toe splints. These devices will help hold down the Hammer Toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.

If the problem persists, consult Dr. Alexander.

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Heel Pain
Heel Pain is a common condition in which weight bearing on the heel causes extreme discomfort.

There are two different categories of Heel Pain. The first is caused by overuse (repetitive stress), a soreness resulting from too much impact on a specific area of the foot. This condition, often referred to as "heel pain syndrome," can be caused by shoes with heels that are too low, a thinned out fat pad in the heel area, or from a sudden increase in activity.

Plantar fasciitis, a very common diagnosis of Heel Pain, is usually caused from a biomechancial problem, such as over-pronation (flat feet). The plantar fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot, from the heel through the midfoot and into the forefoot. Over-pronation can cause the plantar fascia to be excessively stretched and inflamed, resulting in pain in the heel and arch areas of the foot. Often, the pain will be most intense first thing in the morning or after a prolonged period of rest, with the pain gradually subsiding as the day progresses.

To properly treat Heel Pain, you must absorb shock, provide cushioning, and elevate the heel to transfer pressure. This can be accomplished with a heel cup, visco heel cradle, or an orthotic designed with materials that will absorb shock and shear forces.

When the condition is pronation related (usually plantar fasciitis), an orthotic with medial posting and good arch support will control the pronation and prevent the inflammation of the plantar fascia.

Footwear selection is also an important criteria when treating Heel Pain. Shoes with a firm heel counter, good arch support, and appropriate heel height are the ideal choice.

If the problem persists, consult Dr. Alexander.

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Heel Spur
The heel bone is the largest bone in the foot and absorbs the most shock and pressure. A Heel Spur develops as an abnormal growth of the heel bone. Calcium deposits form when the plantar fascia pulls away from the heel area, causing a bony protrusion, or heel spur, to develop. The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Heel Spurs can cause extreme pain in the rearfoot, especially while standing or walking.

A Heel Spur develops as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia pulls away from the heel. This stretching of the plantar fascia is usually the result of over-pronation (flat feet), but people with unusually high arches (pes cavus) can also develop heel spurs. Women have a significantly higher incidence of Heel Spurs due to the (ill-advised) types of footwear worn regularly.

The key for the proper treatment of Heel Spurs is determining the cause of the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support is an effective device to reduce the over-pronation, and allow the condition to heal.

Other common treatments include stretching exercises, losing weight, wearing shoes that have a cushioned heel that absorbs shock, and elevating the heel with the use of a heel cradle, heel cup, or orthotic. Heel cradles and heel cups provide extra comfort and cushion to the heel, and reduce the amount of shock and shear forces associated with everyday activities.

If the problem persists, consult Dr. Alexander.

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Ingrown Toenails
Known to podiatrists as onychocryptosis, Ingrown Toenails are a common, painful condition that occur when skin on one or both sides of a nail grows over the edges of the nail, or when the nail itself grows into the skin. This condition is usually very painful and can be associated with infection of the toe. Some Ingrown Toenails are chronic, with repeated episodes of pain and infection. Irritation, redness, and an uncomfortable sensation of warmth, as well as swelling, can result from an Ingrown Toenail.

Ingrown Toenails develop for many reasons. In some cases, the condition is congenital, such as toenails that simply are too large. People whose toes curl, either congenitally or from diseases like arthritis, are prone to Ingrown Toenails. Often trauma, like stubbing a toe or having a toe stepped on, can cause a piece of the nail to be jammed into the skin. Repeated trauma, such as the pounding to which runners typically subject their feet, also can cause Ingrown Toenails.

The most common cause is cutting your toenails incorrectly, causing them to re-grow into the skin. Tight hosiery or shoes with narrow toe boxes only make matters worse. If the skin is red, painful, or swollen on the sides of the nail, an infection may be present. This occurs because the ingrown nail is often in a warm, moist, bacteria-rich environment. When the nail penetrates the skin, it provides a convenient entry for germs that can cause infection. Untreated, the nail can go under the skin, causing a more severe infection. In either case, the infection needs to be cured with sterile instruments and antibiotics.

