Your feet must last a lifetime, and most Americans log an amazing 75,000 miles on their feet by the time they reach age 50. Regular foot care can make sure your feet are up to the task. With proper detection, intervention, and care, most foot and ankle problems can be lessened or prevented…
On this page, the most common medical issues of the foot, ankle and toes are described. Though many conditions commonly associated with the foot are localized, temporary and easily treatable, some conditions are the result of complicated issues elsewhere in the body, and may require advanced surgery or custom orthotics for treatment. At Louisville Podiatry, we strive for the best solutions for your lifestyle.
The information on this page is for reference only. For actual medical advice, of course, please request an appointment with Louisville Podiatry.
Arthritis, in general terms, 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; just as a sore throat may have its origin in a variety of diseases, so joint inflammation and arthritis are associated with many different illnesses.
Arthritis is a frequent component of complex diseases that may involve more than 100 identifiable disorders. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted and there is no way to avoid the pain of the tremendous weight-bearing load on the feet.
Arthritis is a disabling and occasionally crippling disease; it afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are most prone to arthritis.
Arthritic feet can result in loss of mobility and independence, but early diagnosis and proper medical care can help significantly.
Diabetes is the inability to manufacture or properly use insulin, and it impairs the body's ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) can lead to serious damage to the eyes, heart, kidney, nerves, and feet. Diabetes affects the lives of nearly 26 million people in the United States and nearly seven million don't even know they have the disease yet.
While there is no cure for diabetes, there is hope. With proper diet, exercise, medical care, and careful management at home, a person with diabetes can avoid the most serious complications and enjoy a full and active life. Today's podiatrist plays a key role in helping patients manage diabetes successfully and avoid foot-related complications.
Diabetes warning signs include the following:
A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.
Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable.
Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.
Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem. Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament.
Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body's ability to fight off a potential infection and also slow healing.
High blood pressure is also known as hypertension. Blood pressure refers to the force of blood pushing against the walls of the arteries as your heart pumps out blood. Hypertension occurs when your blood pressure rises and stays above normal over a period of time.
Hypertension is often related to atherosclerosis, which is the buildup of plaque in blood vessels. This condition leads to decreased circulation and peripheral arterial disease (PAD). People with decreased circulation in their legs and feet may develop ulcerations (open wounds on the skin) that can lead to amputations.
As a member of the health-care team, your podiatrist is vitally concerned about hypertension and vascular disease (heart and circulatory problems). Make sure you tell your podiatrist if you have high blood pressure and any medications that you may be taking for treatment.
Symptoms of poor circulation in the feet and legs may include:
Uncontrolled hypertension can also lead to heart disease, which may present as swelling in your feet and legs.
PAD is short for Peripheral Arterial Disease. PAD is caused by a blockage or narrowing of the arteries in the legs when fatty deposits called plaque buildup. The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. This results in a reduction of blood flow to the legs and feet. This is commonly referred to as poor circulation.
PAD occurs most often in the arteries in the legs, but it can also affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys, and the stomach. When arteries inside the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.
PAD affects 8 to 12 million Americans, and one in every five people over the age of 70 has the disease. People with PAD have a two-to-six times' greater chance of death from a heart attack or stroke. PAD and diabetes are the leading causes of foot or leg amputations in the United States.
Risk factors for PAD and other conditions that may complicate PAD include the following:
The symptoms of PAD include the following:
However, many individuals with PAD do not experience typical leg symptoms such as cramping, pain, or fatigue known as claudication.
Peripheral neuropathy is damage of the peripheral nerves. Your peripheral nerves—the nerves in your toes and fingertips—are the ones on the periphery of your body. When the nerves are damaged, they don't function properly. People with peripheral neuropathy have decreased or abnormal sensation in their toes and fingers. Sometimes, they develop problems moving these parts of the body as well.
In the United States, the most common cause of peripheral neuropathy is diabetes. According to the American Diabetes Association, 60 to 70 percent of people with diabetes will develop neuropathy within their lifetime.
Other causes of peripheral neuropathy include:
The most common symptoms of peripheral neuropathy include burning, numbness, tingling, or shooting or stabbing pain in the toes and/or fingertips. Any change in sensation in the fingers or toes may be a symptom of peripheral neuropathy. Be sure to report any abnormal sensations to your doctor. Those sensations may be the first sign of another problem, such as diabetes.
The feet and ankles work together to provide support and mobility to the body. 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.
Injuries are the most common causes of foot and ankle sprains and fractures. Many fractures and sprains occur during sports. Football players are particularly vulnerable to foot and ankle sprains and fractures. Basketball players are prone to ankle sprains, and runners may develop stress fractures of the ankle or foot. Gymnasts and dancers may also develop stress fractures.
