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Conditions We Treat

Arthritis

Arthritis is inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis has multiple causes and is associated with many different illnesses. Symptoms include painful, swollen, and/or stiff joints. Arthritic feet can result in loss of mobility and independence, but early diagnosis and proper medical care can help significantly.

Some causes of arthritis include:

  • Injuries, particularly in athletes and industrial workers, especially if the injuries have been ignored (which injuries of the feet tend to be).
  • Through bacterial and viral infections that strike the joints. The same organisms that are present in pneumonia, gonorrhea, staph infections, and Lyme disease cause the inflammations.
  • In conjunction with bowel disorders such as colitis and ileitis, frequently resulting in arthritic conditions in the joints of the ankles and toes. Such inflammatory bowel diseases seem distant from arthritis, but treating them can relieve arthritic pain.
  • Using drugs, both prescription drugs and illegal street drugs, can induce arthritis.
  • As part of a congenital autoimmune disease syndrome of undetermined origin. Recent research has suggested, for instance, that a defective gene may play a role in osteoarthritis.

Because arthritis can affect the structure and function of the feet, it is important to see a podiatrist if any of the following symptoms occur in the feet:

  • Swelling in one or more joints
  • Recurring pain or tenderness in any joint
  • Redness or heat in a joint
  • Limitation in motion of joint
  • Early morning stiffness
  • Skin changes, including rashes and growths

Treatment Approach

Patient education and early diagnosis is important to effectively treat any form of arthritis. Damage of cartilage is not reversible, and if the inflammation of arthritic disease isn't treated, both cartilage and bone can be damaged, which makes the joints increasingly difficult to move.

Most forms of arthritis cannot be cured, but can be controlled or brought into remission. Arthritis may be treated in many ways. Physical therapy and exercise may be indicated, accompanied by medication. Aspirin is still the first-line drug of choice for most forms of arthritis. A treatment that works for one patient, may be almost no help at all to another. The control of foot functions with shoe inserts called orthotics, or with braces or specially prescribed shoes, may be recommended. Surgery is a last resort treatment option for arthritis, as it is with most disease conditions. Damaged joints can be replaced surgically with artificial joints.

Bunions

A bunion is a “bump” on the joint at the base of the big toe that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated and even making wearing shoes difficult or impossible.

Diagnosis

By simply examining the foot and watching as you move your big toe around, a doctor can usually diagnose a bunion.

Treatment Approach

Treatment options vary with the type and severity of each bunion. A podiatrist may recommend these treatments:

  • Padding and Taping: Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.
  • Medication: Anti-inflammatory drugs and cortisone injections are often prescribed to ease the pain and inflammation caused by joint deformities.
  • Physical Therapy: Often used to provide relief of the inflammation and bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
  • Orthotics: Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
  • Surgical Options: Identifying the deformity early in its development is important in avoiding surgery. When early treatments fail, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available to the podiatrist. Surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.

A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity.

Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint. Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatrist.

Diabetic Foot Ulcers

A diabetic foot ulcer is an open sore or wound that can occur in patients with diabetes and is commonly located on the bottom of the foot. Ulcers that become infected, result in most patients having to be hospitalized, increase the risk of potential lower extremity amputation and in extreme cases, may cause death.

More than 25 million people in the United States are estimated to have diabetes mellitus (DM). Of those 25 million, 15–25% will develop a diabetic foot ulcer during their lifetime.

Treatment Approach

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

Treatment of a diabetic foot ulcer includes:

  • Prevention of infection by:
    • Keeping blood glucose levels under control
    • Keeping the ulcer clean and bandaged
    • Cleansing the wound daily, using a wound dressing or bandage; and avoiding walking barefoot
  • Taking the pressure off the area, called “off-loading,”
  • Removing dead skin and tissue, called “debridement,”
  • Applying medication or dressings to the ulcer
  • Managing blood glucose and other health problems

Not all ulcers are infected; however, if your podiatrist diagnoses an infection, antibiotics, wound care, and possibly hospitalization will be necessary.

Diabetic Foot Care, Infection Management, and Amputation Prevention

Diabetic foot infections (DFI) are one of the most common diabetes-related causes of hospitalization in the United States.

