Haglund’s Deformity

Haglund’s deformity is an enlargement of bone in the back of the heel that is aggravated by shoe irritation. It occurs most commonly in women who wear pump shoes and the deformity is commonly known as the”pump bump”.

Symptoms of the deformity include:

• a reddened spot on the back of the heel
• a noticeable bump on the back of the heel
• swelling (bursitis)
• Achilles tendinitis

Haglund’s deformity affects people with high arched feet or people with tight calf muscles that put stress on the Achilles tendon. People with high arched feet have a heel bone the tilt backwards(like the heel position while coming down a ladder). This places strain on the Achilles tendon.  The irritation and strain of the upturned heel bone against the tendon begins to form the bony prominence we call Haglund’s deformity.   There are also two bursa sacs (fluid filled sacs) in this area that can become inflammed and painful.  This condition is called bursitis and is the most common source of pain associated with Haglund’s deformity.

People with high arched feet tend to walk on the outside of their foot.  Their heel bone is inverted (the ankle sprain position) and in Haglund’s deformity the bony excess tends to form on the outside corner of the heel.  If the bony prominence is located more in the midline of the heel, this could be a heel spur which is directly resultant from Achilles tendinitis or rare metabolic disorders.
An evaluation by the podiatrist should include:

• a history of the complaint, aggravating factors
• a biomechanical examination of the lower extremities
• xrays of the foot and /or ankle
• inspection of footgear

An evaluation may include:

• Diagnostic Ultrasound
• Vascular or neurologic tests
• Blood tests
• MRI, CT scan

Conservative care is used to treat the associated tendinitis and bursitis.  Only surgery can reduce the Haglund’s deformity.

Conservative care includes:

• Anti-inflammatory medicines (NSAIDs)
• Rest and Heat
• Calf stretching exercises
• Heel lifts in the shoe
• Direct padding of the area
• Wearing backless shoes or soft backed shoes
• Physical Therapy with Phonophoresis
• Orthotics
• Walking Boot

Surgery is indicated if conservative measures fail to alleviate pain or the patient has an inability to wear shoes comfortably.  Surgery is done on an outpatient basis.  The surgeon’s instructions must be closely followed. A period of non-weightbearing with crutches or knee roller may follow removal of the Haglund’s Deformity.

Dr. Marc Fink

Heel pain caused by inflammation of the fascia(muscle covering) at the bottom of the foot (plantar fasciitis) is often described as a “stone bruise” by the patient. Pain is usually worse in the morning, especially with the first several steps, or after periods of rest when first standing. As the pain worsens, the heel can hurt even while not weight-bearing.

Heel pain may be caused by many different factors ranging from something simple like abnormal mechanics to complex metabolic diseases such as arthritis. Most heel pain is related to the plantar fascia, a wide muscle covering beginning behind the toes and extending the length of the foot and partially attaching into the heel bone. Many times the patient is mistakenly diagnosed, or has additional masked pathology such as a nerve entrapment. Heel pain is believed to affect more than 2 million Americans each year, and accounts for more visits to a podiatrist than any other foot condition.In order to assure a correct diagnosis of what is actually causing heel pain syndrome, it is necessary to implement several diagnostic modalities in order to make an accurate diagnosis, and assure the best treatment outcome for the patient. These studies will sometimes include X-rays. Additional studies that may be ordered could include diagnostic musculoskeletal ultrasound, Neurosensory Testing and MRI. With the ability to accurately stage and grade the degree of plantar fasciitis, a customized treatment protocol will be selected for each individual patient. By knowing the actual degree of degeneration in the tissue of the plantar fascia, a better and faster treatment regimen can be instituted. Most cases of plantar fasciitis can be treated successfully with non-surgical intervention such as steroid injections.

If all conservative, non-surgical treatments have failed, then surgery may be indicated. The EPF technique is a minimally invasive, endoscopic technique, which releases a portion of the tight plantar fascia.  There have been more than 1 million of these procedures performed since 1990, when the technique was developed.

This new method uses an endoscope which is a small instrument that allows the surgeon to see “anatomy” inside the body-when used in joints, it is called an “arthroscope”. By using a very small incision, less than ½ inch, the procedure releases the extreme tension on the plantar fascia which is the cause of the pain in the majority of cases. All of this is viewed on the television monitor by the surgeon. The procedure itself usually takes less than 30 minutes using local anesthesia and IV sedation in an outpatient setting.  The patient is then non-weightbearing for three weeks and transitioned into a walking boot.

With the older, traditional heel spur surgery, treatment requires a large surgical incision across the inner side of the heel.A recovery period of 4-6 weeks with a gradual return to soft shoes after 3-4 weeks is normal. Often, patients miss work for many weeks and are unable to bear weight on the heel during this time. It is important to note that most heel pain can be treated effectively without surgery. Treatment may include an anti-inflammatory medication, inserts and custom orthotics to redirect the pressure off the heel.

