Metatarsalgia
Metatarsalgia is a condition that refers to pain in the metatarsal bones. The metatarsals are the long bones deep in the foot just before the toes. If you are having pain on the bottom of the foot, at the “ball” area of the foot you might be experiencing this condition. Metatarsalgia, specifically refers to pain along the shaft and heads of these bones can be a symptom of several different conditions. Most commonly, pain in the metatarsals can be the sign of a “stress reaction”. This is essentially swelling within the medullary bone caused by excessive stress and load on the metatarsal. Typically, this will come before a stress fracture. Also, this condition is seen in relation to another condition called hypermobility or 1st ray insufficiency. This is a condition where the big toe joint cannot sufficiently stabilize itself during gait and body weight is transferred abnormally over the to the other metatarsals, most commonly, the 2nd and 3rd metatarsals.
Most times this condition can be treated effectively and quickly with several non-surgical options. The aim of treatment if to essentially correct the biomechanics of the foot in order to properly distribute your body weight during gait and remove excessive stress from the metatarsals. This is achieved in most cases with a custom made insert for your shoes. In the most extreme and severe cases a small surgical procedure can be most beneficial. X-rays are often very helpful to identify the focus of the faulty mechanics and make sure you do not in fact have a fracture. This condition can also be mistaken for Freigberg’s necrosis, or a Neuroma or capsulitis and only a thorough examination from your podiatrist will identify the correct diagnosis and best treatment plan.
Capsulitis
Generally speaking, this condition refers to inflammation and pain of the capsule of any joint in the body. When referring to the foot, it most commonly affects the 2nd toe metatarsal phalangeal joint. Pain will range from mild to severe and patients will most commonly state that they can no longer walk barefoot without some level of pain or discomfort. Also, the pain will increase with increased activity. In the more severe or more advanced cases, you will notice the beginning of a hammer toe and some swelling and warm at this area. This condition is most commonly a result of other conditions of the foot including 1st ray instability/hypermobility, Freigberg’s infarction, hammer toe, neuroma, plantar plate rupture/tear. X rays are needed to identify this condition. Typically, an injection of cortisone or stem cells is extremely effective in alleviating this condition, short term. A custom insert will be extremely effective for long term relief and prevention of recurrence. In the most severe cases, surgical options are available.
Neuroma
This term refers to a problem affecting a peripheral nerve. In the foot this term refers to either an entrapment of one of the nerves in the foot or in most severe cases an actual enlargement of the nerve as a result of chronic entrapment of trauma. Patient with slender feet or patient who wear narrow shoes for many years are prone to developing this condition. Symptoms will be burning, shooting, “electric shock” like feelings going down to the toes, or a feeling of a “bunched up” sock in the shoe. Ultrasound imaging and xrays are very effective in identifying in this condition and treatment will be dictated by the stage of the condition.
Achilles Tendinitis
This term refers to inflammation of the Achilles Tendon. Pain in this area of the foot and ankle can indicating a severe problem and all physical activity should be stopped immediately until you are seen and evaluated by your podiatrist. Pain in the Achilles tendon can indicate imminent tear or rupture of the tendon and chronic inflammation can lead to degeneration and scarring of the tendon which can also lead to weakness and eventually tear or rupture of the tendon. Ultrasound is very effective in evaluating the condition of the tendon. Treatment options vary based on the severity of the condition and can range from stem cell therapy to physical therapy to temporary restriction from activity to surgery in the most severe cases.
Haglund’s Disease
This term refers to a specific type of bone spur on the back of the heel bone which then digs into the Achilles Tendon. Patient will notice warmth, swelling to the area as well as a palpable bone spur or prominence. This causes severe pain when wearing shoes, especially narrow, boots. Because of this, Haglund’s disease is commonly referred to as “pump bump”. Patients with this condition will relate severe pain when wearing shoes and pain with physical activity. An X-ray will confirm this diagnosis. The most effective treatment for this condition is most often surgical. However, Dr. Pasquale Cancelliere will always exhaust all non-surgical treatment options first such as anti-inflammatory therapy, physical therapy and shoe modification.
Plantar Fasciitis
This is a common condition and potentially the most common condition causing patients to be seen by a podiatrist. This condition refers to an inflammation of the plantar fascia ligament which runs from the bottom of the heel to the metatarsal heads in the front of the foot. Pain will typically follow a specific pattern with the onset of pain being at any time the patient begins walking after a period of rest, especially in morning out of bed. Then, with a few minutes of walking, the pain will subside but then will recur after a period of rest. Several problems can result in plantar fasciitis but treatment options vary from anti-inflammatory therapy to stretching and physical therapy to cortisone injections and/or stem cell therapy which has shown to be extremely effective. Long term, a custom insert will be extremely effective in avoiding recurrence. However a thorough evaluation and xrays are needed to make sure the pain is not caused by other problems such as a stress fracture or bone cysts, nerve entrapment and tarsal tunnel syndrome and other problems which can be more serious.
Hallux Limitus/Rigidus
This term refers to a painful arthritic type process affecting the big toe joint. Patient will notice a restriction of joint range of motion, enlargement of the joint and palpable spurs or bony prominences around the area. In the early stages, patients might simply notice some swelling and warm with the pain. Left untreated this condition, like most arthritis type conditions, will progress and worsens. Early diagnosis and treatment will prevent worsening of the problem. Treatment options include, anti-inflammatory therapy, cortisone injections and stem cell therapy and very comfortable, but specific type of custom- made insert. In the most severe cases, where the joint is frozen from advanced damage or loss of the cartilage, a surgical debridement of the joint or fusion is most effective.
Hammer Toes
This condition refers to a visible “curling” of the toes. One toe can be affected of several. Initially the curling will be reducible by hand but it can progress to a permanent curling at the joint of the toes which will cause pain when wearing narrow shoes. The most effective treatment for this condition is a minimally invasive surgical procedure performed in the office under local anesthesia. The precise procedure will depend greatly on the severity of the hammer toe. Regardless, patients can ambulate immediately after the procedure.
Neuropathy
This term refers to any class of symptoms affecting the nerves of the body. In the foot, most commonly it is caused by diabetes mellitus and refers to a group of symptoms which are the result of diseased or injured nerves. Initially patients will relate symptoms of burning, tingling, “ants crawling” on feet and/or “electric shocks” in the feet. In the later or more severe stages of neuropathy patients will develop numbness or “anesthesia” of the foot. Patients will lose the ability to feel the bottoms of their feet. This is extremely dangerous as it can result in limb threatening consequences such as ulcers, and injury due to altered gait patterns. If you are experiencing these types of symptoms you should be seen by a podiatrist immediately and you should advise your family doctor as often times, these symptoms are the first signs of diabetes mellitus. Patient who have undergone chemotherapy or have a history of alcohol abuse can also develop neuropathy. Treatment options, depending on the root cause of the problem, range from topical creams, to customs made inserts and shoes, to medications, to dietary supplements, to surgical treatments of the nerves.