Conditions of wound infection, poor circulation, nerve disease, and kidney disease frequently complicate this condition. The Podiatry Division at Boston Medical Center is a leader in diabetic wound care, amputation prevention and management. While working closely with the Vascular Division and having an active presence in every phase of emergency, inpatient, surgical, and outpatient care; the Podiatry team provides immediate response to not only limb but life threatening lower extremity wounds and infections. With decades of experience and specialized training, we are able to help preserve a functional limb. When this is not possible, we reconstruct the limb to best support the remaining function and shape to receive an orthopedic appliance/prosthesis.

Common Diabetic Services:

  • Nail, callus, corn management at regular intervals
  • Wound management
  • Reconstruction surgery, amputation prevention and management
  • Education

Foot Deformities

Most foot deformities involve an unusually flat or high arched feet with or without pain. Some patients are born with this condition or it may have been caused by an injury.

Flat Foot

Flat foot is a condition in which the entire sole of the foot touches the floor when standing. Some are born with flat fleet while others may get flat fleet from an injury. Many people have flat feet without any pain. Those with pain may experience the following symptoms:

  • Feet tire easily
  • Painful or achy feet, especially in the areas of the arches and heels
  • The inside bottom of your feet become swollen
  • Foot movement, such as standing on your toes, is difficult
  • Back and leg pain

Treating Flat Foot

Your podiatrist may recommend the following treatments for pain caused by flat feet:

  • Rest and ice to relieve pain and reduce swelling
  • Stretching exercises
  • Anti-inflammatories, such as Ibuprofen
  • Physical therapy
  • Orthotic devices, shoe modifications, braces, or casts
  • Injected medications to reduce inflammation, such as corticosteroids
  • In more severe cases, where there is a lot of pain or foot damage is, your doctor may recommend surgery.

High Arched Feet

High arch is an arch, sometimes called the, “pes cavus,” that is raised more than normal. The arch runs from the toes to the heel on the bottom of the foot. High arch is usually caused by a bone or nerve condition. Highly arched feet tend to be painful, because more stress is placed on the section of the foot between the ankle and toes.

Diagnosing High Arched Feet

When the person stands on the foot, the instep looks hollow. Most of the weight is on the back and balls of the foot (metatarsals head).

Your podiatrist will need to check to see if the high arch is flexible, meaning it can be moved around.

Tests that may be done include:

  • Electromyography
  • MRI
  • Nerve conduction studies
  • X-ray of the feet or spine
  • Treatment Options
    • High arches, especially ones that are flexible or well cared for, may not need any treatment. Corrective shoes may help relieve pain and improve walking. This includes changes to the shoes, such as an arch insert and a support insole. In severe cases, surgery to flatten the foot is sometimes needed.

Hammer Toe

A hammer toe is a bent smaller toe, sometimes swollen and painful. There are two different types:

Flexible Hammer Toes: These hammer toes are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammer toes because they are still moveable at the joint.

Rigid Hammer Toes: This variety is more developed and more serious than the flexible condition. Rigid hammer toes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammer toe have become tight, and the joint misaligned and immobile.

Diagnosis

A podiatrist can diagnose a hammertoe by physical exam and x-ray.  Both will tell the doctor how advanced the problem is and help him or her determine what treatments to try first.

Treatment Approach

Treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your doctor will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

  • Padding and Taping: Padding and taping are usually the first steps in treating hammer toes. Padding the hammer toe minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain.
  • Medication: Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the hammer toe.
  • Shoe Inserts: Custom shoe inserts, called orthotics, made by your podiatrist, may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammer toe.
  • Surgery: Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammer toes, may require more complex surgery. Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery.

Heel and Arch Pain/Plantar Fasciitis/Achilles Tendinitis

Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel (arch).

Causes of Heel Pain

  • Heel Spurs: A bony growth on the underside of the heel bone. Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from imbalance when walking, running or jogging, improperly fitted or excessively worn shoes, or obesity.
  • Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band connective tissue (fascia) that runs along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot.
  • Achilles Tendinitis: Pain at the back of the heel is associated with Achilles tendinitis. This is caused by inflammation of the Achilles tendon, which runs from behind the ankle to the back of the heel bone. It is common among people who run and walk a lot and have tight tendons.

Diagnosis

A podiatrist will diagnosis the cause of heel pain by examining the area and may perform diagnostic X-rays to rule out problems of the bone.