Dr. Marc Fink

The most common form of arthritis in the foot is located to the joint behind the great toe. Normally, 90% of body weight pushes off this joint during toe off at the end of a gait cycle.  As the arthritis process continues, motion becomes more and more limited, making walking difficult and painful. In addition, a bone spur may develop on top of the joint, preventing the toe from bending upwards.

Etiology

Hallux rigidus usually occurs in adults between the ages of 30 and 60. It may result from injury to the joint cartilage or differences in foot anatomy or foot mechanics that increases pressure on the joint.

The most common cause of this condition is wear and tear on the joint resulting from years of abnormal foot function. Other causes may include previous trauma, metabolic bone diseases such as gout and inflammatory arthritic processes.

Signs and Symptoms

• Stiffness in the great toe with an inability to bend it up or down
• An enlargement, like a bunion or callous, that develops on top of the foot
• Swelling around the joint
• Pain in the joint when you are active, especially as you push-off on the toes when you walk

Diagnosis

Inability to move the big toe joint up and down without pain is the early sign of Hallux Rigidus. If diagnosed early, this can be treated with conservative care postponing or temporarily avoiding surgery.

We will examine and x-ray the foot to determine the extent of arthritis, and if there are bone spurs or loose, cartilaginous bodies within the joint.

Conservative Treatment

Pain relievers and anti-inflammatory medications may help to reduce the swelling and pain. Heat packs may also be of benefit to help reduce pain and swelling for short periods of time. Wearing a stiff soled shoe with a rocker bottom design or possibly a steel shank or metal brace in the sole may also be of benefit. An orthotic with an extension under the big toe joint, reduces the amount of bending of the joint thereby reducing pain.

When there is damage to the cartilage and conservative care has failed, surgical correction should be performed.

Surgical Treatment

• Cheilectomy  This surgery is recommended when the there is mild to moderate damage to the cartilage. The bone spurs as well as part of the joint bone are removed and smoothed out so that the toe can bend easier. The incision is made on top of the foot, a post operative shoe is worn for at least 2 weeks after surgery, and it is usually 3-4 weeks before a soft shoe may be worn. The toe may remain swollen for several months after the surgery. Most patients do experience long-term relief.
• Metatarsal OsteotomyThis procedure is recommended when there is limitation of motion and the cartilage is still in good condition.

  This procedure involves making a cut in the long metatarsal bone behind the big toe, to shorten the bone (creating more joint space ) and rotating the cartilage ( to allow more motion). The cut in the bone is fixated with 1 or 2 screws.

  The patient is in a post operative shoe for 2-3 weeks. After that time, the patient is allowed to get into a soft shoe and is sent for physical therapy to help create more flexibility in the joint. They are usually back to reasonable shoes in approximately 8-10 weeks.

• Arthroplasty (Joint Replacement )This surgery is recommended in moderate to severe damage to the cartilage. This involves removal of the damaged bone and cartilage of one or both surfaces of the joint and replacing them with a metal or plastic implant. By removing these portions of bone, the appropriate spacing of the joint is restored and allows for reduced pain and increased motion. We have found that using the new Titanium implants has shown relatively easier stability and compatibility and there no worry with regard to setting off alarms, etc. The procedure does not require a cast and patients can usually wear a surgical shoe for 2-4 weeks, then get into a softer shoe. They are sent for physical therapy to create joint motion, and then may be back to reasonable shoes in approximately 2 months.
• Arthrodesis (Fusion )This surgery is reserved for the most severe damage to the cartilage. This is where the 2 joint bones are fused together with  screws or a plate in a permanent fixed position. This procedure will prevent the toe from ever bending again, but does relieve the pain in these most severe cases.

  Most patients are in a post operative show for approximately 3 weeks. Then they are able to get into a softer shoe and after approximately 8-10 weeks may get into normal-type shoes.

Dr. Marc Fink

Morton’s Neuroma is a condition first described by Dr. Thomas Morton, a Viennese physician, in 1876. The condition is quite common. It seems to occur more frequently in women than men and is usually a result of a nerve that is irritated or pinched between the bones in the ball of the foot.

There are five metatarsal bones that comprise the ball of the foot. These are the long bones that extend back from the toes. Nerves course between these metatarsal bones on their way to providing sensation to the corresponding toes. If we count the big toe as number one, the most common area for Morton’s Neuroma to occur is between the third and fourth toe. The reason neuromas occur more frequently in this area is because it is the only area in the front of the foot where two nerves come together. Therefore, in this particular area, (between the third and fourth metatarsal), the nerve is double the size than any other metatarsal space. As the particular nerve is irritated by the heads of the two adjacent metatarsal heads, the nerve becomes irritated and inflamed and over time it may become enlarged.

