Great Neck Family Foot Care

Achilles Tendon Rupture
What is the Achilles Tendon? 
A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the "heel cord," the Achilles tendon facilitates walking by helping to raise the heel off the ground.

What is an Achilles Tendon Rupture?
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 in "weekend warriors" – typically, 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.
Signs and Symptoms 
A person with a ruptured Achilles tendon may experience one or more of the following:

These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the "R.I.C.E." method should be used. This involves:

Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level. Diagnosis
In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon 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. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.

Treatment
Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. The decision of whether to proceed with surgery or non-surgical treatment is based on the severity of the rupture and the patient's health status and activity level.

Non-Surgical Treatment 

Non-surgical treatment, which is generally associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a cast, walking boot, or brace to restrict motion and allow the torn tendon to heal.

Surgery
Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient's push-off strength and improves muscle function and movement of the ankle.
Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient.
Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weightbearing. Complications such as incision-healing difficulties, re-rupture of the tendon, or nerve pain can arise after surgery.

Physical Therapy

Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle.

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Ankle Sprain
What Is an Ankle Sprain? An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue – like rubber bands – that connect one bone to another and bind the joints together. 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. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

Causes

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.

Symptoms
The symptoms of ankle sprains may include:

These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains. Instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if there is no pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain – whether it's your first or your fifth – requires prompt medical attention.

Why Prompt Medical Attention Is Needed

There are four key reasons why an ankle sprain should be promptly evaluated and treated by a foot and ankle surgeon:

Diagnosis
In evaluating your injury, the foot and ankle surgeon 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.

Non-surgical Treatment

When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins. Your foot and ankle surgeon may recommend one or more of the following treatment options:

When Is Surgery Needed?
In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. The foot and ankle surgeon will select the surgical procedure best suited for your case based on the type and severity of your injury as well as your activity level. After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see your foot and ankle surgeon during this period to ensure that your ankle heals properly and function is restored.

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Athlete's Foot (Tinea Pedis)
Athlete's foot is a skin infection caused by fungus. A fungal infection may occur on any part of the body; on the foot it is called athlete's foot, or tinea pedis. Fungus commonly attacks the feet because it thrives in a dark, moist, warm environment such as a shoe.
Fungal infections are more common in warm weather when feet tend to sweat more. Fungus thrives in damp areas such as swimming pools, showers, and locker rooms. Athletes commonly have sweaty feet and use the facilities where fungus is commonly found, thus the term "athlete's foot."
Athlete's foot usually produces itchy, dry, scaling skin. It is commonly seen on the soles of the feet and in between the toes. In advanced cases, inflammation, cracks, and blisters may form; an infection caused by bacteria can also result. The fungus can spread to other areas of the body, including toenails.

Avoiding walking barefoot combined with good foot hygiene can help reduce the spread of the fungus. Feet should be washed every day with soap and water and thoroughly dried, including between the toes. Feet should be kept as dry as possible. If your feet sweat a lot you may need to change your socks during the day. Anti-fungal powders, sprays, and/or creams are often utilized to treat athlete's foot. Your foot and ankle surgeon will recommend the best treatment for you.

Athletic Performance Evaluations
In athletics there is a greater importance on balance, support and endurance for your feet. You can improve your performance by combining the right shoe insert, socks and properly fitted shoes for every sport from golf to skiing to running. Dr. Alec Hochstein a fitness enthusiast and certified Zumba® Fitness instructor evaluates the biomechanics of your foot and ankle from this unique perspective, to ensure you reach your highest fitness potential.

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Bone Tumors in the Foot
Bone tumors are caused by an abnormal growth of cells. They may be benign (noncancerous) or malignant (cancerous). Although rare, bone tumors can occur in the foot and ankle. They can be primary (originating in the bone), or secondary (originating in another part of the body).
Symptoms of a bone tumor may include:
• Fracture from slight injury,
• Bone pain, often at night,
• Occasionally a mass or swelling in the area.

A bone tumor is first diagnosed with x-rays. Advanced imaging modalities may be used to further evaluate the tumor. Surgical removal by a foot and ankle surgeon may be required for a definitive diagnosis.

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Brachymetararsia
Brachymetatarsia is a condition in which one of the bones in the front of the foot is significantly shorter than the others. Although it may affect any of the five metatarsals, it most commonly affects the fourth metatarsal. Looking at the foot, it might appear that the fourth toe itself is shorter than the adjacent toes. Sometimes it may even appear as if the fourth toe is raised up, with the third and fifth toes touching each other below it. The condition occurs when the affected metatarsal bone fails to develop fully, or its growth plate closes prematurely. It is easily diagnosed with an x-ray.

