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By Dr. Kuvent, June 24, 2010 3:35 pm

Pain in the ball of your foot is often slapped with an all inclusive, catch all medical term that leaves patients feeling as if they’ve become just another number in the crowd with an obscure, difficult to pronounce condition. While this is one broad condition, its causes are many, and to properly treat your foot pain, the root of the problem needs to be discovered.

While pain in the ball of your foot is generally not serious or life-threatening, it can be a hindrance keeping you on the sidelines instead of participating in the things you like to do. Fortunately for you, conservative treatments, such as ice and rest or proper footwear along with insoles or arch supports, may be all you need to solve, or at least minimize your pain and get you back on track!  

You can ask five people, all experiencing pain in the ball of their feet, and get a different list of symptoms from each of them; needless to say, symptoms vary. You may be experiencing sharp, intense pain, or a dull, aching pain, or even both depending on the day of the week. You may find that your pain lies in the area around your second, third and/or fourth toes — or, only around your big toe. Most likely, your pain will get worse when you stand, walk or run and will improve after resting. It’s possible to have sharp, shooting pain in your toes or to have completely numb toes. Some patients also report feeling as if they’re walking with a pebble in their shoe. Most of the time, any or all of these symptoms will develop gradually over time; however, they can start suddenly if you’ve recently increased the amount of time you spend exercising or the intensity at which you exercise.

In each of your feet, there are five metatarsal bones that run from your arch to your toes. When you push-off during walking or running, your body weight is transferred to these metatarsals and your toes. Most of the time, pain experienced in the ball of the foot is due to some problem affecting the way your weight is distributed to these bones, putting excess pressure on the metatarsals, which causes inflammation and pain, especially in the ends of the metatarsals where they connect with the toes. Sometimes the pain is caused by one problem, but often it is due to a combination of reasons. These reasons range from increased activity, to wearing ill-fitting shoes, to gaining excess weight.

When left untreated, the pain can spread to other areas of the same foot or the other foot, and after enough time, it may even spread to other areas of the body such as the knees, hips or back. This is why you should not ignore pain in the ball of your foot for too long. While you don’t necessarily need to rush to your podiatrist the first time you take a painful step, you should consider making an appointment if the pain persists or worsens over the course of several days to weeks.

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By Dr. Kuvent, June 10, 2010 10:36 am

Have you noticed lately that you are unable to walk as far as you used to without needing to rest? Do you experience calf pain soon after beginning an activity, forcing you to stop before you want to? Have your feet felt cold or your toenails become thickened? Has the hair on your feet stopped growing? If you can answer yes to any or all of these questions, you may be suffering from a serious problem involving the blood vessels in your legs and feet. In the medical community, this condition is called PVD (“peripheral vascular disease”), but all this medical jargon really means is that the blood vessels in your legs are blocked, leading to decreased blood flow to your calves and feet. This blockage may be due to a number of reasons, like clogging, narrowing or hardening of the arteries. No matter what the underlying cause is, you should see a doctor to determine the proper treatment to get you back on your feet and walking without pain. Your podiatrist will be able to do a series of physical tests to assess your problem, and they may request a consult with a doctor who specializes in blood vessels to aid in the diagnosis of the specific problem at hand.

A hallmark of this clinical condition is that the pain occurs periodically with an activity such as walking, then after a moment of rest (the length of this rest time varies from patient to patient), you are able to continue walking. Other signs that point to PVD include a bluish discoloration of the lower legs and feet, decreased hair growth or shiny skin on the tops of the feet and toes, decreased temperature of the affected limb, and decreased pulses felt in the feet.

While this may seem odd or opposite to common sense, exercise is often the best option to improve your symptoms (provided they are mild – severe symptoms will often require more intensive forms of treatment). You should always talk with your doctor before beginning an exercise program, to ensure your health won’t be compromised. Let’s say, for example, you experience pain and require rest after walking two blocks. This should not encourage you to simply avoid walking two blocks! Instead you should set realistic goals, such as making it three blocks before resting, then seek to improve your ability to walking four blocks and then five, and so on. Medications that aid in controlling blood pressure, diabetes and cholesterol will help keep your blood vessels in good working order, and thus help you to walk further without pain.