Symptoms:

Walking and/or wearing tight shoes squeezes the two metatarsals together sending a painful sensation into the two affected toes. The sensation can be sharp, electric shock like, burning, pins/needles and/or numbness. Sometimes the pain is relieved by taking off the offending shoe and massaging the ball of the foot.

Diagnosis:

The diagnosis of Morton’s Neuroma is made by performing a simple test. The doctor will gently squeeze the foot from side to side and use a thumb to push up between the metatarsal heads. In advanced cases of Morton’s Neuroma, there will be a snap or clicking sensation felt in the area .This is called a Mulder’s Sign. The Mulder’s Sign mimics what takes place in the shoe with every step. Squeezing the foot simulates the shoe and pushing up on the bottom of the foot simulates the reactive forces of the ground as it pushes against the foot with each step.

Treatment: 

Approximately seventy five percent of Morton’s Neuromas can be effectively treated with conservative therapy. This includes better fitting shoes, pads that separate the affected metatarsal bones, prescription orthotics, and/or cortisone injections. While conservative treatment sometimes relieves the symptoms, some patients require surgical intervention. The most common surgical procedure for correcting Morton’s neuroma has been to perform a neurectomy. This consists of an incision, retraction of the metatarsal bones, and removal of the enlarged nerve. This surgery is quite successful and patients usually are up and about with minimal disability.

The New Technique:

Instratek^® Edintrak II^™ is designed for endoscopic decompression of the intermetatarsal nerve, commonly referred to as “Morton’s Neuroma”. Endoscopic neurolysis has superior efficacy without the serious potential complication of amputation neuroma (Recurrent Morton’s Neuroma). This minimally invasive technique allows for faster recovery when compared with open techniques.Edintrak II^™ endoscopically divides the transverse intermetatarsal ligament (TIML) of the 2nd and 3rd web space decompressing the nerve. Our system includes procedure specific endoscopic instrumentation providing atraumatic insertion of the oval cannula under the TIML from the digital web space through a uni-portal approach. This provides protection of the plantar neurovascular structures while allowing endoscopic visualization and complete division of the TIML.

The procedure takes under thirty minutes and patients walk immediately afterwards.  There is minimal, if any, post operative pain. I have been trained to utilize this new technique and am now able to use this to aid patients return to their normal lifestyle with less pain.

More information on this technique can be found below:

EDINII_Surgical-Technique

Dr. Marc Fink

Quick recovery and minimal discomfort are among the benefits of many of the newer, less invasive surgical techniques used in foot and ankle surgery today. Physical therapy sometimes can speed up the recovery of the surgical process. There are many different physical therapy modalities that are available. Immediately after surgery, physical therapy protocols are established such as the application of cold packs plus the elevation of the effected areas. Sometimes modalities such as passive range of motion, ultrasound, TENS(transcutaneous electrical nerve stimulation) and many others are utilized. A TENS unit is a battery operated device typically housed in a small box, with attached electrodes. When placed on the feet, the electrodes can safely deliver electrical impulses that both ease discomfort and stimulate healing.

Podiatrists are physicians trained to use the latest in techniques and equipment to keep feet and ankles healthy and working well. We use a wide range of therapies and surgeries to treat conditions related to foot and ankle structure and function. We can also teach you how to avoid foot problems in the future. Is foot surgery part of your treatment plan? At Family Foot and Ankle Care we will do our best to have you comfortable and back on your feet in the shortest amount of time.

Dr. Marc Fink

P.S. Discomfort is usually greatest two or three days after foot and ankle surgery.

If there is one thing that everyone in the national debate on health care would probably agree on, it is that it is all terribly complicated. Medicare rules and regulations are just one part of the picture, but for many older Americans in particular, they are often the most confused about what is covered. For example, not all patients can qualify for routine foot care such as nail debridement and the shaving of corns and callouses. A patient’s primary care physician must qualify the patient based on certain diagnosis to receive this care under Medicare. Other services though, are covered such as bunions, foot and ankle sprains, circulation issues and arthritis care. Medicare will cover a wide range of podiatric services. Nothing these days are simple, but do not neglect foot care because of uncertainty about insurance or Medicare coverage.

If you have questions about Medicare coverage for foot and ankle problems, please do not put off calling us. We do not want you to ignore foot and ankle pain and problems in the hopes that they will go away and you will not have to face the prospect of costly medical bills. Actually taking care of the small problems can prevent most of the big ones from even occurring at all,cutting down on costs for everyone. For complete foot and ankle care call Family Foot and Ankle Care at 757-547-3668!