Tripping or stumbling on uneven ground is another common cause of foot and ankle sprains and fractures.
Pain, swelling, bruising, and difficulty walking on the affected foot or ankle are the most common symptoms of a sprained or fractured foot or ankle.
Haglund's Deformity is a bony enlargement of the back of the heel bone. Sometimes it's called “pump bump” because the deformity often occurs in women who wears pumps.
The shape of your foot can contribute to the development of Haglund's Deformity. If you have high arches, a tight Achilles tendon, or a tendency to walk on the outside of your feet, you're more likely to develop Haglund's Deformity than other people. Wearing shoes with a firm, rigid back may also contribute to the development of Haglund's Deformity.
The primary symptoms of Haglund's Deformity are an enlarged bony prominence on the back of the heel and heel pain. You might also develop blisters on your heels as a result of your shoes rubbing against the bump.
The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.
Heel pain has many causes. Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear (such as flimsy flip-flops); or being overweight.
Heel Spurs: A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome." 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 biomechanical imbalance, 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 of fibrous connective tissue (fascia) running 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, and it can be quite painful.
The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
Excessive Pronation: Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Achilles Tendinitis: Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
Other possible causes of heel pain include:
Tendinitis is the inflammation of a tendon. Tendons are thick cords of tissue that connect muscles to bone.
Achilles tendinitis, or an inflammation of the Achilles tendon, is one of the most common causes of foot or ankle pain. Other types of foot/ankle tendinitis include posterior tibial tendinitis and peroneal tendinitis.
Tendinitis can result from an injury or over-use. Improper stretching prior to exertion or incorrect form during physical activity can also contribute to the development of tendinitis. Some people, including those with “flat feet,” tight tendons or arthritis, are particularly prone to tendinitis.
Pain is the most prominent symptom of tendinitis. The pain will be most noticeable when you try to move that part of your body. The involved tendon may swell.
Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth. Not all fungus conditions are athlete's foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete's foot.
The warmth and dampness of areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi. Because the infection was common among athletes who used these facilities frequently, the term "athlete's foot" became popular.
The signs of athlete's foot, singly or combined, include the following:
Athlete's foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere. The organisms causing athlete's foot may persist for long periods. Consequently, the infection may be spread by contaminated bed sheets or clothing to other parts of the body.
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 often occur where a toe rubs against the interior of a shoe. Excessive pressure at the balls of the feet—common in women who regularly wear high heels—may cause calluses to develop on the balls of the feet.
People with certain deformities of the foot, such as hammer toes, are prone to corns and calluses.
Corns and calluses typically have a rough, dull appearance. They may be raised or rounded, and they can be hard to differentiate from warts. Corns or calluses sometimes cause pain.
Psoriasis is a skin condition caused by faster-than-normal turnover of skin cells. Normally, new skin cells rise to the surface of the skin once a month; the old surface skin cells die and slough 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 in dry, whitish-silver patches.
Some people have mild cases of psoriasis. Others have extensive cases that affect multiple parts of the body.
Psoriasis is an autoimmune disease and seems to run in families. Psoriasis tends to be more severe in people with weakened immune systems, including those with AIDS and those undergoing treatment for cancer. Stress also seems to make psoriasis worse.
People with psoriasis typically have areas of thick, reddened skin with dry, whitish-silver patches. The dry patches are called psoriatic plaques. The skin may feel itchy.
Psoriasis is most commonly found on the elbows, knees, and bottoms of the feet. It can also affect the fingernails, toenails, and joints of the body.
Skin cancer can develop anywhere on the body, including in the lower extremities. 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.
We often view the sun's harmful rays as the primary cause of skin cancer; the condition is often found on parts of the body that receive the most sun exposure. Skin cancers of the feet, however, are more often related to viruses, exposure to chemicals, chronic inflammation or irritation, or inherited traits. Unfortunately, the skin of the feet is often overlooked during routine medical examinations, and for this reason, it important that the feet are checked regularly for abnormalities that might indicate evolving skin cancer.
Some of the most common cancers of the feet are:
Basal Cell Carcinoma: Basal cell carcinoma frequently is seen on sun-exposed skin surfaces. With feet being significantly less exposed to the sun, it occurs there less often. This form of skin cancer is one of the least aggressive cancers in the body. It will cause local damage but only rarely spreads beyond the skin. Basal cell cancers may appear as pearly white bumps or patches that may ooze or crust and look like an open sore. On the skin of the lower legs and feet, basal cell cancers often resemble non-cancerous skin tumors or benign ulcers.
