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Doctors' Answers to "Frequently Asked Questions" - Foot Problems


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Black Stripes on Toes  [posted 12/11/98]
Question: I've noticed for the past several weeks both big toes have a black line down the center of each! This has been since approximately, August. HELP! This is making me nervous and HMO won't let me see anyone till NOV

Answer: Probably, no big deal, but needs to be checked to exclude melanoma.

Possible Tendonitis [posted 12/09/98]
Question: I have a broken bone under my big toe. On Monday my doctor injected it with cortisone. Is this a usual treatment? Will it delay the healing? Thank you.

Answer: No, but there is also no bone under your big toe? Is he/she treating tendonitis?

Morton's Neuromas [posted 10/21/98]
Question: Years ago my mother had a Morton's Neuroma on her one foot which was successfully cured by surgery. Now, at age 70, she has incredible ankle pain in her other foot with spreading toes. This ankle has been x-rayed and no fractures or dislocations were found. Can Morton's Neuroma cause severe ankle pain. Should she see a podiatrist or orthopedist for this problem? Thankl you.

Answer: Shouldn't be the Morton's, I'd see the podiatrist.

Neuromas of the Foot [posted 10/20/98]
Question: What causes them and what are the suggested relievers of pain for this condition?

Answer: They seem to grow in certain people and there is probably a genetic predisposition. Once they cause pain, surgery is often the only answer.

Heel Pain [posted 10/20/98]
Question: Please describe treatment for a bursa (left heel, been injected twice in a year, tendon very stiff) and tendonitis in the right foot (top of foot about 3 inches above the ankle down to about half way of the foot.)

Answer: You have a problem. If anti-inflammatories and steroid injections haven't worked, then usually casting is the next step. This needs regular checks with a sports medicine specialist or arthritis specialist.

Achilles Tendon Pain [posted 10/2/98]
Question: What would cause severe pain in both achilles tendons? I have terrible pain when walking in both feet.

Answer: Usually Achille's Tendonitis. I would see a physician or podiatrist since if left untreated increased the risk for tendon rupture, a very disabling condition in these tendons.

Foot: Plantar Fascitis Treatment [posted 9/29/98]
Question: I have been diagnosed with plantar fascitis in my right foot. Treatment has included anitinflammatory over the counter drugs, steroidal injections, strapping, stretching exercises, Arthrotec, and avoiding walking as exercise on hard surfaces. I get relief for a couple of days following the injections and strapping, but the pain soon returns. My doctor has now recommended surgery. Can you please give me information on this procedure and follow-up treatment. I have asked questions of my doctor, but would like to compare notes before deciding what to do in the future.

Answer: Plantar fascitis is an inflammatory process which involves the large ligament like structure which connects your toes to your heel. This fibrous like structure is anatomically present to keep ones foot intact during the pressure of walking, running etc. However, like tendons and ligaments in other areas, can become inflammed. In general, early treatment with antiinflammatories(as has been done with you) will fix the problem. But, occasionally, surgery to remove calcium deposits(heel spurs and the like) is necessary. It should be avoided if possible, but, it sounds like you have gone the distance. Recovery is generally about a 6-8 week process, since you need to be off your feet. Crutches will usually suffice. Some think that this is as important to recovery as the surgery itself. The other risks are pretty minimal-the usual infection, etc. Ask to talk to another patient who has had the surgery for their perspective.

Heel Pain [posted 8/5/98]
Question: I'm having problems with the heel of my right foot, constantly having a sharp pain in it. Also, when I wake up in the morning, and if I sit for a while my feet begin to hurt. I'm 5'11", 234 lbs, and 32 years old.

Answer: Probably plantar fascititis. This is an inflammation of the large structure than connects your toes with your heel called the plantar fascia. This is commonly inflamed if one walks/runs in correct shoes. Ongoing inflammation can lead to a calcium deposit on the middle of the heel bone called a spur. This can usually be treated by getting heel cups in your shoes (available at any drug store) avoiding high heel shoes, and taking non-steroidal anti-inflammatory drugs like Aleve or Motrin for 10 days to 2 weeks.

Foot Pain
Question: I have an unusual pain in my left foot where my arch meets my heel and a slight reddish discoloration at the center of the pain. It started as a minor annoyance whenever I put pressure on it now it hurts whenever I walk, and the pain is now spreading to my ankle and sometimes my leg. What could this be?

