Common Foot Problems & Causes

Arch Pain / Arch Strain

Definition
The term arch pain (often referred to as arch strain) refers to an inflammation and/or burning sensation at the arch of the foot.

Cause
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 a common condition called plantar fasciitis.

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 may develop, known as a heel spur. It is important to treat the condition promptly before it worsens.

Treatment and Prevention
This is a common foot condition that can be easily treated. If you suffer from arch pain avoid high-heeled shoes whenever possible. Try to 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.

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Arthritis

Definition
Arthritis is a disease characterized by the inflammation of the cartilage and lining of the bodys joints. Inflammation causes redness, warmth, pain and swelling. There are about 40 million Americans who suffer from arthritis. The National Institute of Arthritis and Musculoskeletal and Skin Diseases, estimates that by the year 2020, about 60 million Americans will have arthritis. The primary targets for arthritis are 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 type is called osteoarthritis. Osteoarthritis causes excessive strain and the wearing away of cartilage in the joints of the foot. Movement becomes very difficult and painful. The 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 gouty arthritis than women.

Rheumatoid Arthritis
Another type of arthritis is rheumatoid arthritis. It can develop at any age and there is no known cause for this condition. Rheumatoid arthritis is the most crippling form of the disease that can affect people of all ages. It 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, claw toes, and others.

Cause
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.

Forefoot problems such as hammer toes, claw toes, mallet toes, and bunions often develop as a result of arthritis, particularly Rheumatoid arthritis. Problems can also develop in the heel and ankle area due to the erosion of the involved joints.

Treatment and Prevention
Conservative treatment (non-surgical treatment) of the arthritic foot includes proper footwear, orthotics, and/or forefoot supports. Arthritic footwear should provide the following benefits:

High, wide toe box (high and wide space in the toe area) Removable insoles for fitting flexibility and the option to insert orthotics if necessary. Rocker Soles designed to facilitate ambulating (walking) and to reduce stress and pain at the ball-of-the-foot. Arthritic footwear should also accommodate swelling of the foot. Orthotics designed to provide comfort, support and extra cushioning are also recommended. Orthotics made with a material called Plastazote are often recommended because they mold to your feet to provide customized comfort. The proper footwear and orthotics will reduce pressure to provide a comfortable and healthy environment for the foot.

Forefoot supports such as gel toe caps, gel toe shields, gel toe straighteners and others can often provide relief.

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Athlete's Foot

Definition
Athletes foot is a fungal infection that causes red, dry, flaking skin, sometimes accompanied by pain or itching. The condition usually occurs between the toes or on the soles or sides of the feet. In its acute stage, the infected foot exhibits blisters that itch or weep. Athletes Foot can spread to the toenails, causing chronic fungal infections. Often when a patient thinks the feet are only dry and cracking, Athletes Foot is responsible for the problem.

Cause
Fungal infections like Athletes Foot are often contracted in showers, gyms, dressing rooms, swimming pool lockers, or other warm, damp areas where fungus can thrive. The name of the condition comes from the fact that athletes spend the most time in these environments and therefore are at a higher risk of fungal infection.

Once fungal spores are present on the feet, they can enter fissures or sores and remain there to spread, unless the feet are carefully washed and thoroughly dried after exposure.

Athletes Foot can spread from the toes to the toenails. If the patient touches or scratches the infection and then touches other parts of the body, the fungus can spread to fingernails or other parts of the body, including the groin or underarms.

Like any foot condition, Athletes Foot is of special concern to people with diabetes and compromised immune systems who are more susceptible to developing infections that can lead to serious medical problems.

Treatment and Prevention
Vigilant foot hygiene can prevent Athletes Foot. Daily washing of the feet with soap and water followed by thorough drying, especially between the toes, is important. Wearing dry, airy shoes and socks, not borrowing footwear from others, avoiding tight hosiery and using foot powder all help to keep the feet dry and infection-free. When using public showers or pool areas it is a good idea to wear protective shoes.

Once an infection has occurred, it is important to see a doctor, have the problem diagnosed correctly, and treat it promptly. Fungal infections can be stubborn and difficult to treat, and can become chronic. Treatment plans include prescription antifungal medications, either topical or oral, and continued attention to keeping the feet clean and dry.

Continue to consult with your foot doctor until the problem is eradicated.

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Bunions

Definition
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 called 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 which some individuals experience 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.

Cause
Bunions are a common problem experienced mostly by women. The deformity can develop from an abnormality in foot function, or arthritis, and may be exacerbated by wearing improper fitting footwear. 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 normally wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot.

It is important for men and women to realize that wearing dress shoes and boots, which are tapered in the toe area, can cause the bunion to worsen to the point where surgery is necessary.

Treatment and Prevention
In the early stages of the formation of a bunion, soaking feet in warm water can provide temporary relief. The best way to alleviate the 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 using 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 formation, relieve pain and provide a healthy environment for the foot.

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Calluses

Definition
The formation of calluses is caused by an accumulation of dead skin cells that harden and thicken over an area of the foot. This callus formation isthe 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 particular type of callus can be especially painful to pressure. This condition is often referred to as Intractable Plantar Keratosis.