If your doctor determines the blockages in your arteries are too serious to simply prescribe exercise, they may consider surgery. This option is typically reserved for conditions that are life or limb threatening or significantly interfere with your ability to complete activities of daily living.

You deserve to enjoy the activities in your life! If you suffer from any of the symptoms discussed above, make an appointment with your local Chandler podiatrist today and get started with the rest of your life!

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By Dr. Kuvent,

The term “gangrene” is derived from Greek and Latin words, neither of which have anything to do with the word “green”. It is purely coincidence that the tissues affected by this condition may have a greenish color. Whether you know of someone who has it or you’ve watched any number of different war movies, you’ve probably heard of gangrene. The question is: what exactly is it, and what will happen to those who have it?

Gangrene, by definition, is a condition involving cell death and is characterized by the decay of body tissues. The affected tissues may become black, green, or even yellowish brown, and often have a foul odor. It is most common in the lower extremities, particularly the feet and toes. Gangrene can be caused by an infection of some sort, but more often than not, it is the end result of critically reduced blood supply to the affected tissues. Some major risk factors for developing gangrene are disease states like diabetes or circulatory problems, and long-term smoking.

There are three types of gangrene: dry, wet and gas.

Dry gangrene often starts in areas like the toes and feet. It develops in cases where blood supply is interrupted by some reason other than infection. This particular type of gangrene spreads slowly until the blood supply is so poor that the tissues are no longer able to survive. The affected area is dry and dark black, and some say it resembles mummified flesh. People with impaired blood flow, such as diabetics and the elderly, are at a greater risk of developing dry gangrene. Early signs include a dull ache, the affected area feeling cold, and the skin appearing pale white. If caught early, it can be reversed by surgery; however, if tissue death occurs, the affected tissue must be removed.

Wet gangrene occurs more often in naturally moist tissues and organs but can occur in the foot. Here, the tissue is infected, which causes the tissue to swell and give off a foul smell. While dry gangrene spreads slowly, this tends to develop rapidly. In the affected area, blood pools and remains still, which promotes the rapid growth of bacteria. These bacteria produce toxic products which are absorbed into the blood and can spread to the whole body, potentially resulting in death. Like in dry gangrene, the affected area is swollen, soft, rotten and dark.

Gas gangrene is very serious and deadly. Like wet gangrene, it is caused by an infection, only in this case, the infection produces gas within tissues and spreads rapidly into the nearby healthy tissues. For this reason, gas gangrene is considered a medical emergency. 

Treatment of gangrene revolves around restoring adequate blood flow to the affected area, to allow proper healing. Other treatment options include removal of the dead tissue or amputation of the affected limb.

If you or someone you know has signs or symptoms of gangrene of the foot, you should seek medical treatment right away! Your local podiatrist will know the appropriate course of action to make sure everything that can be done to save your foot will be done.

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By Dr. Kuvent, May 27, 2010 12:00 pm

If you have an ulcer anywhere on your foot or ankle, you should never mutter that ever popular Monty Python phrase “it’s just a flesh wound” and ignore it! An ulcer is a serious wound involving the complete loss of the top layer of skin and possible extension into the deeper layers and tissues. These are especially dangerous in the diabetic population. If you, or someone you know, has diabetes, then you must be aware of the signs to look for involving ulcers, and you should see a podiatrist routinely. Diabetic foot ulcerations are the most common single precursor to lower extremity amputations.