Ingrown Toenails should be treated as soon as they are recognized. In many cases, people with uninfected Ingrown Toenails can obtain relief with the following simple regimen:

  • Soak the feet in warm salt water
  • Dry them thoroughly with a clean towel
  • Apply a mild antiseptic solution to the area
  • Bandage the toe

If excessive inflammation, swelling, pain, or discharge is present, the toenail probably is infected and should be treated by a podiatrist. A podiatrist can trim or remove the infected nail with a minor in-office surgical procedure, by removing the offending portion of the nail or overgrown skin with a scalpel and treating the infection. Unless the problem is congenital, the best way to prevent Ingrown Toenails is to protect the feet from trauma and wear shoes with adequate room for the toes.

Properly cut toenails do much to prevent Ingrown Toenails. Using a safety nail clipper, cut the nails straight across, so that the nail corner is visible. If the nail is cut too short, the nail corner may grow into the skin. It is the natural tendency, when the edge of the nail starts to grow in, to cut down at an angle at the nail edge, to relieve the pain. This does relieve the pain temporarily, but it also can start a downward spiral, training the nail to become more and more ingrown.

If the problem persists, consult Dr. Alexander.

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Mallet Toes
 Many disorders can affect the joints in the toes, causing pain and preventing the foot from functioning as it should. A Mallet Toe occurs when the joint at the end of the toe cannot straighten. Excessive rubbing of the Mallet Toe against the top of the shoe can lead to pain and the development of a corn. The tip of the toe is often turned down against the shoe, causing pressure and discomfort.

Mallet Toes are often caused by bone and muscle imbalances. These imbalances become exaggerated in people with active lifestyles. For example, those who are constantly on their feet or participate in athletic activities are more likely to develop Mallet Toes.

Arthritis can also lead to many forefoot deformities, including 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.

Any forefoot problems that cause pain or discomfort should be given prompt attention. Ignoring the symptoms can aggravate the condition and lead to a breakdown of tissue, or possibly even infection. Conservative treatment of Mallet Toes begins with accommodating the deformity, with the goal of relieving pressure, reducing friction, and transferring forces from the sensitive areas.

Shoes with a high and broad toe box (toe area) are recommended for people suffering from forefoot deformities, such as Mallet Toes. This prevents further irritation in the toe area. Other conservative treatment includes 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.

If the problem persists, consult Dr. Alexander.

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Metatarsalgia
Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot). This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia (ball-of-foot-pain) is often located under the second, third, and fourth metatarsal heads, or more isolated at the first metatarsal head (near the big toe).

With this common foot condition, one or more of the metatarsal heads can become painful and/or inflamed, usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with Metatarsalgia. Ball-of-foot pain is often caused from improper fitting footwear, most frequently by women's dress shoes and other restrictive footwear. Footwear with a narrow toe box (toe area) forces the ball-of-foot area to be forced into a minimal amount of space. This can inhibit the walking process and lead to extreme discomfort in the forefoot.

Other factors can cause excessive pressure in the ball-of-foot area that may result in Metatarsalgia. These include shoes with heels that are too high or participating in high impact activities without proper footwear and/or orthotics. Also as we age, the fat pad in our foot tends to thin, making us much more susceptible to pain in the ball-of-the-foot.

The first step in treating Metatarsalgia is to determine the cause of the pain. If improper fitting footwear is the cause of the pain, the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole is ideal for treating Metatarsalgia. The high, wide toe box allows the foot to spread out, while the rocker sole reduces stress on the ball-of-the-foot.

Unloading pressure to the ball-of-the-foot can be accomplished with a variety of footcare products. Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad. The orthotic is constructed with the pad placed behind the ball-of-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Other products often recommended include gel metatarsal cushions and metatarsal bandages. When these products are used in conjunction with proper footwear, you should experience significant relief.

If the problem persists, consult Dr. Alexander.

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Morton's Neuroma
Morton's Neuroma is a common foot problem associated with pain, swelling, and/or an inflammation of a nerve, usually at the ball-of-the-foot between the third and fourth toes. Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton's Neuroma may also cause numbness, tingling, or cramping in the forefoot.