Beyond concerns about the toe's appearance, the shortened metatarsal may not contact the ground properly or carry its share of the person's body weight, resulting in pain and discomfort. It may also change the appearance and contour of the ball of the foot, making shoe selection difficult. In some cases brachymetatarsia causes no pain or discomfort, and may be treated with careful shoe selection. In others, surgical treatment may be required.

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Bunions (Hallux Abducto Valgus)
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.

What is a Bunion? A bunion (also referred to as hallux valgus or hallux abducto valgus) 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."

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.

Causes
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.

Although wearing shoes that crowd the toes won't actually cause bunions, it sometimes makes the deformity get progressively worse. Symptoms may therefore appear sooner.

Symptoms
Symptoms, which occur at the site of the bunion, may include:

Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.

Diagnosis
Bunions are readily apparent – the prominence is visible at the base of the big toe or side of the foot. However, to fully evaluate the condition, the foot and ankle surgeon may take x-rays to determine the degree of the deformity and assess the changes that have occurred.
Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike – some bunions progress more rapidly than others. Once your surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs.

Non-Surgical Treatment

Sometimes observation of the bunion is all that's needed. To reduce the chance of damage to the joint, periodic evaluation and x-rays by your surgeon are advised. In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won't reverse the deformity itself. These include:

When Is Surgery Needed?
If non-surgical treatments fail to relieve bunion pain and when the pain of a bunion interferes with daily activities, it's time to discuss surgical options with a foot and ankle surgeon. Together you can decide if surgery is best for you. A variety of surgical procedures is available to treat bunions. The procedures are designed to remove the "bump" of bone, correct the changes in the bony structure of the foot, and correct soft tissue changes that may also have occurred. The goal of surgery is the reduction of pain.

In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

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Calcaneal Apophysitis (Sever's Disease)
What Is Calcaneal Apophysitis?
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 (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.

Calcaneal apophysitis is also called Sever's disease, although it is not a true "disease." It is the most common cause of heel pain in children, and can occur in one or both feet.

Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn't improve in this manner. In fact, walking typically makes the pain worse.

Causes

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.
Symptoms
Symptoms of calcaneal apophysitis may include:

Diagnosis
To diagnose the cause of the child's heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon 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.

Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis:

Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

Can Calcaneal Apophysitis Be Prevented?
The chances of a child developing heel pain can be reduced by:

Callus
A callus is a thickened area of skin on the foot caused by pressure and repeated rubbing, such as from a shoe or sock. The rubbing causes the skin to produce a layer of protective skin (a callus). Calluses vary in size, and can become painful.

There are a number of treatments for painful calluses. People who have calluses are cautioned against performing "bathroom surgery," as this can lead to cuts and infection. A foot and ankle surgeon can evaluate the cause of the calluses and recommend the treatment most appropriate for your condition. However, if the underlying cause of the callus is not treated or removed, the callus may return.

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Charcot Foot
What Is Charcot Foot?
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.

Causes
Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain, or trauma. Because of diminished sensation, the patient may continue to walk—making the injury worse.
People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot.

The symptoms of Charcot foot may include:

Diagnosis
Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays and other imaging studies and tests may be ordered.
Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.

Non-Surgical Treatment
It is extremely important to follow the surgeon's treatment plan for Charcot foot. Failure to do so can lead to the loss of a toe, foot, leg, or life.

Non-surgical treatment for Charcot foot consists of:

When is Surgery Needed?
In some cases, the Charcot deformity may become severe enough that surgery is necessary. The foot and ankle surgeon will determine the proper timing as well as the appropriate procedure for the individual case.

Preventive Care
The patient can play a vital role in preventing Charcot foot and its complications by following these measures:

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Chronic Pain Relief
People who experience chronic foot or ankle pain often assume it is an inevitable side effect of sports or aging and presume they're in it for the long haul. But many suffer needlessly. Certain problems—including sports-induced tendonitis, heel pain, Achilles pain and stress fractures - can be treated non-surgically with braces, casts, shoe inserts (orthotics) and physical therapy.

Despite popular belief, the vast majority of people who see a surgeon—approximately nine out of ten—don't need operations. Dr. Alec Hochstein and the staff at Great Neck Family Foot Care are experienced in targeting and relieving foot pain, so stop suffering needlessly and get back to enjoying your life.

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Cosmetic Foot Sugery
Although most qualified podiatric surgeons can perform surgery on common foot conditions, here at Great Neck Family Foot Care, we also pay special attention to the cosmetic appearance following our procedures. Our patients not only enjoy relief from painful conditions but are thrilled at the cosmetic results achieved by our experienced cosmetic foot surgeons. If you have been putting off relief from your painful foot deformity, because you are afraid you will be left with an unsightly scar, call our office and see the difference that an experienced cosmetic foot surgeon can make.