Treatment Approach

  • Medication: Early treatment for heel pain might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, or taping or strapping to support the foot. Physical therapy may be used in conjunction with such treatments.
  • Shoe Inserts: Custom shoe inserts, called orthotics, made by your podiatrist, will effectively treat the majority of heel and arch pain without the need for surgery.
  • Surgery: Patients with heel pain rarely require more surgery. However, if surgery is necessary, it may involve the release of the plantar fascia or other soft-tissue growth.

Injuries, Breaks, and Sprains

A foot or ankle sprain is a soft tissue injury. Most often, a sprain occurs when an injury pulls, stretches, or tears the ligaments that connect bone to bone. A fracture is actually a break in the bone. Many breaks and sprains occur during sports. Tripping or stumbling on uneven ground is another common cause of foot and ankle sprains and fractures. Symptoms of a sprained or broken foot or ankle include pain, swelling, bruising, and difficulty walking on the affected foot or ankle.

Diagnosis

A podiatrist will carefully examine your feet and ankles and take a complete medical history. He or she will also order tests, including an X-ray, ultrasound, or MRI, to determine the extent of your injury. If you have a fracture that's clearly visible on X-ray, you may not need additional testing.

Treatment Approach

Treatment will depend on your injury. If you have a broken bone, your podiatrist may attempt to “reduce” the fracture, which means lining up the ends of the bones so they can heal properly. (You'll be given a local anesthetic to numb the area first.) If the fracture is “unstable,” meaning that the ends of the bone do not stay in place after a reduction, surgery may be needed. Podiatrists can use metal plates and screws to fix broken bones.
Stress fractures are treated with rest and immobilization. You will be instructed to stay off the affected area until healing is complete. Crutches and/or a special “boot” or cast may be used to immobilize the area.

Sprains are also treated with a period of immobilization. Depending on the extent of your sprain, you may be able to resume activity fairly quickly, or you may need to wear a soft cast or special “boot” and use crutches for a period of weeks.

Professional athletes may undergo surgery to repair torn ligaments.

Oral anti-inflammatory medication, such as ibuprofen, can be used to decrease pain, swelling, and inflammation.

Neuromas

A neuroma, also called a “pinched nerve” or a nerve tumor is a non-cancerous growth of nerve tissue. It is usually found between the third and fourth toes. It brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot.

Causes of Neuromas

Different factors can contribute to the formation of a neuroma:

  • Foot deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma. These foot types bring on instability around the toe joints, leading to the development of the condition.
  • Trauma can cause damage to the nerve, resulting in inflammation or swelling of the nerve.
  • Improper footwear that causes the toes to be squeezed together is problematic. Avoid high-heeled shoes higher than two inches.
  • Repeated stress can create or aggravate a neuroma.

Diagnosis

Your podiatrist will examine and likely X-ray the affected area to suggest a treatment plan that best suits your individual case.

Treatment Approach

Treatment options vary with the severity of each neuroma. For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, additional treatment or surgery may be necessary to remove it.

  • Padding and Taping: Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma.
  • Medication: Anti-inflammatory drugs and cortisone injections can be prescribed to ease pain and inflammation caused by the neuroma.
  • Shoe Inserts: Custom shoe inserts, called, “orthotics,” made by your podiatrist may be useful in controlling foot function. Orthotics may reduce symptoms and prevent the worsening of the condition.
  • Surgery: When early treatments fail podiatric surgery may be necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Your podiatrist will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is easily managed with medications prescribed by your podiatrist.

Skin and Nail Conditions

Skin/toenail conditions include any unusual discoloration, irritation or unusual appearance. Some examples include:

