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By Dr. Kuvent, April 29, 2010 12:50 pm

          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, March 17, 2010 9:33 am

A low-arched foot type is not something commonly associated with an inflammatory disease process. On the contrary, like fingerprints, people tend to think of foot shape and walking patterns as innate characteristics which are unique to an individual and are more or less permanent. However, the foot and ankle are dynamically complex structures which can in fact change shape over time due to age, disease, and other factors. A perfect example of this is when one of the major tendons of the ankle becomes inflamed, damaged, and dysfunctional. The end result is a condition commonly referred to as adult acquired flatfoot.

          The force that allows you to roll your heel inwards or step up on your toes is generated by a major tendon which runs along the inside of your ankle behind the bump or “malleolus” on your inner ankle. This tendon runs under and across the sole into the underside of the ball area of the foot. Not only is this tendon responsible for performing those basic maneuvers, but it also plays a major role in maintaining the arch of the foot. As one might guess, when this tendon becomes inflamed or damaged, not only is weakness a possible outcome, but the arch and thus the entire foot structure are subject to change.

          The exact causes behind the tendon breakdown and weakness haven’t been fully described yet but there are many associated factors. Gout, psoriasis, diabetes, smoking, RA, and high blood pressure among others have all been linked to this disorder. Patients typically present walking on a collapsed mid-foot with both the heel and toes rotated outward away from their normal positions, and pain indicated on both the inside and outside of the ankle and mid-foot.

          Cases of adult acquired flatfoot with tendon dysfunction are first managed with a thorough clinical evaluation. Following this, your foot doctor may want to order one or more diagnostic exams such as an X-ray, MRI, or ultrasound. These findings will be helpful in determining the extent of the injury as well as which treatment options are most appropriate. These treatments may include anything from casting and physical therapy to surgical procedures to repair the tendon or even fuse several bones of the foot.

          In many cases, the arch of the foot doesn’t necessarily need to be collapsed for the disease process to be well underway. This condition is ranked in progressive stages which may only be able to be determined clinically or with radiographs. Therefore, even if you only notice mild pain and tenderness along the arch of your foot, or weakness when standing and performing other activities, it’s certainly not a bad idea to contact your podiatrist in Chandler. Tendon inflammation along the inner ankle can be treated much more easily when caught earlier- before structural changes begin to take place.