Foot Conditions

Definition

Charcot Marie Tooth disease

Charcot-Marie-Tooth, or CMT, is inherited peripheral neuropathy and is found worldwide among all races and ethnic groups. Discovered in 1886 by three physicians, Jean-Martin Charcot, Pierre Marie, and Howard Henry Tooth, CMT affects an estimated 2.6 million people.

CMT usually isn’t life-threatening and almost never affects brain function. It is not contagious, but it is hereditary and can be passed down from one generation to the next.

CMT patients slowly lose normal use of their extremities as nerves degenerate and muscles weaken because the affected nerves no longer stimulate the muscles. Many patients also have some loss of sensory nerve functions.

Symptoms

 

Although there are many different genetic causes of CMT, all types tend to have remarkably similar symptoms.

  • A high arched foot is generally one of the first signs of this disorder, although in some instances extremely flat feet are also typical of CMT.
  • As the disease progresses, structural foot deformities take place. The patient may develop a pes cavus (high-arched) foot and hammertoes.


  • The progressive muscle wasting of CMT also leads to problems with walking, running, and balance. Ankle weakness and sprains are common, and many patients develop foot drop.
  • Later in the course of the disease, hand function may become affected. Tasks requiring manual dexterity become difficult. The loss of nerve function is often accompanied by tingling and burning sensations in the hands and feet. This usually causes little more than mild discomfort, but some people experience severe neuropathic pain and require medication to control it.
  • Weakness of the respiratory muscles is in rare in people with CMT, but when present, it can cause life-threatening problems. If shortness of breath is an issue, a patient should be checked by a respiratory specialist to see if the use of a ventilator is recommended. 


It is important to note that the severity of symptoms can vary greatly from patient to patient, even within the same family. A child may or may not be more severely disabled than his/her parent. Some family members may experience significant impairment and require bracing while others have no noticeable symptoms but are found to have CMT upon examination by EMG or nerve conduction studies.

Treatment and Prevention

Although there is no cure for CMT at the present time, there are many therapies that can greatly improve life and function for CMT patients.

  • Physical therapy can maintain what movement, muscle strength and flexibility they have.
  • Many people benefit from occupational therapy which helps people accomplish the tasks of daily living with the use of assistive devices.
  • Bracing is another non-invasive form of correcting problems caused by CMT. Often gait abnormalities can be corrected by the use of either articulated (hinged) or unarticulated, molded braces called AFOs (ankle-foot orthoses). These braces help control foot drop and ankle instability and often provide a better sense of balance for patients.
  • Appropriate footwear is important for people with CMT, but they often have difficulty finding well-fitting shoes because of their high arched feet and hammered toes. Falls can generally be avoided by watching where one walks and by wearing appropriate footwear.
  • It is important for CMT patients to control their weight. Not only does extra weight make physical activity more difficult, but it also increases the stress on already compromised joints and muscles.
  • Patients should try to maintain as much strength and flexibility as possible. Generally, patients should consult a physical therapist or physician before beginning an exercise program, and avoid strenuous activity and overwork. Moderate activity and physical exercise can be beneficial, but patients must be conscious of their physical limitations.
  • Finally, stress management is important in maintaining a healthy body.

Any disabling condition can affect the way people think and feel about themselves, but having a chronic illness like CMT, which is often unseen, places stress on individuals and often causes depression. People with CMT can suffer from low self-esteem and relationships with others can be affected. Even when a person has learned to live with CMT, the progressive nature of the disorder may bring about more loss and the grieving process can begin again.

Some patients cope successfully on their own or with the support of family and friends; others find it therapeutic to talk to a professional counselor or to participate in a support group. To find additional information about CMT, please visit the CMTA’s webiste at www.cmtausa.org.

If the problem persists, consult your doctor.

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Foot Conditions 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 patient's 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 else's 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.

If you suspect that you have toenail fungus, see your foot doctor.

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Foot Conditions The 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.

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 person's 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:

  1. 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.
     

  2. 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.
     

  3. 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.
     

  4. 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.
     

  5. 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.
     

  6. 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.
     

  7. 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.

    DO NOT cross your legs for long periods of time.
    DO NOT wear tight socks, elastic, or rubber bands, or garters around your legs.
    DO NOT wear restrictive footwear or foot products. Foot products that can cut off circulation to the feet, such as products with elastic, should not be worn by diabetics.
    DO NOT smoke. Smoking reduces blood flow to your feet. If you have high blood pressure or high cholesterol, work with your health care team to lower it.
     

  8. 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.
     

  9. 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.

If the problem persists, consult your foot doctor.

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Foot Conditions 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 don't 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.

If the problem persists, consult your foot doctor.

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Foot Conditions Sesamoiditis

Definition

Sesamoiditis is a common ailment that affects the forefoot, typically in young people who engage in physical activity like running or dancing. Its most common symptom is pain in the ball-of-the-foot, especially on the medial or inner side. The term is a general description for any irritation of the sesamoid bones, which are tiny bones within the tendons that run to the big toe. Like the kneecap, the sesamoids function as a pulley, increasing the leverage of the tendons controlling the toe. Every time you push off against the toe the sesamoids are involved, and eventually they can become irritated, even fractured. Because the bones are actually within the tendons, sesamoiditis is really a kind of tendinitis - the tendons around the bones become inflamed as well.