Squamous Cell Carcinoma: Squamous cell carcinoma is the most common form of cancer on the skin of the feet. Most types of early squamous cell carcinoma are confined to the skin and do not spread. However, when advanced, some can become more aggressive and spread throughout the body. This form of cancer often begins as a small scaly bump or plaque, which may appear inflamed. Sometimes there is a history of recurrent cracking or bleeding. Occasionally it begins as a hard projecting callus-like lesion. Though squamous cell cancer is painless, it may be itchy. Squamous cell cancer may resemble a plantar wart, a fungal infection, eczema, an ulcer, or other common skin conditions of the foot.
Malignant Melanoma: Malignant melanoma is one of the deadliest skin cancers known. Non-surgical treatments are rarely effective, and many remain experimental. This type of skin cancer must be detected very early to ensure patient survival. Melanomas may occur on the skin of the feet and on occasion beneath a toenail. They are found both on the soles and on the top of the feet. As a melanoma grows and extends deeper into the skin, it becomes more serious and may spread through the body through the lymphatics and blood vessels.
Malignant melanoma has many potential appearances, leading to its nickname, “The Great Masquerader.” This skin cancer commonly begins as a small brown-black spot or bump; however, roughly one third of cases lack brown pigment and thus appear pink or red. These tumors may resemble common moles; however, close inspection will usually demonstrate asymmetry, irregular borders, alterations in color, and/or a diameter greater than 6 mm. Melanomas may resemble benign moles, blood blisters, ingrown nails, plantar warts, ulcers caused by poor circulation, foreign bodies, or bruises.
Excessive sweating of the feet is called hyperhidrosis. It's more common in men than in women, and more common in young adults than older adults.
People whose feet sweat excessively often also have problems with excessive sweating of the palms. According to the International Hyperhidrosis Society, 3 percent of the population suffers from hyperhidrosis.
Excessive sweating of the feet seems to be an inherited problem. No one knows exactly why it occurs, but people who sweat excessively seem to have a different “set point” than other people. Most people sweat when it's hot out, or when they become warm. People with hyperhidrosis sweat excessively almost all the time.
The most obvious symptom of hyperhidrosis is feet that sweat excessively. Some people sweat so much that their feet may slip around inside their shoes.
The feet may also have a whitish, wet appearance; sometimes, foot infections are present as well. (Constant wetness breaks down the skin, allowing infection to set in.) Foot odor is common.
Those suffering from hyperhidrosis may also experience emotional stress and worry regarding foot odor. Sweat-related anxiety and isolation can be particularly severe among teens with plantar hyperhidrosis.
Warts are one of several soft tissue conditions of the foot that can be quite painful. They 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. Children, especially teenagers, tend to be more susceptible to warts than adults. Some people seem to be immune to warts.
The virus that causes warts generally invades the skin through small or invisible cuts and abrasions. The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.
If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, creating another route for spreading. Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.
Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses, which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.
Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.
When plantar warts develop on the weight-bearing areas of the foot (the ball of the foot, or the heel, for example), they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.
A bunion is a “bump” on the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—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. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion—from the Latin "bunio," meaning enlargement—can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor's bunion".
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.
Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.
Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.
Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.
The symptoms of a bunion include the following:
A hammer toe is a contracture, or bending, of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammer toes are more common in females than males.
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, making surgery the usual course of treatment.
A hammer toe develops because of an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammer toe. Arthritis is another factor, because the balance around the toe in people with arthritis is disrupted. Wearing shoes that are too tight and cause the toes to squeeze can also cause a hammer toe to form.
The symptoms of a hammer toe include the following:
A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a benign growth of nerve tissue frequently 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.
The principal symptom associated with a neuroma is pain between the toes while walking. Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe. The vast majority of people who develop neuromas are women.
Although the exact cause for this condition is unclear, a number of factors can contribute to the formation of a neuroma:
The symptoms of a neuroma include the following:
Ingrown nails, the most common nail impairment, 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 other toes can also become affected.
Ingrown toenails may be caused by the following:
The following symptoms may be present with ingrown toenails:
Toenail fungus, or onychomycosis, is an infection underneath the surface of the nail caused by fungi. When the tiny organisms take hold, the nail often becomes darker in color and smells foul. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails. If ignored, the infection can spread and possibly impair your ability to work or even walk. The resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Onychomycosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate.
Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where you are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors may be a history of athlete's foot and excessive perspiration.
Toenail fungus is often ignored because the infection can be present for years without causing any pain. The disease is characterized by a progressive change in a toenail's quality and color, which is often ugly and embarrassing.