Dr. Marc Fink

P.S. A podiatrist is a doctor who cares for the foot and ankle, and is able to prescribe medications and perform surgery

How can you get rid of those hard little spots that occur on the bottom, or “plantar” area of the foot? Your doctor may offer a number of choices. Chemical removal involves a series of treatments with caustic agents to destroy warts. In surgical curretage, a small scoop, or “currette” separates the wart from the foot, often followed by cauterization to discourage regrowth. In addition to traditional surgery (removal by incision, closure with stitches), laser surgery uses high-frequency laser light to destroy wart cells by vaporizing their moisture; cryosurgery calls for a liquid nitrogen and carbon dioxide to destroy the tissue. Surgical galvanism, or electrolysis uses electrical current for wart removal.

Warts! Nobody wants them and, luckily, they are usually not that hard to get rid of. But, as an infection caused by a virus, warts almost never go away on their own, and you would be smart to have your podiatrist get rid of yours once you discover one on your feet. We can deal with all kinds of foot and ankle problems including warts, bunions, sports injuries, circulation disorders, skin conditions and more. Could your feet benefit from professional care? Call us at Family Foot and Ankle Care for all your foot and ankle needs.

Dr. Marc Fink

P.S.Although plantar warts are most common on the bottom of the feet, they can also appear on the top and sides of the feet.

One of the longest running myths about foot care is that ingrown toenails are self-treatable. Just angle or cut down the corners of your toenails and they will not have a chance to become ingrown-or so the story goes. Unfortunately, that myth is in fact just a myth, a false notion. One of the worst things you can do in an attempt to either prevent or treat ingrown toenails is to cut down the corners. The reason is that toenails grow out from the matrix, inside the toe. A nail becomes ingrown when the tissue surrounding it closes in on the sides of the nail, making it appear that the nail is growing out of the flesh. Ingrown nails require professional care. Left untreated, pain and infection are likely to result.

Do you have a painful or unsightly nail problem? Do not hide behind these five dangerous words-“maybe it will go away”. Nail problems are common complaints, but most do not just disappear on their own. Your podiatrist can can treat them effectively with medication,surgical procedures, and routine podiatric care, such as nail debridements.
Do not take your feet for granted-call us at Family Foot and Ankle Care.
Patients tell us all the time-we are good and we stop the pain!

Dr. Marc Fink

P.S. Routine diabetic foot examinations can prevent ingrown toenails with periodic nail debridements.

Next time you develop a hard, painful, corn, treat it with tenderness. After all,corns are usually just the feet’s way if trying to protect themselves from such abuses as the friction of poorly fitting shoes or misaligned toes. A corn starts to form when persistent friction causes the blood supply to increase to a given spot on the foot. This speeds up the production of corn cells, which then multiply to form a protective shield against the friction. Over time, a hard central core forms inside the corn, killing the healthy cells below in a cone shape. The larger the corn, the deeper the point of this hard cone extends into the foot. Treatment may range from changing footwear to surgical removal.

Painful corns have probably caused more foot pain and misery than any other single problem. And since life is complicated enough without having to contend with problems that can be corrected, professional advice from a podiatist, someone who has been specially trained to care for feet and ankles and their particular problems, is your best defense. We are on your side here at Family Foot and Ankle Care, whether you are dealing with corns, callouses, hammertoes, nail disorders,sports injuries,bunions or arthritis.

Dr. Marc Fink

P.S. Never try to to trim a corn’s hard tissue yourself. It is too easy to cut normal tissue, inviting infection.

What is a classic picture of relief? Relaxing in a comfy chair, a soothing cup of tea, or warm milk in hand, feet plunged into a tub of water. The fact is, foot soaks can be beneficial to tired feet, as well as an important part of therapy for painful conditions such as arthritis. Warm whirlpool baths can gently massage sore joints and muscles, even speed healing. There are several precautions that must be observed, however. The water should be between 93 to 102 degrees(lower if the whole body is submerged), and gentle foot exercises should be done during the soak to prevent pooling of blood and swelling. Also, take care that circulation is not cut off by tightly rolled-up pant legs or the edge of the tub.

Most people suffer from some kind of foot or ankle disorder-from athlete’s foot or ingrown toenails to bunions,hammartoes or corns. Tight-fitting or high-heeled shoes are often the culprits, but heredity, poor foot care, injuries or medical conditions can also cause problems. Whatever the state of your feet, your podiatrist can treat your problems to restore your comfort and ease of movement, and recommend action, like foot soaks.We at Family Foot and Ankle Care can find a solution to your aching feet and ankles with numerous state of the art treatments.

Dr. Marc Fink

P.S. A solution of Epsom salts makes a great way to soak your feet and if you are diabetic just use half the recommended amount on the instructions.