Gout is a disorder that results from the build-up of uric acid in the tissues or a joint. It most often affects the joint of the big toe. Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is farthest from the heart, it’s also the coolest part of the body – and, thus, the most likely target of gout. However, gout can affect any joint in the body.

The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. An attack of gout can be miserable, marked by the following symptoms:

• Intense pain that comes on suddenly – often in the middle of the night or upon arising
• Signs of inflammation such as redness, swelling, and warmth over the joint.

If you believe you might be suffering from Gout the best way to diagnose gout is to call an Advanced Foot and Ankle doctor near you! The doctor will ask questions about your personal and family medical history, followed by an examination of the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.

Hammertoe is a bending of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop. A hammertoe can start out mild but progress over time. Because of the progressive nature of hammertoes, they should receive early attention.

Hammertoes never get better without some kind of intervention. If untreated, a hammertoe in a more mature state will not respond to non-surgical treatment. It is important to see an Advanced Foot and Ankle specialist near you as soon as possible, if you believe that you are affected with a hammertoe!

When a toenail is ingrown, it is curved and grows into the skin, usually on the edges of the nail. This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment. A bunion is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.” Symptoms usually appear at later stages, although some people never have symptoms.

Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called “hallux limitus.”

But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus,” in which the big toe becomes stiff, or what is sometimes called a “frozen joint.”

Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.

Charcot foot is a very serious condition that can lead to severe deformity, disability, and even amputation. Because of its seriousness, it is important that patients with diabetes, a disease often associated with neuropathy, take preventive measures and seek immediate care if signs or symptoms appear.

A ganglion cyst is a sac filled with a jellylike fluid that originates from a tendon sheath or joint capsule. The word “ganglion” means “knot” and is used to describe the knot-like mass or lump that forms below the surface of the skin. Ganglion cysts are among the most common benign soft-tissue masses. Although they most often occur on the wrist, they also frequently develop on the foot – usually on the top, but elsewhere as well. Ganglion cysts vary in size, may get smaller and larger, and may even disappear completely, only to return later.

To diagnose a ganglion cyst, your local Advanced Foot and Ankle doctor will

perform a thorough examination of the foot. The lump will be visually apparent and, when pressed in a certain way, it should move freely underneath the skin. Sometimes the surgeon will shine a light through the cyst or remove a small amount of fluid from the cyst for evaluation. Your doctor may take an x-ray, and in some cases additional imaging studies may be ordered.

The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. This is important for maintaining proper alignment and strength of the joint. Injuries to the Lisfranc joint most commonly occur in automobile accident victims, military personnel, runners, horseback riders, football players and participants of other contact sports, or something as simple as missing a step on a staircase.

Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot.

Lisfranc injuries are sometimes mistaken for ankle sprains, making the diagnostic process very important. To arrive at a diagnosis, your Advanced Foot and Ankle professional will ask questions about how the injury occurred and will examine the foot to determine the severity of the injury. X-rays and other imaging studies may be necessary to fully evaluate the extent of the injury.

A fracture is a partial or complete break in a bone. Fractures in the ankle can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering- type breaks of the tibia, fibula, or both.

Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.

Following an ankle injury it is important to have the ankle evaluated by your Advanced Foot and Ankle doctor for a proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with your AFA doctor as soon as possible for a more thorough assessment.

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. In the ankle joint, ligaments provide stability by limiting side-to-side movement.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved.

Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface. Sometimes ankle sprains occur because of a person is born with weak ankles. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.

In evaluating your injury, your Advanced Foot and Ankle professional will obtain a thorough history of your symptoms and examine your foot. X-rays or other advanced imaging studies may be ordered to help determine the severity of the injury.

A wart is a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot.

Plantar warts most commonly occur in children, adolescents, and the elderly.

There are two types of plantar warts:

• A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional “satellite” warts.
• Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.

The symptoms of a plantar wart may include:

• Thickened skin - Often a plantar wart resembles a callus because of its tough, thick tissue.
• Pain - Walking and standing may be painful. Squeezing the sides of the wart may also cause pain.
• Tiny black dots - These often appear on the surface of the wart. The dots are actually dried blood contained in the capillaries (tiny blood vessels)

Plantar warts grow deep into the skin. Usually this growth occurs slowly, with the wart starting small and becoming larger over time.

To diagnose a plantar wart, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a wart.

Although plantar warts may eventually clear up on their own, most patients desire faster relief. The goal of treatment is to completely remove the wart.

The foot and ankle surgeon may use topical or oral treatments, laser therapy, cryotherapy (freezing), acid treatments, or surgery to remove the wart.