Now, you may be wondering why diabetics are more susceptible to lower extremity problems. The answer is fairly complex, but here is a general overview: Diabetics may have a series of pathologies in the nerves, blood vessels, muscles, and skin. Problems in the nerves result in impaired protective sensation, making it possible to sustain an injury to the foot without feeling it. The damaged nerves also can result in weakened muscles because without adequate innervation, muscles can’t function properly. This can manifest as hammer toes, bunions and instability while standing or walking. Conditions involving blood vessels can result in many medical problems, including but not limited to insufficient oxygen and nutrient delivery to tissues and possible blockages. This can lead to pain, ulceration and ultimately gangrene of the foot. Lastly, diabetics experience changes in their skin. The skin becomes dry and is more prone to cracking and callus formation, which can lead to increased susceptibility to infections. Toe nails become thickened and brittle, and many times are infected with fungus. Thickened nails coupled with high pressure forces being applied to the nails can lead to nail bed ulcerations.

This picture seems pretty grim, doesn’t it? Well, there is extremely good news: diabetic foot problems are very preventable! Serious consequences, such as amputations usually start out as preventable, easy to treat problems. If you have diabetes, the key is to see a podiatrist on a regular basis for routine inspections of your feet. Studies by the US National Institute of Health show that comprehensive foot care programs can reduce amputation rates by 45-85%. Your local podiatrist can perform proper nail care, reduce callus build-up, and make sure your skin is sufficiently hydrated. Furthermore, he or she can educate you on your specific needs, as every patient experiences different challenges in caring for their feet. Good foot health is just a doctor’s appointment away!

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By Dr. Kuvent, May 18, 2010 9:35 am

While many conditions ending in that ever familiar suffix “-oma” are indeed associated with cancer, you need not worry if your doctor tells you the pain in your foot is caused by a Morton’s Neuroma.

A neuroma, by definition, is an abnormal swelling or thickening of a nerve. Morton’s neuroma (aka interdigital neuroma) is a condition involving an enlarged or inflamed portion of a nerve in the foot, specifically located in the third interdigital space. As the nerves of the foot travel toward the spaces between the toes, they split into two terminating branches, one to each adjacent side of a toe; thus each nerve provides sensation to two different toes. A Morton’s neuroma typically occurs just before these nerves divide into their terminal branches. The nerve lies between the fat padding below it and a strong ligament above it. If there is enough enlargement of this nerve, as you walk or place weight on the foot, the nerve becomes compressed by the ligament and the surrounding structures, causing severe discomfort.

Morton’s neuromas are four times more common in females than males, and more often than not occur in the later years of life. If you have this condition, you will typically experience localized pain, along with any number of the following symptoms: a burning sensation that may spread beyond the site of the neuroma, numbness in the involved toes, swelling, electric shock sensations, or the feeling of a lump in your shoe. A common way to relieve the discomfort is by loosening the laces of your shoes or removing your shoes completely. You may also try gently massaging the affected area to lessen the pain. Your symptoms will usually worsen with a number of activities, all revolving around placing weight on the affected foot.

There are many options to treat Morton’s neuromas. Most doctors will start by obtaining an x-ray of the foot to rule out other causes of pain such as a fracture, and they may even order an MRI to discover the approximate size and exact location of the neuroma. Depending on these imaging studies,  your podiatrist will decide whether conservative treatment will be enough, or if it will require a surgical procedure. Conservative treatments include a change in footwear and taping or padding to offload the pressure around the neuroma. Shoes with a firmer sole will decrease the amount of stretching of the foot and wider shoes will allow for less crowding of your toes, both resulting in less aggravation of the neuroma. Another option is to use an injection of numbing medication mixed with cortisone to temporarily relieve your pain. In severe cases, when conservative treatments do not yield the desired results, surgery may be necessary. Your podiatrist may release some surrounding structures to relieve the pressure around the neuroma, or they may remove the neuroma altogether. Another approach that has proven to be very effective is to use a series of injections of a diluted alcohol to kill the nerve at the site of the neuroma. You should be aware that while these different treatments will relieve the pain, they may also result in loss of sensation between the third and fourth toes (the area supplied by the nerve).