Cause
Calluses develop becuase 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.

Treatment and Prevention
Many people try to alleviate the pain caused by calluses by cutting or trimming them with a razor blade or knife. This is not the way to properly treat calluses. This 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 with 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 steer away from wearing high-heeled shoes.

As always, surgery should be the very last resort.

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Corns

Definition
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 a very common ailment 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.

Cause
Some of the common causes of corn development are tight fitting footwear, high heeled footwear, tight fitting stockings and socks, deformed toes, or the foot sliding forward in a shoe that fits too loosely. 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 the development of an ulcer.

Treatment and Prevention
There are very simple ways to prevent and treat the corns. You should 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. Also avoid tight socks and stockings to provide a healthier environment for the foot.

Try to steer away from corn removing solutions and medicated pads. These solutions can sometimes increase irritation and discomfort. Diabetics and all other individuals with poor circulation should never use any chemical agents to remove corns.

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Diabetic Foot

Definition
Diabetes is a serious disease that can develop from lack of insulin production in the body or due to the inability of the body's insulin to perform its normal everyday functions. Insulin is a substance produced by the pancreas gland that helps process the food we eat and turn it into energy.

Diabetes affects approximately 16 million Americans and is classified into 2 different types: Type 1 and Type 2. Type 1 is usually associated with juvenile diabetes and is often linked to heredity. Type 2, commonly referred to as adult onset diabetes, is characterized by elevated blood sugars, often in people who are overweight or have not attended to their diet properly.

Many complications can be associated with diabetes. Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs, and feet. People with diabetes should pay special attention to their feet.

Cause
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 a loss of ability to feel pain, heat, and cold. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the 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 very important 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 risks of serious foot conditions.

Poor Circulation
Diabetes often leads to peripheral vascular disease that inhibits a persons 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 swelling and 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.

Treatment and Prevention
Footwear and orthotics play an important role in diabetic footcare. Orthotics designed with Plastazote foam, the #1 material for protecting the insensitive diabetic foot, are usually recommended. Plastazote is a material designed to accommodate pressure hot spots by conforming to heat and pressure. By customizing to the foot, Plastazote provides the comfort and protection needed in diabetic footcare. Footwear constructed with Plastazote is also recommended frequently for the diabetic patient. Diabetic footwear should also provide the following protective benefits:

High, wide toe box (high and wide space in the toe area) Removable insoles for fitting flexibility and the option to insert orthotics if necessary. Rocker Soles designed to reduce pressure in the areas of the foot most susceptible to pain, most notably the ball-of-the-foot. Firm Heel Counters for support and stability.

If you are a diabetic, you should be particularly alert to any problems you may be having with your feet. 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 your foot doctor.

Footcare & Diabetes
Proper footcare is especially critical for diabetics because they 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 characteristics.

Check Your Feet Every Day
You may have foot problems that you may not be aware of. 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. You can also ask a family member to help you.

Important Reminder Be sure to call your doctor immediately if a cut, sore, blister, or bruise on your foot does not heal 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 to make sure it is not too hot. You should use a thermometer or your elbow. Dry your feet well. Be sure to dry between your toes. 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 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 foot doctor 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, and nylons with your shoes to help avoid the possibility of blisters and sores developing. Be sure to choose seamless socks that are made of materials that wick moisture away from your feet and absorb shock and shear. Socks made of these materials help keep your feet dry. Always check the insides of your shoes before putting them on. 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 bottle 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 avoid frostbite.

Keep the Blood Flowing to Your Feet
Put your feet up when you are sitting. Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to improve blood flow in your feet and legs.

If you have high blood pressure or high cholesterol, work with your health care team to lower it.

Be More Active
Ask your doctor to plan 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 or 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. Ask your doctor for proper footcare tips and for the name of your local podiatrist.

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Hammer Toes

Definition
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. 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.

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

Treatment and Prevention
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.

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Heel Fissures

Definition
Heel fissures, also known as cracked heels can be a simple cosmetic problem and a nuisance, but can also lead to serious medical problems. Heel fissures occur when the skin on the bottom, outer edge of the heel becomes hard, dry and flaky, sometimes causing deep fissures that can be painful or bleed.

Cause
Heel fissures can affect anyone, but risk factors include:

Like many foot conditions, heel fissures can become more dangerous if they go untreated and become deep or infected. This is especially dangerous for people with diabetes or compromised immune systems.

Treatment and Prevention
Moisturizing the feet regularly can prevent heel fissures. Once they occur, you can use a pumice stone daily to gently decrease the thick and flaky layer of skin. Avoid going barefoot or wearing open-backed shoes, sandals or shoes with thin soles. Shoes with strong shock absorption can help to improve the condition.

Moisturizing the feet at least twice a day and wearing socks over moisturizer while sleeping can also help.

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Heel Pain

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

Cause
There are two different categories of heel pain. The first is caused by over-use repetitive stress which refers to 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. The pain will gradually subside as the day progresses.

Treatment and Prevention
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.