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Custom Orthotic Fabrication
Orthotics, also known as orthoses, refers to any device inserted into a shoe, ranging from felt pads to custom-made shoe inserts that correct an abnormal or irregular, walking pattern. Sometimes called arch supports, orthotics allow people to stand, walk, and run more efficiently and comfortably. While over-the-counter orthotic are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual's unique foot structure. At Great Neck Family Foot Care, we use the most advanced foot scanning capture techniques to ensure the perfect fit and function of your orthotic.

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Diabetic Limb Salvage
The most common reason diabetics are hospitalized in the United States is foot infections. I know that's hard to believe, but true. Diabetes can be dangerous and devastating to your feet. With the rising number of people being diagnosed with diabetes mellitus as well as the rising number of lower extremity amputation, it is more important then ever that a diabetic patient seek out and receive the best possible care and treatment.

Dr. Alec Hochstein and his team specialize in diabetic limb salvage. Utilizing an aggressive team approach that includes other top specialists in the field of limb salvage, Dr. Hochstein and his team have been successful in the prevention of many unneccessary limb amputations.

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Clubfoot
Clubfoot (congenital talipes equinovarus) is a deformity that is present at birth in about one in every 1,000 children. It occurs in males more often than females, and can affect one or both feet. The feet of an infant with clubfoot point down and inward. It is not painful, but must be corrected to avoid a lifetime of disability. Parents can be assured that, in most cases, clubfoot can be effectively treated if it is undertaken as early as possible. Casting of the legs and feet is usually successful, but in some cases surgery may be required.

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Compartment Syndrome
Compartment syndrome, a build-up of pressure within the tissue of the foot, is a painful condition that can result in tissue damage. Potential causes are injury (acute compartment syndrome) or exercise (exertional compartment syndrome).
When compartment syndrome occurs following an injury, immediate surgery is required to prevent damage to the nerves, blood vessels and muscles of the foot. Exercise-induced compartment syndrome is a chronic condition, and is usually not a medical emergency. It commonly occurs in seasoned athletes who perform repetitive motions while running, bicycling and swimming. Symptoms include aching, burning or cramping, and can be confused with shin splints. The symptoms are usually relieved by discontinuing the exercise.

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Corns
A "corn" is a small circular thickened lesion in the skin of the foot. It usually forms due to repeated pressure on the skin, such as the rubbing of a shoe. The name "corn" comes from its resemblance to a kernel of corn. A corn is different from a callus in that it has a central core of hard material.
People with foot deformities, such as hammertoes, often suffer from corns because the tops of the bent toes rub against the tops of shoes.
There are a number of treatment options for corns. When corns get hard enough to cause pain, a foot and ankle surgeon will recommend the treatment option most appropriate for you. However, if the underlying cause of the corn is not treated or removed, the corn may return. It is important to avoid trying to remove a corn at home or using medicated corn pads, as serious infection may occur.

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Digital Imaging
The first and most important advantage of digital x-ray technology is the elevated quality of care. The imaging range of the digital receptor in our equipment allows discovery of problems like hairline fractures that are unnoticeable with conventional film-based systems. In other words, we have a much better diagnostic tool that provides immediate and precise diagnosis. Digital radiography is also better for the environment having no disposable films and chemicals, this is another step in our office becoming "green", which ultimately leads to better health for all.

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Flexible Flatfoot
Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch. Other characteristics shared by most types of flatfoot include:

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 soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed. The term "flexible" means that while the foot is flat when standing (weight-bearing), the arch returns when not standing. Symptoms, which may occur in some persons with flexible flatfoot, include:

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Foot Odor
Foot odor is a common condition in children and adults who wear shoes on a daily basis. People with smelly feet may also suffer from sweaty feet. Most people with this condition will have sweaty and smelly feet year round, not just in the hot summer months. The odor is produced by bacteria and/or fungus that grows in the shoes and attaches to the skin. Some bacteria actually eat away the top layer of the skin, producing a foul odor. Hygiene is very important to help prevent smelly feet. Feet should be washed daily with soap and water and clean dry socks worn. Some synthetic materials used in shoes, when mixed with sweat and bacteria, can produce smelly feet. The foot and ankle surgeon will recommend one of a variety of treatments for this condition.

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Fractures of the Calcaneus (Heel Bone Fractures)
What is the Calcaneus? 
The calcaneus, also called the heel bone, is a large bone that forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint. This joint is important for normal foot function.

