Podiatry

Podiatry (or podiatric medicine) is the study, diagnosis, and medical and surgical treatment of disorders of the foot, ankle, and parts of the leg.

Podiatrists are Doctors of Podiatric Medicine (DPM). Their education follows a similar path of a traditional Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO), which includes:

• Four years of undergraduate work
• Followed by four years in an accredited podiatric medical school
• Followed by a three- or four-year hospital-based surgical residency

The podiatrists at Florida Orthopaedic Institute diagnose and treat existing foot and ankle conditions while addressing any underlying health issues that may be causing the symptoms. They can also help prevent future foot pain and injuries you may be susceptible to.

Instead of attempting to self-treat your foot condition at home and hoping it will resolve itself, make an appointment today. Our podiatrists can determine what is causing your foot and ankle problem to address it successfully.

INGROWN TOENAILS

Ingrown toenails affect individuals of all ages. The most common risk factors include:

• Genetics
• Restrictive shoes
• Foot injuries
• Poor nail-cutting techniques
• Fungal debris

In some cases, removing part of the nail (a wedge excision) can alleviate the pressure on the skin border.

An in-office procedure called a partial nail avulsion is used for patients who experience severe pain, impaired walking ability, and infection. A partial nail avulsion removes the problem nail border, followed by a partial nail removal (matricectomy).

In patients who have a history of trauma to the nail bed or significant thickening of the nail causing discomfort in shoe gear, a total nail avulsion may be performed.

Trimming nails straight across is the best prevention for ingrown toenails.

TINEA PEDIS (FUNGAL FOOT INFECTION) & UNGUIUM

Tinea Pedis is one of the most commonly treated foot conditions affecting patients of all ages. It is most common amongst athletes as their training environment can be where bacteria may multiply. Tinea often affects the skin and often spreads to the toenails and sometimes also to the hands. Warm, moist, and dark environments are optimal for fungal infections.

Tinea pedis is a foot infection caused by a dermatophyte fungus. It is particularly prevalent in hot, tropical, urban environments. It is the most common dermatophyte (a pathogenic fungus that grows on the skin).

Infection in multiple toes is common. It is more commonly known as athlete’s foot, although some people use the term for any kind of tinea pedis. It can be accompanied by tinea cruris, tinea manuum, or tinea unguium.

Misshapen toenails, thickened, or have a partially destroyed nail plate (dystrophic) can be mistaken for a fungal infection of the nails (onychomycosis) in patients who suffer repeated sudden-stop trauma associated with sports like running, soccer, basketball, and tennis. The diagnosis can be confirmed with various lab tests. Since toenails grow slowly, a cure can take 9-12 months.

Tinea unguium is another type of fungal infection. It can infect the fingernails and, more commonly, the toenails. It’s more common older adults, men, diabetics, people with peripheral vascular disease or other health problems that weakens the immune system.

Tinea pedis usually occurs in males, adolescents and young adults but can also affect females, children, and older people. Infection is usually caused by direct contact with the fungus – using a shared towel or walking barefoot in a public changing room.

Other risk factors include:

• Closed footwear (for example, heavy industrial boots)
• Excessive sweating (hyperhidrosis)
• Underlying immunodeficiency or diabetes mellitus
• Systemic corticosteroids or immune-suppressive medications
• Poor peripheral circulation or lymphoedema

Tinea pedis usually has one or more of three following symptoms:

• Itchy erosions and scales between the toes, especially between the 4th and 5th toes
• Scale covering the sole and sides of the feet
• Small to medium-sized blisters, usually affecting the inner parts of the foot

Less commonly, it can also cause oozing and ulceration between the toes or blisters.

Based on these symptoms, the diagnosis of tinea pedis can usually be made. The toenails, groin, and palms of the hands should also be examined for fungal infection.

Diagnosis can be confirmed by skin scrapings sent for microscopy and lab cultures.

Usually, treatment begins with antibiotic creams applied directly to the skin, along with proper education on hygiene and managing abnormally excessive sweating that’s not necessarily related to heat or exercise (hyperhidrosis).

The first steps should include:

• Meticulous drying of feet, especially between the toes
• Avoid tight and confined footwear
• Use moisture-absorbing antifungal foot powder once or twice daily
• Using sandals in communal facilities
• Thoroughly dry shoes and boots
• Cleaning shower and bathroom floors using a product containing bleach

These steps will also minimize recurrence.