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Heel Spurs

Definition
The heel bone is the largest bone in the foot and absorbs the most amount of 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.

Cause
Heel spurs develop 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 types of footwear often worn on a regular basis.

Treatment and Prevention
The key for the proper treatment of heel spurs 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.

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 experienced from everyday activities.

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Ingrown Toenails

Definition
Known to physicians as onychocryptosis, ingrown toe nails 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, an uncomfortable sensation of warmth, as well as swelling can result from an ingrown toenail.

Cause
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 nails.

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 and 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.

Treatment and Prevention
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:

Cutting toe nails properly goes a long way toward the prevention of ingrown toenails. Using a safety nail clipper, cut the nails straight across, so that the nail corner is visible. If you cut the nail too short, you are inviting the nail corner to 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.

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Metatarsalgia

Definition
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 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head (near the big toe).

Cause
With this common foot condition, one or more of the metatarsal heads 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 womens 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 can 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 get older, the fat pad in our foot tends to thin out, making us much more susceptible to pain in the ball-of-the-foot.

Treatment and Prevention
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 with proper footwear, you should experience significant relief.

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Shin Splints

Definition
Shin splints are a common lower extremity complaint, especially among runners and other athletes. They are characterized by pain in the front or inside aspect of the lower leg due to overexertion of the muscles. The pain usually develops gradually without a history of trauma, and might begin as a dull ache along the front or inside of the shin (Tibia) after running or even walking. Small bumps and tender areas may become evident adjacent to the shin bone. The pain can become more intense if not addressed, and shin splints should not be left untreated because of an increased risk of developing stress fractures.

Shin splints usually involve small tears in the leg muscles where they are attached to the shin bone. The two types of shin splints are: anterior shin splints, in the front portion of the tibia; and posterior shin splints, occurring on the inside of the leg along the tibia.

Cause
Shin splints can be caused when the anterior leg muscles are stressed by running, especially on hard surfaces or extensively on the toes, or by sports that involve jumping. Wearing athletic shoes that are worn out or dont have enough shock absorption can also cause this condition. Over-pronated (flat feet) are another factor that can lead to increased stress on the lower leg muscles during exercise. People with high arched feet can also experience shin splint discomfort because this foot type is a poor shock absorber.

Treatment and Prevention
The best way to prevent shin splints is to stretch and strengthen the leg muscles, wear footwear with good shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball-of-the-foot. Insoles or orthotics that offer arch support for over-pronation are also important.

Treatment for shin splints should include taking a break from the exercise that is causing the problem until pain subsides. Icing the area immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Another option is taking aspirin or ibuprofen to relieve pain and reduce inflammation.

It is important not to try to train through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics that support the foot and correct over-pronation. In more severe cases, ice massage, electrostimuli, heat treatments and ultra-sound might be used.

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Toenail Fungus

Definition
Toenail fungus, known by physicians as Onychomycosis, affects about half of Americans by the age of 70. It is relatively rare in children, but the incidence increases with age. Fungus infections occur when microscopic fungi gain entry through a small trauma in the nail, then grow and spread in the warm, moist environment inside the patients socks and shoes.

Symptoms of toenail fungus, which can be caused by several types of fungi, include swelling, yellowing, thickening or crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. Toenail color can vary from brown or yellow to white with this condition.

Fungal infections can affect the fingernails as well as the toenails, but toenail fungus is more difficult to treat because toenails grow more slowly. It occurs most often on the big or small toe, but might occur on any toe.

Cause
Toenail fungus can be picked up in damp areas such as public gyms, shower stalls or swimming pools, and can be passed among family members. Athletes and people who wear tight-fitting shoes or tight hosiery that cause trauma to the toes or keep the feet from drying out are at higher risk. The condition can also spread from one toe to another, or to other parts of the body.

Other risk factors include abnormal PH level of the skin, not drying off the feet thoroughly after bathing or exercise, and a compromised immune system in someone who has been exposed to a fungus. Diabetics have an increased risk of contracting a toenail fungus because their immune system is compromised. They should have their nails cut and debrided by a podiatrist.

Treatment and Prevention
Because it is difficult to treat or eradicate toenail fungus, it is a good idea to try to prevent it. It helps to wear protective shoes or sandals in public showers, pool areas and gyms, and to avoid borrowing someone elses shoes or sharing socks or towels with someone who has toenail fungus. An orthotic device can be used to add cushioning and/or control over-pronation, support the longitudinal arch, and reduce stress on the lower leg muscles.

Wash your feet regularly, and dry them thoroughly when they get wet. Wearing nail polish on the toes is not advised because it can seal in fungus and allow it to grow. Keep toenails trimmed, and be sure to disinfect any pedicure tools before using them.

If you do develop toenail fungus, see your foot doctor. The doctor might remove as much of the nail as possible by trimming, filing or dissolving it. Medicated nail polish might be prescribed for a localized infection, but a serious infection will likely be treated with a prescription oral antifungal medication. These medications can have side effects, so be sure to work closely with your doctor on your treatment plan. Only in severe cases will surgical removal of the nail be recommended.

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