The calcaneus is often compared to a hard boiled egg, because it has a thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell is broken, the bone tends to collapse and become fragmented. For this reason, calcaneal fractures are severe injuries. Furthermore, if the fracture involves the joints, there is the potential for long-term consequences such as arthritis and chronic pain.
How do Calcaneal Fractures Occur?
Most calcaneal fractures are the result of a traumatic event—most commonly, falling from a height, such as a ladder, or being in an automobile accident where the heel is crushed against the floorboard. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.
Types of Calcaneal Fractures 
Fractures of the calcaneus may or may not involve the subtalar and surrounding joints. Fractures involving the joints (intra-articular fractures) are the most severe calcaneal fractures, and include damage to the cartilage (the connective tissue between two bones). The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury.

Fractures that don't involve the joint (extra-articular fractures) include:

The severity and treatment of extra-articular fractures depend on their location and size.

Signs and Symptoms
Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures.
The signs and symptoms of traumatic fractures may include:

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Fractures of the Fifth Metatarsal
What is a Fifth Metatarsal Fracture?
Fractures (breaks) are common in the fifth metatarsal – the long bone on the outside of the foot that connects to the little toe. Two types of fractures that often occur in the fifth metatarsal are:

Other types of fractures can occur in the fifth metatarsal. Examples include mid-shaft fractures, which usually result from trauma or twisting, and fractures of the metatarsal head and neck.

Symptoms
Avulsion and Jones fractures have the same signs and symptoms. These include:

Diagnosis
Anyone who has symptoms of a fifth metatarsal fracture should see a foot and ankle surgeon as soon as possible for proper diagnosis and treatment. To arrive at a diagnosis, the surgeon will ask how the injury occurred or when the pain started. The foot will be examined, with the doctor gently pressing on different areas of the foot to determine where there is pain. The surgeon will also order x-rays. Because a Jones fracture sometimes does not show up on initial x-rays, additional imaging studies may be needed.

Non-surgical Treatment
Until you are able to see a foot and ankle surgeon, the "R.I.C.E." method of care should be performed:

The foot and ankle surgeon may use one of these non-surgical options for treatment of a fifth metatarsal fracture:

When is Surgery Needed? If the injury involves a displaced bone, multiple breaks, or has failed to adequately heal, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

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Ganglion Cyst
What Is a Ganglion Cyst?
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.

Causes
Although the exact cause of ganglion cysts is unknown, they may arise from trauma – whether a single event or repetitive micro-trauma.
Symptoms
A ganglion cyst is associated with one or more of the following symptoms:

Diagnosis

To diagnose a ganglion cyst, the foot and ankle surgeon 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.

Non-Surgical Treatment

There are various options for treating a ganglion cyst on the foot:

When is Surgery Needed?
When other treatment options fail or are not appropriate, the cyst may need to be surgically removed. While the recurrence rate associated with surgery is much lower than that experienced with aspiration and injection therapy, there are nevertheless cases in which the ganglion cyst returns.

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Gangrene
Gangrene occurs when there is a lack of blood supply to tissue, depriving it of oxygen, and thereby causing death and decay of the tissue. The two types of gangrene are wet (caused by bacterial infection) and dry (no infection). Most common causes of gangrene are diabetes, arteriosclerosis, tobacco abuse, burns, and frostbite. Treatment for gangrene includes surgical removal of the dead tissue and use of antibiotics when infection is present.

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Gout
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. Causes
Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid.
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. For example, the body's ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications ("water pills"), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men as well as in women.

Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.

Symptoms
An attack of gout can be miserable, marked by the following symptoms:

Diagnosis
To diagnose gout, the foot and ankle surgeon 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.

Treatment
Initial treatment of an attack of gout typically includes the following:

The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint.

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Hammertoe
What Is Hammertoe?
Hammertoe is a contracture (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.

Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.
Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
Causes
The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.

Hammertoes may be aggravated by shoes that don't fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.

Symptoms
Common symptoms of hammertoes include:

Diagnosis

Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.

Hammertoes are progressive – they don't go away by themselves and usually they will get worse over time. However, not all cases are alike – some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

Non-surgical Treatment

There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors. A number of non-surgical measures can be undertaken:

When Is Surgery Needed?
In some cases, usually when the hammertoe has become more rigid and painful, or when an open sore has developed, surgery is needed. Often patients with hammertoe have bunions or other foot deformities corrected at the same time. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity, the number of toes involved, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

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Heel Pain (Plantar Fasciitis)
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. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain.

Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

Causes

The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one's job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.