Puncture wounds are not the same as cuts. A puncture wound has a small entry hole caused by a pointed object, such as a nail that you’ve stepped on. In contrast, a cut is an open wound that produces a long tear in the skin. Puncture wounds require different treatment from cuts because these small holes in the skin can disguise serious injury.

There are different ways of determining the severity of a puncture wound. Depth of the wound is one way to evaluate it. The deeper the puncture, the more likely it is that complications such as infection will develop. Many patients cannot judge how far their puncture extends into the foot. Therefore, if you’ve stepped on something and the skin was penetrated, seek treatment as soon as possible. A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications.

Even if you have gone to an emergency room for immediate treatment of your puncture wound, see your Advanced Foot and Ankle doctor for a thorough cleaning and careful follow-up. The sooner you do this, the better: within 24 hours after injury, if possible.

Your doctor will make sure the wound is properly cleaned and no foreign body remains. He or she may numb the area, thoroughly clean inside and outside the wound, and monitor your progress. In some cases, x-rays may be ordered to determine whether something remains in the wound or if bone damage has occurred. Antibiotics may be prescribed if necessary.

Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. This foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet.

The arch of a cavus foot will appear high even when standing. Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.

Diagnosis of cavus foot includes a review of the patient’s family history. Your Foot and Ankle doctor examines the foot, looking for a high arch and possible calluses, hammertoes, and claw toes. The foot is tested for muscle strength, and the patient’s walking pattern and coordination are observed. If a neurologic condition appears to be present, the entire limb may be examined. The surgeon may also study the pattern of wear on the patient's shoes.

Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and progresses in severity throughout the adult years. As the deformity worsens, the tendons and ligaments of the arch may stretch or tear and can become inflamed.

Symptoms, which may occur in some persons with flexible flatfoot, include:

• Pain in the heel, arch, ankle, or along the outside of the foot
• “Rolled-in” ankle (over-pronation)
• Pain along the shin bone (shin splint)
• General aching or fatigue in the foot or leg
• Low back, hip or knee pain.

In diagnosing flatfoot your Advanced Foot and Ankle doctor examines the foot and observes how it looks when you stand and sit. X-rays are usually taken to determine the severity of the disorder. If you are diagnosed with flexible flatfoot but you don’t have any symptoms, your surgeon will explain what you might expect in the future.

Calcaneal apophysitis is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone is not fully developed until at least age 14. Until then, new bone is forming at the growth plate, a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.

Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable. Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

To diagnose the cause of the child’s heel pain and rule out other more serious conditions, your Advanced Foot and Ankle doctor obtains a thorough medical history and asks questions about recent activities. Your doctor will also examine the child’s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed. Your Advanced Foot and Ankle doctor is able to distinguish between all the possibilities and determine the underlying source of your heel pain.

To arrive at a diagnosis, your doctor will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain.

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping.

Achilles tendon ruptures are most often seen typically in middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

In diagnosing an Achilles tendon rupture your Advanced Foot and Ankle specialist will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The doctor will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes.

Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. When it involves both feet, the limitation of motion is sometimes worse in one foot than in the other.

People with equinus develop ways to "compensate" for their limited ankle motion, and this often leads to other foot, leg, or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by "toe walking," while a smaller number take steps by bending abnormally at the hip or knee.

There are several possible causes for the limited range of ankle motion. Often it is due to tightness in the Achilles tendon or calf muscles. In some patients, this tightness is present at birth and sometimes it is an inherited trait. Other patients acquire the tightness from being in a cast, being on crutches, or frequently wearing high-heeled shoes. In addition, diabetes can affect the fibers of the Achilles tendon and cause tightness.

To diagnose equinus your Advanced Foot and Ankle specialist will evaluate the ankle's range of motion when the knee is flexed as well as extended. This enables the specialist to identify whether the tendon or muscle is tight and to assess whether bone is interfering with ankle motion. X-rays may also be ordered. In some cases, your Advanced Foot and Ankle specialist may refer the patient for neurologic evaluation.

Commonly referred to as “poor circulation,” Peripheral Arterial Disease (P.A.D.) is the restriction of blood flow in the arteries of the leg. When arteries become narrowed by plaque, the oxygen-rich blood flowing through the arteries cannot reach the legs and feet. The presence of P.A.D. may be an indication of more widespread arterial disease in the body that can affect the brain, causing stroke, or the heart, causing a heart attack.

To diagnose P.A.D., your Advanced Foot and Ankle doctor obtains a comprehensive medical history of the patient. Your doctor performs a lower extremity physical examination that includes evaluation of pulses, skin condition, and foot deformities to determine the patient’s risk for P.A.D. If risk factors are present, your Advanced Foot and Ankle doctor may order further tests.