Cause

Sesamoiditis typically can be distinguished from other forefoot conditions by its gradual onset. The pain usually begins as a mild ache and increases gradually as the aggravating activity is continued. It may build to an intense throbbing. In most cases there is little or no bruising or redness. One of the major causes of sesamoiditis is increased activity. You've probably stepped up your activity level lately, which has forced you to put more pressure on the balls of your feet. Speedwork, hillwork, or even increased mileage can cause this. If you have a bony foot, you simply may not have enough fat on your foot to protect your tender sesamoids. Also, if you have a high arched foot, you will naturally run on the balls-of-your-feet, adding even more pressure.

Treatment and Prevention

Treatment for sesamoiditis is almost always noninvasive. Minor cases call for a strict period of rest, along with the use of a modified shoe or a shoe pad to reduce pressure on the affected area. This may be accomplished by placing a metatarsal pad away from the joint so that it redistributes the pressure of weight bearing to other parts of the forefoot. In addition, the big toe may be bound with tape or athletic strapping to immobilize the joint as much as possible and allow for healing to occur. It is recommended to decrease or stop activity for awhile. This will give your sesamoids time to heal. You should apply ice to the area for 10 to 15 minutes after exercise, or after any activity that aggravates the area. As with icing, anti-inflammatories will help the swelling go down so healing can begin. While the injury is healing, women should wear flat shoes on a daily basis.

If home remedies do not work, see your doctor for a correct diagnosis.

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Pregnancy and Your Feet

Definition

Pregnancy triggers many different changes in a woman's body. Many women have common complaints throughout their pregnancy. One of these complaints, often overlooked, is foot pain. Due to the natural weight gain during pregnancy, a woman's center of gravity is completely altered. This causes a new weight-bearing stance and added pressure to the knees and feet.Two of the most common foot problems experienced by pregnant woman are over- pronation and edema. These problems can lead to pain at the heel, arch, or the ball-of-foot. Many women may also experience leg cramping and varicose veins due to weight gain. Because of this, it is important for all pregnant women to learn more about foot health during their pregnancy to help make this nine month period more comfortable for them. Two of the most common foot problems experienced by pregnant woman are over-pronation and edema. These problems can lead to pain at the heel, arch, or the ball-of-foot. Many women may also experience leg cramping and varicose veins due to weight gain. Because of this, it is important for all pregnant women to learn more about foot health during their pregnancy to help make this nine month period more comfortable for them.

Cause

Over-pronation and edema a very common foot problem experienced during pregnancy. Over-Pronation, also referred to as flat feet, is caused when a person's arch flattens out upon weight bearing and their feet roll inward when walking. This can create extreme stress or inflammation on the plantar fascia, the fibrous band of tissue that runs from the heel to the forefoot. Over-pronation can make walking very painful and can increase strain on the feet, calves and/or back. The reason many pregnant women suffer from over-pronation is the added pressure on the body as a result of weight gain. Over-pronation is also very prominent in people who have flexible, flat feet or in people who are obese. Edema, also referred to as swelling in the feet, normally occurs in the latter part of pregnancy. Edema results from the extra blood accumulated during pregnancy. The enlarging uterus puts pressure on the blood vessels in the pelvis and legs causing circulation to slow down and blood to pool in the lower extremities. The total water fluid in the body remains the same as before pregnancy, however it becomes displaced. When feet are swollen, they can become purplish in color. Sometimes extra water is retained during pregnancy, adding to the swelling. If there is swelling in the face or hands, a doctor should be contacted immediately.

Treatment and Prevention

There are effective ways to treat both over-pronation and edema during pregnancy. Over-Pronation can be treated conservatively with "ready-made" orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to correct the over-pronation. Proper fitting footwear is also very important in treating over-pronation. Choose comfortable footwear that provides extra support and shock absorption. It is important to treat over-pronation for pain relief but also to prevent other foot conditions from developing such as Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-Tib Tendonitis and/or Bunions. Edema in the feet can be minimized by the following methods: Elevate your feet as often as possible. If you have to sit for long periods of time, place a small stool by your feet to elevate them. Wear proper fitting footwear. Footwear that is too narrow or short will constrict circulation. Have your feet measured several times throughout your pregnancy. They will probably change sizes. Wear seamless socks that do not constrict circulation. If you are driving for a long period of time, take regular breaks to stretch your legs to promote circulation. Exercise regularly to promote overall health; walking is the best exercise. Drink plenty of water to keep the body hydrated. This helps the body retain less fluid. Eat a well-balanced diet and avoid foods high in salt that can cause water retention. Swelling is normally similar in both feet. If swelling is not symmetrical in both feet, this may be a sign of a vascular problem and a doctor should be contacted immediately.

If any problems persist, consult your doctor.

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