  • Ingrown Nails
    • Ingrown nails are nails whose corners or sides dig painfully into the soft tissue of nail grooves, often leading to irritation, redness, and swelling. Usually, toenails grow straight out. Sometimes, however, one or both corners or sides curve and grow into the flesh. The big toe is the most common location for this condition, but it can also occur on other toes. Ingrown toenails may be caused by improperly trimmed nails, they run in your family, shoe pressure that crowds the toes, or repeated trauma to the feet from normal activities.
    • You should see a podiatrist immediately if any drainage or excessive redness is present around the toenail. Home treatments may help treat ingrown toenails. If there is no improvement after three days, see your podiatrist. If you have diabetes or poor circulation, you should seek immediate treatment at the first signs of an ingrown toenail, as it can lead to more severe complications.
  • Fungal Nails
    • Toenail fungus, or onychomycosis, is an infection underneath the surface of the nail caused by fungi. Symptoms include a progressive change in a toenail's quality and color, which is often ugly and embarrassing.
    • You should visit a podiatrist when you notice any discoloration, thickening, or deformity of your toenails. The earlier you seek professional treatment, the greater your chance at getting your nails to clear. Treatments vary, but may include an oral antifungal, a topical prescription, or surgery to remove the infected nail.
  • Warts
    • Warts are caused by a virus and can appear anywhere on the skin. Those that appear on the sole of the foot are called plantar warts.
    • Your podiatrist can remove warts by a simple surgical procedure or laser treatment, performed under local anesthetic.
  • Corns and Calluses
    • Corns and calluses are areas of thickened skin that develop to protect that area from irritation. They occur when something rubs against the foot repeatedly or causes excess pressure against part of the foot. If the thickening of skin occurs on the bottom of the foot, it's called a callus. If it occurs on the top of the foot (or toe), it's called a corn. Corns and calluses are not contagious but may become painful if they get too thick. In people with diabetes or decreased circulation, they can lead to more serious foot problems.
    • Corns and calluses are diagnosed based on appearance and history. If you have mild corns or calluses, your podiatrist may suggest changing your shoes and/or adding padding to your shoes. Larger corns and calluses are most effectively reduced (made smaller) with a surgical blade. A podiatrist can use the blade to carefully shave away the thickened, dead skin—right in the office. The procedure is painless because the skin is already dead. Additional treatments may be needed if the corn or callus recurs.
  • Skin cancer
    • Skin cancers of the feet have several features in common. Most are painless, and often there is a history of recurrent cracking, bleeding, or ulceration. Frequently, individuals discover their skin cancer after unrelated ailments near the affected site.
    • Podiatrists are uniquely trained as lower extremity specialists to recognize and treat abnormal conditions on the skin of the lower legs and feet. Skin cancers affecting the feet may have a very different appearance from those arising on the rest of the body. For this reason, a podiatrist's knowledge and clinical training is of extreme importance for patients for the early detection of both benign and malignant skin tumors.
    • Learn the ABCDs of melanoma. If you notice a mole, bump, or patch on the skin that meets any of the following criteria, see a podiatrist immediately:
      • Asymmetry - If the lesion is divided in half, the sides don't match.
      • Borders - Borders look scalloped, uneven, or ragged.
      • Color - There may be more than one color. These colors may have an uneven distribution.
      • Diameter – The lesion is wider than a pencil eraser (greater than 6 mm).
    • To detect other types of skin cancer, look for spontaneous ulcers and non-healing sores, bumps that crack or bleed, nodules with rolled or “donut-shaped” edges, or scaly areas.
  • Other conditions such as psoriasis, sweaty feet, dry skin
    • Dry Skin (Cracked Heels)
      • There are many potential causes of "cracked heels." Dry skin (xerosis) is common and can get worse if you wear open-back shoes, gain weight, or have increased friction from the back of shoes. Dry cracking skin can also be a subtle sign of more significant problems, such as diabetes or loss of nerve function (autonomic neuropathy).
      • Heels should be kept well moisturized with a cream to help reduce the cracking. If an open sore is noted, make an appointment with a podiatrist.
    • Sweaty Feet
      • Sweaty feet are a common disorder in which the sweat glands of the feet produce excessive sweat. People with this condition usually have a genetic predisposition or are under stress, which activates the brain to produce more sweat to keep the body cool. Athlete’s foot or smelly feet may accompany sweaty feet. The foot and ankle surgeon can recommend one of a variety of treatments for this condition.
    • Psoriasis
      • Psoriasis is a skin condition characterized by dry, whitish patches on the skin. Normally, new skin cells rise to the surface of the skin once a month; the old surface skin cells die and fall off while the new cells are moving to the surface. In people who have psoriasis, the new cells move to the surface so rapidly that the dead cells build up on the surface.
      • Some people have mild cases of psoriasis. Others have extensive cases that affect multiple parts of the body
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