If you are experiencing the symptoms of a Morton’s neuroma, you should talk with your podiatrist soon to find out what can be done to relieve your pain. You shouldn’t have to endure such discomfort with every step you take!

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By Dr. Kuvent,

          You’re probably aware that heel pain is a very common problem affecting many people today. Countless products are made to support our arches and provide relief to our aching heels each year. Much of the attention is aimed at relieving the tenderness at the bottoms of our heels. However, one often-overlooked source of pain occurs at the back of the heel. This, of course, is where the Achilles tendon inserts and thus can lend itself to a wide variety of problems. One common source of pain which may occur alone or in conjunction with other forms of heel pain is called a “bursitis”.

          A “bursitis” is the technical term for inflammation and irritation of a bursa. A bursa is basically a small pad-like sack or cavity which contains fluid; almost like a small water balloon. Bursas are found at multiple locations within the human body where their primary function is to reduce friction between bones and tendons, tendons and ligaments, and other structures. A perfect example is found at the back of the heel. Because the Achilles tendon inserts at an angle along the top and back of the heel bone, a bursa in this location helps to prevent excessive rubbing and wear and tear which could otherwise damage the tendon.

          There are many causes of a bursitis including trauma, poorly-fitting shoes, arthritis, and sports injuries. The normal function and congested area in which heel bursas are found makes them naturally susceptible to injury and irritation. In many cases, the structure of the heel bone itself is such that there is an overlying prominence which puts even more pressure on the bursa and Achilles tendon. Patients with this problem usually have a dull, aching soreness over the top of the heel bone which is aggravated by shoe pressure. Women who are 20 to 30 years old are the most common individuals to encounter this condition as it is loosely associated with the wearing of high-heeled shoes. Nonetheless, males and other age groups may also be affected.

          As with any sort of structural disorder, a thorough evaluation is imperative, and this is where your local Chandler foot doctor can be of great assistance. Distinguishing between bony pathology, a bursitis, or an Achilles problem is critical. For this, your podiatrist may want to order some X-rays, an MRI, or other lab tests after first evaluating your heel in the office. The differential is huge and may include things such as rheumatoid arthritis, gout, Achilles tendon calcifications, various tumors, an infection, or even spinal cord problems.

          The standard of care for treating a bursitis is based on the severity of symptoms and is usually done as conservatively as possible. This may include shoe gear modifications, braces, prescription anti-inflammatory medications, aspiration, and steroid injections (which is done cautiously). If these treatments are ineffective, more invasive measures can be considered to excise the bursa in order to provide relief. If you have any questions, feel free to call today!

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By Dr. Kuvent, May 7, 2010 2:28 pm

          Even when they are perfectly healthy, kids have a way of drawing attention to themselves. As a parent or responsible caretaker, you also have a natural inclination to observe your children for their health and well-being in addition to their unique personalities. Occasionally, foot and ankle concerns such as flat feet may arise which can be tricky to pick up in a developing child. In these situations, thorough and professional evaluations can help ensure that more serious problems do not arise down the road.

          Due to the way that young children develop, they typically have different biomechanical standards than adults. These are based on their age, genetic makeup and other factors. For example, kids generally have more pliable soft tissues as well as a more pronated foot type which is normal until about 7 or 8 years of age. Of course, everyone is different, but there are also even more specific standard measurements for the heel position at particular ages. As a parent, there are a few things that you can monitor such as the sleeping and sitting positions, shoe wear, growing pains, and levels of activity of your child. Because young kids are not able to give a detailed description of their symptoms, subtle signs including a low threshold for physical activities can serve as a red flag that something may be wrong.