Morton's Neuroma is a foot condition caused from an abnormal function of the foot that leads to bones squeezing a nerve usually between the third and fourth metatarsal heads. Symptoms of Morton's Neuroma often occur during or after significant pressure on the forefoot area, while walking, standing, jumping, or sprinting. This condition can also be caused by footwear selection, with footwear with pointed toes and/or high heels often the culprit. Constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain.

The first step in treating Morton's Neuroma is to select proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating and relieving the pain. The next step in treatment is to use an orthotic designed with a metatarsal pad. This pad is located behind the ball-of-the-foot to unload pressure, and relieve the pain caused by the neuroma.

If the problem persists, consult Dr. Alexander.

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Morton's Toe
Morton's Toe is a common forefoot disorder where the second toe is longer than the Big Toe (the Hallux).

Morton's Toe leads to excessive pressure on the second metatarsal head (behind the second toe at the ball-of-the-foot) resulting in pain similar to the discomfort associated with metatarsalgia. The constant pressure placed on the longer second toe while walking or standing can lead to callus formation under the second metatarsal head due to this excessive pressure.

Proper treatment of Morton's Toe starts with the selection of proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating this condition. It also may be necessary to buy footwear a half size to a size larger to accommodate the longer second toe.

Orthotics that feature arch support to keep the foot aligned and a metatarsal pad to reduce stress on the ball-of-the-foot are often recommended when treating this condition. Proper footwear combined with a effective orthotic will provide relief from pain associated with Morton's Toe.

If the problem persists, consult Dr. Alexander.

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Neuropathy
Of the 16 million Americans with diabetes, 25% develop foot problems related to the disease, primarily due to a condition called Neuropathy. Diabetic neuropathy is a complication of diabetes that affects the nerves. The most common type of diabetic neuropathy is called peripheral neuropathy and affects the peripheral nerves. Peripheral nerves are the nerves that go out from the brain and spinal cord to the muscles, skin, internal organs, and glands. Peripheral neuropathy impairs proper functioning of these sensory and motor nerves. Its most common symptoms include numbness and loss of feeling, usually in the feet and hands.

Diabetic neuropathy can cause insensitivity or an inability to feel pain, heat, and cold. Diabetics suffering from Neuropathy can develop minor cuts, scrapes, blisters, or pressure sores of which they may not be aware, due to insensitivity. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet.

It is essential for diabetics to take the necessary precautions to prevent all foot-related injuries. Due to the consequences of Neuropathy, daily observation of the feet is critical. When a diabetic patient takes the necessary preventative footcare measures, he or she reduces the risk of developing serious foot conditions.

The most successful way to prevent diabetic neuropathy is to control the diabetes. It is important to maintain blood sugars at normal levels and maintain normal blood pressure. In addition, it is important to:

  • Stop Smoking
  • Limit alcohol consumption
  • Have regular physical exams
  • Have regular blood and urine tests

It is important for diabetics with neuropathy to take the necessary precautions to prevent injury and keep their feet healthy.

If you have diabetes and are experiencing a foot problem, immediately consult Dr. Alexander.

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Overlapping Toe
Many disorders can affect the joints in the toes, causing pain and preventing the foot from functioning properly. People of all ages can experience forefoot problems. Overlapping toes can occur in any of the toes and can cause extreme irritation if not corrected.

Wearing footwear with a constricting toe box can lead to overlapping toes. Another common cause is bunions, usually found in adult women. Overlapping of the fifth toe may occur among children and can be easily corrected.

Pain and inflammation are common symptoms of overlapping toes. Left untreated, this condition can interfere with the normal function of the foot.

Any problems that cause pain or discomfort in the toes should be given prompt attention. Ignoring the symptoms can aggravate the condition and lead to a breakdown of tissue or even infection.

Conservative treatment (non-surgical treatment) of overlapping toes begins with accommodating the disorder. Shoes with a high, broad toe box (toe area) are recommended for people suffering from overlapping toes.

Forefoot supports such as gel toe straighteners, gel toe caps, and toe combs are often recommended to keep overlapping toes apart. These effective devices are designed to reduce friction to help relieve the discomfort.

