Advanced Foot Care » diabetes

Plantar Pain

Dr. Kuvent — Thu, 29 Apr 2010 19:50:43 +0000

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.

What a Pain in the Arch!

Red Flags

Dr. Kuvent — Wed, 17 Mar 2010 16:49:03 +0000

One of the most interesting aspects of the lower extremity is how many systemic diseases tend to show up in the feet, ankles, and lower legs. Diabetes is, of course, an obvious example, but there are also many diseases affecting the blood vessels which tend to show up in the lower limbs either before or during the time that they begin to affect other vital organs of the body. Many of these disorders will demonstrate predictable skin manifestations which help to offer clues about the underlying disease process.

‘Vasculitis’ is a general term referring to a state of inflammation or damage to the arteries or veins which transport blood throughout our body. There are many different diseases within this category which can affect different-sized blood vessels as well as different organs. However, many of the disorders result when the immune system causes damage to the walls of a blood vessel which in turn allows blood cells to leak out of these vessels. This can lead to skin lesions of the feet and lower legs which typically involve both extremities and may be severely painful.

One important thing to keep in mind about vasculitis is that different conditions can present with a variety of different symptoms. Some diseases will involve painful blistering or ulceration of the skin while others will result in skin color changes, pain with walking, or nail pathology. Besides immune system malfunctions, other causes of vasculitis include infections, various types of cancer, and drug reactions. Similarly, the long-term and systemic prognoses of these diseases can vary widely. If left unchecked, some of these disorders may go on to cause blindness or other severe outcomes.

Unfortunately, it isn’t possible to discuss each of the different vasculitis conditions here. However, if you would like a professional opinion, an appointment with your local Chandler podiatrist is certainly worth your while. He can perform several simple exams and help to sort out the possibilities in order to differentiate your symptoms from other possible skin or blood vessel disorders. Ultimately, he may recommend a biopsy to confirm the diagnosis before deciding on the appropriate therapy.

While vasculitis may seem like merely an irritating rash of the feet or lower legs, in reality it is a systemic disease which can affect your joints, nerves, heart, lungs, kidneys, or GI tract. Therefore, early screening and detection is very important. The symptoms of the lower extremity may be just the tip of the iceberg.

Arch Enemy

Dr. Kuvent — Wed, 17 Mar 2010 16:33:48 +0000

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.

What a Pain in the Arch!

A Foot Nerve’ous Breakdown

Dr. Kuvent — Wed, 28 Oct 2009 06:05:44 +0000

If you’ve ever walked barefoot across a gravel parking lot, you’re probably well-aware that human feet are very sensitive structures. That’s a good thing because it allows our feet to move and adjust to potentially damaging objects on the ground-such as a sharp stone or a piece of glass. Normally, we are able to avoid such objects with ease and protect ourselves from cuts, infections, and other risks. However, the greatest threat to our feet is more internal rather than external. It occurs when our nerves become damaged and that vital protective sensation in our feet is lost.

There are unfortunately MANY things which can lead to weakened or damaged nerves in our feet. One of the most common and well-known causes is diabetes. As individuals lose control of their blood sugars, the nerves particularly in the feet tend to become damaged and insensitive. Other metabolic issues such as B-vitamin deficiencies, alcoholism, and various toxins such as heavy metals can also lead to this problem. It’s pretty interesting to consider how certain health issues like Ulcerative colitis or Crohn’s disease can affect vitamin absorption to affect nerve function and indirectly the health of our feet!

Certain inherited and autoimmune disorders can also cause the feet to become insensitive. Things like Charcot-Marie-Tooth disease, Lupus, Guillain-Barre syndrome, allergic conditions, and blood disorders can all have this effect. Mechanical issues like an entrapped nerve or a spinal root problem may also be causing the problem. On top of these and other causes, the medications you are taking can also alter the nerve function in your feet. Various seizure medications, immunosuppressive agents, oral contraceptives, and tuberculosis drugs can all have this side effect.

Perhaps one of the biggest problems with nerve dysfunction to affect our feet simply occurs as we age. Often times, visual changes in combination with insensitive feet make it extraordinarily difficult for individuals to monitor the ground as well as the health of their feet. Believe it or not, it’s not uncommon for some people to have needles and other sharp objects lodged in their feet without them even knowing it! Not only can the individual not feel the object, but they’re also not able to see what may be a large and potentially-infected wound. This can be a huge hazard for those who live alone or do not have their feet checked regularly, as the infection can spread quickly and cause major damage.

Podiatrists have lots of experience dealing with insensitive feet. They’re able not only to closely monitor the various components of nerve degeneration, but they’re also able to check for infections, care for wounds, and determine whether a foreign body is actually lodged within the foot. Sometimes various objects show up within the foot on an X-ray which is not otherwise very obvious. If you suspect you’re having such a problem, contact your podiatrist immediately.

Bursitis Breakdown