          One fairly common developmental abnormality is a foot which is rotated outwards on the ankle joint-essentially the opposite of a clubfoot. This is caused by intrinsic factors such as muscle imbalances and weak ligaments as well as extrinsic factors including a small uterus, increased fetal size, early walking and crawling, or simply ill-fitting shoes. The condition occurs in about 1 in 1,000 live births and may be a flexible or a fixed deformity. Generally, this condition will resolve with time, but in certain situations it should be treated early-ideally within the first year of life. The treatment most often involves manipulation of the involved extremity with splints or serial casting to rotate it back into a neutral position.

          Another condition which should be evaluated in young kids occurs when the heel position is fairly normal but the forefoot is deviated inwards. This also may or may not progress to become a painful deformity and thus require treatment. However, it is typically a milder deformity and thus may be effectively treated when the child is several years older.

          Other more obvious but serious abnormalities include a high-arched foot, a ‘rocker-bottom’ foot, or a foot with misshapen digits. These conditions warrant professional attention as soon as possible. If you have questions regarding these or any others affecting the feet or ankles of your child, don’t hesitate to contact your local Chandler podiatrist today. He can assist you in determining what is normal and whether any sort of intervention is appropriate. For all youngsters, it is important to start off on the right foot!

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By Dr. Kuvent, April 29, 2010 12:55 pm

Plantar fasciitis is a term that you’ve probably come across if you have dealt with heel pain in the past or have read much about it. Indeed, it is a major cause of symptoms, but unfortunately many patients and physicians often overlook the many other possible causes behind aching heels. One commonly misdiagnosed etiology is neurologic based heel pain.

          If you were to take a look at the anatomy of a human ankle, you’d notice that there are several major nerves running through the ankle and into the foot. At various locations these nerves branch to form even more nerves. Of course this is essential for our normal functioning as our feet not only contain many muscles but they are also very sensitive-which is a good thing! However, the space within the ankle and hind-foot is fairly narrow and occasionally one or more of those nerves can become compressed resulting in sore heels.

          One of the most common nerve entrapments creating heel pain involves a nerve which runs across the bottom of the heel towards the outside of the foot where it supplies a muscle of the 5^th toe. This nerve runs through a tight space where it can easily be compressed by a heel spur, the plantar fascia (central location of plantar fasciitis), and other structures. This type of pain is known as Baxter’s neuritis, and as opposed to plantar fasciitis, it will more often be painful following activities as compared to early morning or first-step pain.

          There are multiple other causes of neurologic pain in addition to a Baxter’s neuritis. For example, even irritation within the lower spine can create symptoms of pain at the heel. These symptoms may be difficult to distinguish from other causes, but it is generally more of a tingling, numbing, or burning sort of pain. Depending on your case, your local podiatrist may recommend several different diagnostic techniques after a thorough clinical exam if your pain is persistent. These may include X-rays, nerve-conduction studies, or an MRI to exclude any possible tumors or other space-occupying lesions.

          The treatment for neurologic heel pain depends upon its exact etiology and which specific nerves are affected. Initial treatments are often similar to those for plantar fasciitis and include the use of certain medications, mechanical supports, and anesthetic injections. If these measures are ineffective, surgical treatment usually involves a simple procedure in which a small incision is made at the bottom of the heel. The doctor then creates more space by removing some of the excess tissue which may be pressing against the nerve.

          In addition to nerve complications, there are many other possible causes of heel pain which should also be ruled out. If you have questions, feel free to contact your local foot doctor in Chandler today.

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By Dr. Kuvent,

          When you think of tumors you may think of cancer, and when you think of cancer, you probably don’t immediately think of the foot or ankle. However, there is in fact a very wide variety of tumors which do show up primarily in the foot and ankle. Thankfully, ten times as many of these lesions are benign as they are cancerous, but it’s still intriguing to note that 45% of soft tissue sarcomas occur in the lower extremity. One of the more common benign tumors of the foot is known as a “plantar fibroma”.