If problem persists, consult Dr. Alexander.

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Over Pronation (Flat Feet)
Over-Pronation, or flat feet, is a common biomechanical problem that occurs in the walking process when a person's arch collapses as it becomes weight bearing. This motion can cause extreme stress or inflammation on the plantar fascia, potentially causing severe discomfort and leading to other foot problems.

Over-Pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding stress to other parts of the foot. As a result, Over-Pronation, often leads to Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis, and/or Bunions.

There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch, leading to Over-Pronation. Often people with flat feet do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.

Over-Pronation can be treated conservatively (non-surgical treatments) with orthotics.
These orthotics should be designed with appropriate arch support and medial rearfoot posting to prevent the Over-Pronation.

Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems.

If the problem persists, consult Dr. Alexander.
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Plantar Fasciitis
Plantar Fasciitis is an inflammation caused by excessive stretching of the plantar fascia. The plantar fascia is a broad band of fibrous tissue running along the bottom surface of the foot, attaching at the bottom of the heel bone and extending to the forefoot. When the plantar fascia is excessively stretched, this can cause Plantar Fasciitis, which can also lead to heel pain, arch pain, and heel spurs.

The excessive stretching of the plantar fascia that leads to inflammation and discomfort can be caused by the following:

  • Over-pronation which results in the arch collapsing upon weight bearing
  • A foot with an unusually high arch
  • A sudden increase in physical activity
  • Excessive weight, usually attributed to obesity or pregnancy
  • Improperly fitting footwear

Over-pronation (flat feet) is the leading cause of Plantar Fasciitis. Over-pronation occurs in the walking process, when a person's arch collapses upon weight bearing, causing the plantar fascia to be stretched away from the heel bone.

With Plantar Fasciitis, the bottom of the foot usually hurts near the inside of the foot where the heel and arch meet. Pain is often acute, typically either first thing in the morning or after a long rest, since the plantar fascia contracts back to its original shape while resting. As the day progresses and the plantar fascia continues to be stretched, the pain often subsides.

The key for the proper treatment of Plantar Fasciitis is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support is an effective device to reduce the over-pronation and allow the condition to heal.

Unusually high arches can also lead to Plantar Fasciitis, so cushion the heel, absorb shock, and wear proper footwear that will accommodate and comfort the foot.

Other common treatments include stretching exercises, using plantar fasciitis night splints, wearing shoes that have a cushioned heel to absorb shock, and elevating the heel with the use of a heel cradle or heel cup. Heel cradles and heel cups provide extra comfort, cushion the heel, and reduce the amount of shock and shear forces placed during everyday activities.

Every time your foot strikes the ground, the plantar fascia is stretched. You can reduce the strain and stress on the plantar fascia by following these simple instructions—Avoid running on hard or uneven ground, lose excess weight, and wear shoes and orthotics that support your arch to prevent over-stretching of the plantar fascia.

If problem persists, consult Dr. Alexander.

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Post-Tib Tendonitis

Post-Tib Tendonitis is a strain placed on the posterior tibial tendon. The posterior tibial tendon runs along the inside of the ankle and the foot. When there is post-tibial tendon dysfunction, the tendon does not function to hold up the arch, resulting in flat feet. This can lead to heel pain, arch pain, plantar fasciitis and/or heel spurs. With Post-Tib Tendonitis, pain will be more severe upon weight bearing, especially while walking or running.

Post-Tib Tendonitis occurs when the muscle is overused and the tendon (soft tissue) that connects the muscle to your bone is strained. Years of over-pronation (flat feet) left untreated can also lead to posterior tibial tendon dysfunction. At first, the pain or swelling may come and go quickly, but eventually the problem may become more permanent.

To treat Post-Tib Tendonitis, reduce its symptoms by limiting activity to control the pain and swelling. Stay off your feet a few days, then slowly increase activity. Rest allows foot tissue to heal.

The conservative treatment (non-surgical) is wearing a foot orthotic with rearfoot posting and longitudinal arch support to reduce strain on the post tibial tendon and prevent excessive stretching of the plantar fascia. This orthotic should also be designed with materials to comfort the foot and absorb shock.