Answer: It’s hard to tell, but most it is most likely plantar fasciatitis. The plantar fascia is a big membrane or ligament which connects your toes to your heel. Using the wrong type of shoes will inflame this ligament and cause pain at the point of the heel commonly causing "heel spurs". Try non- steroidal anti-inflammatory drugs for 10 days on a regular basis and heel cups (purchased at any pharmacy). Avoid high heels! If it doesn’t get better, you'll need to see your doctor.

Foot Stress
Question: I have been going to the doctor for a month because my heels were really sore. I was in a great deal of pain, but since I’ve been taking my medication of indomethacin the pain has kind of gone away. Is ice good for swollen feet?

Answer: Foot pain is a very common complaint that effects all age groups and patients with all levels of activity. Although, by far and away the most common cause is day-to-day muscular strain due to walking, climbing stairs, etc., as well as poorly fitting shoes, other possible less common causes can also produce foot pain. Of course, vigorous activity causing sprains, strains, or fractures are common in active individuals. Conditions such as gout, various forms of arthritis, vascular disease, and others, are also considered by your physician when he or she evaluates a patient with foot pain. Factors that include age, level of daily activities, other conditions you may have, and of course, the findings from a thorough physical examination, all help your physician decide what additional tests are necessary, if any, to determine what is causing your pain. Ice application, or cold packs are employed to reduce the body's natural increase in blood flow to the effected area, thereby reducing swelling. For some acute injuries, this is helpful in the short term, until the injury can be evaluated by a physician. A rule of thumb is that if an injury swells to the point of requiring ice, it should be evaluated by your health care provider. Other conditions that may cause foot pain, on the other hand, may not improve with ice, or, in some cases, may actually get worse. Later, after 24-48 hours, warm applications may actually help by increasing blood flow to the affected area, and presumably removing waste products from the injured tissue. Injuries aside, ice application to an area of pain should only be done after making arrangements to see your physician promptly.

Heel Pain
Question:

Answer: You are probably suffering from plantar lascitis. This is also called a “heel spur”. Sufficient inflammation has occurred to cause calcium deposits to form on the heel bone. There are several traditional treatments. First is avoiding walking and use of a "heel cup". This is a plastic insert (available in any drug store) to spread the force of walking across the heel rather than to one point. Second is use of non-steroidal antiinflammatory drugs(like Advil, Aleve, etc.) which should be used regularly for about one week until after the pain is gone. Occasionally steroid injection or surgery will be necessary in severe cases. Some shoes and all the better walking sneakers have heel cups built into the body of the shoe. I'd recommend you purchase and wear these rather than traditional shoes.

Swollen Heels
Question: What could be the reason why the heels of my feet swell up after long distance running?

Answer: This is due to a combination of trauma causing extravasation of fluid and the mechanical effect of gravity.

Nerve Damage
Question: About two years ago I had an operation on the bottom of my foot. During this operation, some of the nerves were severed, leaving a large part of the bottom of my foot numb. This condition has not improved since the operation. Is it possible to reattach nerves to eliminate this numbness? It is very uncomfortable to deal with.

Answer: Nerves can regrow, but very slowly. They regenerate at the rate of 1/16 inch per month or so. This is under optimum conditions. Also, even if they regenerate, the feeling will be a little different than prior to surgery. That is, you'll have feeling, but it will feel very different. Nerve grafts are possible, but rarely used due to a low success rate. I would avoid any further surgery. I suspect you may get some sensation back over the next two to three years.

Foot Problems
Question: I had an excision of cavernous haemangioma in my left sole done a half year ago. However, my toes became curved after the operation. How can I straighten them again?

Answer: Stretching exercises should do it if it can be done. There may be strictures of the tendons or tendon sheaths that will prevent any further improvement, so see a physical therapist.

Dropped Foot
Question: I have been told that I have a "dropped foot". In doing research, I can't locate any information in regards to "dropped foot". Is this a layman’s term? If so, what is the correct medical terminology? What could have caused this condition, and what could be done to alleviate this condition?

Answer: A dropped foot is actually a medical term. It refers to the weakness seen in those people with damage to the flexor muscles(or more usually the nerves to these muscles) of the foot. This leads to dropping of the foot when walking or stepping over curbs.



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