          Plantar fibromas are generally found in patients in their 20s, 30s, and 40s and are most commonly seen in men. About half of cases involve both feet, and they are more common in people with epilepsy, diabetes, and alcoholics with liver disease. Also, they are classically associated with a condition involving the hands in which the ring and small fingers are contracted forwards and are unable to be straitened. This is called a Dupuytren’s contracture. Of course, it’s important to remember that not all individuals with this condition fit these criteria.

          Essentially, plantar fibromas are thickenings of fibrous tissue within the plantar fascia which is a normal band of tissue that runs along the sole. These nodule-like thickenings are usually found towards the middle or inside of the sole, and they sometimes arise in non-weight-bearing areas making them asymptomatic. On the other hand, the lesions can grow to 2 cm in diameter, and although they are not cancerous, they can be locally aggressive leading to significant pain and discomfort when walking.

          A major key to properly managing plantar fibromas is achieving the correct diagnosis. This is because there are so many other possible tumors and lesions-both benign and malignant-within the foot and ankle. Your local Chandler podiatrist can help you in determining whether your condition is actually a ganglion cyst, an infection, hernias of the fat pad, tumors involving nervous tissue, a cancerous lesion, or indeed a plantar fibroma. In some cases, an MRI may be requested to help the doctor make this distinction.

          The treatment for plantar fibromas is based on the grade, size, and location of the tumors as well as the nature of your symptoms. Foot doctors like to start out as conservatively as possible by implementing certain medications, shoe-gear modifications, steroid injections, and other modalities before moving on to surgical intervention. In severe cases such as those involving pain, difficulty fitting into shoes, or a growing lesion, the doctor may recommend surgery to excise the lesion. There is a chance of recurrence, however.

          If you have symptoms of a plantar fibroma, such as painful ‘lumps’ on the soles of your feet, feel free to call and make an appointment today.

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By Dr. Kuvent,

Ulcers and other types of wounds are some of the most common problems that podiatrists deal with in the lower extremity. Part of the reason for that is because there are so many possible causes including diabetic ulcers, pressure ulcers, and blood-flow related ulcers as well as burns, traumatic wounds, and skin grafts or flaps. One unique treatment option that can be used in all of these settings is known as “negative pressure” or “wound vacuum” therapy.

          In short, wound vacuum therapy is an active but non-invasive form of therapy which uses controlled pressure over a wound to promote healing. This principle was actually first developed in 1841 when vacuum bells were applied to different body parts with the idea of drawing blood away from diseased organs! Later in the 1950’s, newer designs were developed and studies were carried out examining healing potential and how the body responded to changes in pressure. The most popular device today received FDA approval in 1995 and was approved by Medicare in 2000.

          There are several popular wound vacuum models in use today and a great deal of quality research has been done supporting their efficacy. The studies have shown that vacuum devices help by creating an ideal healing environment within the wound. They do this by offering protection and support as well as increasing local blood flow, removing excess fluid, decreasing bacteria, and promoting the formation of healthy tissue over the wound. Additionally, wound vacuum devices are shown to improve the success rates of skin grafts and flaps when they are necessary. Of course, vacuum therapy is not indicated in all wounds, and not every patient is a candidate.

          As already noted, there are several different wound vacuum models in use today. Many of the models include a foam dressing with a suction device which is specially applied over the wound. The dressing is then attached by a length of tubing and connectors to the actual battery-powered suction device. This device is usually small and lightweight and can travel easily with patients. It can be programmed to offer the proper amount of negative pressure in order to optimally heal the wound or wounds in question.

          Wound vacuum therapy is just one of many options available for the management of ulcers and other types of wounds. Your podiatrist in Chandler can tell you if this is an appropriate therapy for your condition and then help to manage that therapy effectively. Some wounds require constant suction while others require intermittent suction, and this can all be pre-programmed into the device. Vacuum therapy has proven to be an exceptional cost-saving measure in that it can help augment surgery, reduce the number of dressing changes, speed the transition to less invasive health care settings, and provide a treatment option to patients who are not ready for surgery. If you have questions, feel free to make an appointment today!