Symptoms
The symptoms of plantar fasciitis are:

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they've been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.
In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Non-Surgical Treatment

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches:

When Is Surgery Needed?
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. Long-term Care
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

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Ingrown Toenail
What Is an Ingrown Toenail?
When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides 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.

Causes
of ingrown toenails include:

Treatment

Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if an infection is suspected, or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot, or poor circulation.
Home care:
If you don't have an infection or any of the above medical conditions, you can soak your foot in room-temperature water (adding Epsom's salt may be recommended by your doctor), and gently massage the side of the nail fold to help reduce the inflammation.
Avoid attempting "bathroom surgery." Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it's time to see a foot and ankle surgeon.

Physician care:
After examining the toe, the foot and ankle surgeon will select the treatment best suited for you. If an infection is present, an oral antibiotic may be prescribed. Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail. After applying a local anesthetic, the doctor removes part of the nail's side border. Some nails may become ingrown again, requiring removal of the nail root.
Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.

Preventing Ingrown Toenails
Many cases of ingrown toenails may be prevented by:

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Laser Nail
Laser toenail fungus treatment procedures are safe and work without discomfort, compare this to painful toenail removal surgery and leading prescription topical treatments for toenail fungus, such as Penlac, that only provide an 8% effective rate after months of treatment of fungal toenails or fingernails. Dr. Alec Hochstein and Onycholase™ Laser Nail Centers are the leading resource for laser nail fungus treatment information and providers which offer hope for those who have been suffering from toe nail fungus infections.

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Toe and Metatarsal Fractures (Broken toes)
The structure of the foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in the foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.
What Is a Fracture?
A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact, such as seriously stubbing your toe. Traumatic fractures can be displaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated).
Signs and symptoms of a traumatic fracture include:

Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. They can also be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored. They require proper medical attention to heal correctly.

Symptoms of stress fractures include:

Consequences of Improper Treatment
Some people say that "the doctor can't do anything for a broken bone in the foot." This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

Treatment of Toe Fractures
Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:

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Turf Toe
What is Turf Toe? Turf toe is a sprain of the big toe joint resulting from injury during sports activities. The injury usually results from excessive upward bending of the big toe joint. The condition can be caused from either jamming the toe, or repetitive injury when pushing off repeatedly when running or jumping. Although this injury is most commonly reported in football players, participants in soccer, basketball, wrestling, gymnastics and dance also are at risk.

Causes
The name "turf toe" comes from the fact that this injury is especially common among athletes who play on artificial turf. When playing sports on artificial turf the foot can stick to the hard surface, resulting in jamming of the big toe joint. There has also been some indication that less-supportive flexible shoes worn on artificial turf are also to blame.

Symptoms
The signs and symptoms of turf toe can include pain, swelling, and limited joint movement.
If turf toe is caused by repetitive actions that cause injury, the signs and symptoms will usually begin slowly and can gradually worsen. Turf toe can also be caused by a direct injury leading to damage of the bone beneath the cartilage. If direct injury is the cause, the signs and symptoms may begin suddenly and get worse over a 24-hour period.

Diagnosis
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. X-rays are typically ordered to rule out any broken bone. Other advanced imaging studies may also be helpful for proper diagnosis.

Treatment
Initial treatments include rest, ice, compression, and elevation. (RICE), as well as a change to less-flexible footwear. Operative treatment is reserved for individuals with severe cases and prolonged pain.

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Ulcers
Ulcers, which are open sores in the skin, occur when the outer layers of the skin are injured and the deeper tissues become exposed. They can be caused by excess pressure due to ill-fitting shoes, long periods in bed, or after an injury that breaks the skin. Ulcers are commonly seen in patients who have diabetes, neuropathy or vascular disease. Open wounds can put patients at increased risk of developing infection in the skin and bone. 

The signs and symptoms of ulcers may include drainage, odor, or red, inflamed, thickened tissue. Pain may or may not be present.
Diagnosis may include x-rays to evaluate possible bone involvement. Other advanced imaging studies may also be ordered to evaluate for vascular disease, which may affect a patient's ability to heal the wound.

Ulcers are treated by removing the unhealthy tissue and performing local wound care to assist in healing. Special shoes or padding may be used to remove excess pressure on the area. If infection is present, antibiotics will be necessary. In severe cases that involve extensive infection or are slow to heal, surgery or other advanced wound care treatments may be necessary.

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Verrucae (Wart) Removal
With Laser Wart Removal, the wait for an effective wart treatment is over. Don't waste time with smelly and expensive creams that don't work or procedures that damage the tissue surrounding your wart(s). The podiatrists at Great Neck Family Foot Care are highly experienced in the use of lasers, the most advanced treatment for wart removal.

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