Here are tips to prevent the recurrence of Post-Tib Tendonitis:

  • Wear shoes that provide cushioning, support, and shock absorption.
  • Use orthotics with sufficient arch support that are constructed from shock absorbing, cushioning materials.
  • Vary exercise routines. Variety keeps one set of muscles from being under continuous stress.

If the problem persists, consult Dr. Alexander.

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Pregnancy and Your Feet
Pregnancy triggers many different changes in a woman's body. Many women have common complaints throughout their pregnancy. One of these complaints, often overlooked, is foot pain. Due to the natural weight gain during pregnancy, a woman's center of gravity is significantly altered. This causes a completely new posture, with added pressure to the knees and feet.

Two of the most common foot problems experienced by pregnant woman are over-pronation and edema. These problems can lead to pain at the heel, arch, or the ball-of-foot. Many women may also experience leg cramping and varicose veins due to weight gain. Because of this, it is important for all pregnant women to learn more about foot health during their pregnancy to help make this nine-month period more comfortable for them.

Over-pronation and edema a very common foot problem experienced during pregnancy.

Over-pronation, also referred to as flat feet, is caused when a person's arch flattens out upon weight bearing and their feet roll inward when walking. This can create extreme stress or inflammation on the plantar fascia, the fibrous band of tissue that runs from the heel to the forefoot.

Over-pronation can make walking very painful and can increase strain on the feet, calves, and/or back. The reason many pregnant women suffer from over-pronation is the added pressure on the body as a result of weight gain. Over-pronation is also very prominent in people who have flexible, flat feet or in people who are obese.

Edema, also referred to as swelling in the feet, normally occurs in the latter part of pregnancy. Edema results from the extra blood accumulated during pregnancy. The enlarging uterus puts pressure on the blood vessels in the pelvis and legs causing circulation to slow down and blood to pool in the lower extremities. The total water fluid in the body remains the same as before pregnancy, but it becomes displaced. When feet are swollen, they can become purplish in color. Sometimes extra water is retained during pregnancy, adding to the swelling. If there is swelling in the face or hands, a doctor should be contacted immediately.

There are effective ways to treat both over-pronation and edema during pregnancy.

Over-pronation can be treated conservatively with orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to correct the over-pronation. Proper fitting footwear is also very important in treating over-pronation. Choose comfortable footwear that provides extra support and shock absorption.

It is important to treat over-pronation for pain relief but also to prevent other foot conditions from developing such as Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-Tib Tendonitis, and/or Bunions.

Edema (swelling) in the feet can be minimized by the following methods:

  • Elevate your feet as often as possible. If you have to sit for long periods of time, place a small stool by your feet to elevate them.
  • Wear proper fitting footwear. Footwear that is too narrow or short will constrict circulation.
  • Have your feet measured several times throughout your pregnancy, as they will probably change sizes.
  • Wear seamless socks that do not constrict circulation.
  • If you are driving for a long period of time, take regular breaks to stretch your legs to promote circulation.
  • Exercise regularly to promote overall health; walking is the best exercise.
  • Drink plenty of water to keep the body hydrated, to help the body retain less fluid.
  • Eat a well-balanced diet and avoid foods high in salt that can cause water retention.

Swelling should be similar in both feet. If swelling is not symmetrical in both feet, this may be a sign of a vascular problem and a doctor should be contacted immediately.

If any problems persist, consult Dr. Alexander.

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Sesamoiditis
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.

Sesamoiditis typically can be distinguished from other forefoot conditions by its gradual onset. 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. One of the major causes of Sesamoiditis is increased activity, putting more pressure on the balls of your feet. For runners, 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.

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. This may be accomplished by placing a metatarsal pad away from the joint so that it redistributes the pressure of weight bearing to other parts of the forefoot. 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 further recommended to decrease or stop activity for a period of time. This will give your sesamoids time to heal. You should apply ice to the area for ten to fifteen minutes after exercise or after any activity that aggravates the area. As with icing, anti-inflammatories will help the swelling go down so healing can begin. While the injury is healing, women should wear flat shoes.

If any problems persist, consult Dr. Alexander.

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