Topical antifungal therapy once or twice daily for two to four weeks is usually sufficient to cure mild infections. Topical antifungals include those containing azoles, allylamines, butenafine, ciclopirox, and tolnaftate.

If topical treatments do not work, or if patients are immunocompromised or have a severe moccasin-type infection (scaly, thickened skin on the sole and heel of the foot), they may require oral antifungal treatment with monitoring of their liver function as appropriate for a few weeks.

VERRUCAE (PLANTAR WARTS)

With warts being spread by skin-to-skin contact, the most common areas affected are the hands and feet. Plantar warts lead to pain and pressure and cause difficulty moving and walking. Risk factors include communal showers, pool decks, and locker rooms where individuals walk barefoot.

Plantar warts are often mistaken for hyperkeratotic tissue (a thickening of the outer layer of the skin). Your podiatrist can diagnose by noting disruption in friction ridges, pain when applying pressure to either side of the lesion, and pinpoint bleeding upon debridement. In some cases, a plantar wart can resolve on its own. In other cases, if left untreated could linger for years. Acid-based treatment, cryotherapy, and excision are the most common treatments.

BIOMECHANICS

The foot and ankle form a complex system of 28 bones, 33 joints, 112 ligaments, controlled by 13 extrinsic and 21 intrinsic muscles.

Your foot and ankle function as a rigid structure for weight-bearing but flexible to conform to uneven terrain. They also provide various important functions, including supporting body weight, providing balance, shock absorption, transferring ground reaction forces, and compensating for other parts of the body that are not aligned properly.

When your feet have issues, it can affect other body parts, particularly those used in walking. Callus formation can indicate where the problem may have originated.

Malalignment of the foot during the gait cycle in patients whose foot rolls inward as they move (over pronation) or over supination (when the foot rolls outwardly when lifted off the ground to take a step) can affect the knee, hip, and lower back. Overpronation of the foot can cause the leg to rotate internally. This causes increased stress to the medial collateral ligaments of the knee and increased pain to the hip. Proper foot orthotics and education on appropriate footwear can reduce this pain.

CUSTOM ORTHOTICS AND BRACING

An orthotic can help alleviate pain caused by any suboptimal position in a patient’s muscles, tendons, ligaments, joints, or bones. They help correct any biomechanical imbalances and provide stability during standing, walking, or running.

Following a 3D impression of the foot, the prescription for the orthotics is selected based on a patient’s height, weight, daily shoe gear, and medical complaints. They may be rigid, semirigid, semiflexible, or accommodative.

Patients with specific needs are best served with a pair of custom orthotics rather than over-the-counter inserts. While custom orthotics are an investment that is typically not covered by insurance, they generally last much longer than over-the-counter options.

Orthotics can help support your feet, protect your joints, improve strength/flexibility of tendons, reduce pain, enhance athletic performance, and prevent injury.

Certain bracing options that include a custom footplate can also be fitted in the same manner using a 3-D impression of the foot and ankle.

CONDITIONS PODIATRISTS TREAT

Podiatrists treat many foot-related conditions, including:

• Abnormal Growths
• Achilles Tendinitis
• Arch Pain
• Arthritis
• Athlete’s Foot
• Blisters
• Bunions
• Calluses
• Corns
• Diabetic Foot Ulcers
• Fallen Arches
• Flat Feet
• Foot Deformities
• Foot Fractures
• Fractures and Sprains
• Fungal Toenail Infections
• Gout
• Hammer Toe
• Heel Pain
• Heel Spurs
• Infection Management and Amputation Prevention
• Ingrown Toenails
• Injuries and Breaks
• Morton’s Neuroma
• Other Neuromas (pinched nerves)
• Plantar Fasciitis
• Plantar Warts
• Sports Injuries
• Warts

They also treat patients with these symptoms:

• Arch pain
• Cracked heels
• Cracks or cuts on the feet
• Excessive sweating
• Foot pain
• Growths-like warts
• Heel pain
• Nerve damage
• Numbness and tingling
• Other skin and nail conditions
• Scaling or peeling on your soles
• Thick or discolored toenails

The podiatrists at Florida Orthopaedic Institute can not only diagnose and treat existing foot and ankle conditions but can also address any underlying health issues that may be causing the symptoms. They can also help prevent future foot pain and injuries you may be susceptible to.