Next Step: Foot Care In Connecticut

Posts for: May, 2013

Flatfoot is common in both children and adults. When this deformity occurs in children, it is referred to as "pediatric flatfoot". Although there are various forms of flatfoot, they all share one characteristic- partial or total collapse of the arch.

Pediatric flatfoot can be classified as symptomatic or asymptomatic. Symptomatic flatfeet exhibit symptoms such as pain and children at the podiatristlimitation of activity, while asymptomatic flatfeet show no symptoms. These classifications can assist your foot and ankle surgeon in determining an appropriate treatment plan.

Flatfoot can be apparent at birth or it may not show up until years later. Most children with flatfoot have no symptoms, but some have one or more of the following symptoms:

  • Pain, tenderness, or cramping in the foot, leg, and knee
  • Outward tilting of the heel
  • Awkwardness or changes in walking
  • Difficulty with shoes
  • Reduced energy when participating in physical activities
  • Voluntary withdrawal from physical activities

In diagnosing flatfoot, the foot and ankle surgeon examines the foot and observes how it looks when the child stands and sits. The surgeon also observes how the child walks and evaluates the range of motion of the foot. Because flatfoot is sometimes related to problems in the leg, the surgeon may also examine the knee and hip.

X-rays are often taken to determine the severity of the deformity. Sometimes additional imaging and other tests are ordered.

If a child has no symptoms, treatment is often not required. Instead the condition will be observed and re-evaluated periodically by the foot and ankle surgeon. Custom orthotic devices may be considered for some cases of asymptomatic flatfoot.

When the child has symptoms, treatment is required. The foot and ankle surgeon may select one or more of the following non-surgical approaches:

  • Activity modifications. The child needs to temporarily decrease activities that bring pain as well as avoid prolonged walking or standing.
  • Orthotic devices. The foot and ankle surgeon can provide custom orthotic devices that fit inside the shoe to support the structure of the foot and improve function.
  • Physical therapy. Stretching exercises, supervised by the foot and ankle surgeon or a physical therapist, provide relief in some cases of flatfoot.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to help reduce pain and inflammation.
  • Shoe modification. The foot and ankle surgeon will advise you on footwear characteristics that are important for the child with flatfoot.

In some cases, surgery is necessary to relieve the symptoms and improve foot function. The surgical procedure or combination of procedures selected for your child will depend on his or her type of flatfoot and degree of deformity.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

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The accessory navicular (os navicularum or os tibiale externum) is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area.

An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people.

People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of the following:

  • Trauma, as in a foot or ankle sprain
  • Chronic irritation from shoes or other footwear rubbing against the extra bone
  • Excessive activity or overuse

Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular.

Adolescence is a common time for the symptoms to first appear. This is a time when bones are maturing and cartilage is developing into bone. Sometimes, however, the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include:

  • A visible bony prominence on the midfoot (the inner side of the foot, just above the arch)
  • Redness and swelling of the bony prominence
  • Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity

To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or swelling. The doctor may press on the bony prominence to assess the area for discomfort. Foot structure, muscle strength, joint motion, and the way the patient walks may also be evaluated.

X-rays are usually ordered to confirm the diagnosis. If there is ongoing pain or inflammation, an MRI or other advanced imaging tests may be used to further evaluation the condition.

The goal of non-surgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used:

  • Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation.
  • Ice. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation. 
  • Physical therapy. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms.
  • Orthotic devices. Custom orthotic devices that fit into the shoe provide support for the arch, and may play a role in preventing future symptoms. 

Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear. When this happens, non-surgical approaches are usually repeated.

If non-surgical treatment fails to relieve the symptoms of accessory navicular syndrome, surgery may be appropriate. Surgery may involve removing the accessory bone, reshaping the area, and repairing the posterior tibial tendon to improve its function. This extra bone is not needed for normal foot function.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

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When injuries like these happen, you know it's going to take a long time for someone to recover. 

San Francisco 49ers wide receiver Michael Crabtree tore his Achilles tendon during organized team activities on Tuesday.

According to NFL.com's Ian Rapoport Crabtree has already had surgery to repair the tendon and will begin six months of rehabilitation. Crabtree could return as early as November.

49ers coach Jim Harbaugh talked with reporters on Wednesday and confirmed that the wide receiver had successful surgery. He does not expect Crabtree to miss the whole season. 

In days past, an injury like this meant the player would be out the entire season, but due to advances in podiatric medicine, recovery from surgery is greatly reduced. Last spring Baltimore Ravens linebacker Terrell Suggs and Tampa Bay Buccaneers defensive end Da'Quan Bowers tore their Achilles tendons and rejoined their teams after time recuperating. However, neither player was 100 percent when they returned to the field. 

Denver Broncos wide receiver Demaryius Thomas tore his tendon during training in February 2011, right after his rookie season. Thomas had surgery and was cleared to practice seven months later, after missing all of the Broncos' offseason workouts and training camp. He wasn't fully back until October 2011 and can sympathize with how Crabtree is feeling.

"He's a great player and I'm sure he's going to work hard to get back and listen to all the people that he's got to listen to," Thomas said. "But it's difficult at first, because it took a while for me to be able to do anything. You know, I had to wear a boot for six to eight weeks, and I couldn't do anything but upper body stuff. Once I got it off, I still had time, because it's a serious injury, and you don't want to take it too fast."

Crabtree, 25, had a stellar year for the 49ers last season. He had career highs in reception (85), yards (1,105), and touchdowns (9). In the three seasons past Crabtree had struggled to live up to the expectations the team put on him after drafting him 10th overall in 2009.

Crabtree had a great postseason as well, with 20 catches for 285 yards and three touchdowns, with one touchdown in the Super Bowl. He had the potential to score the winning goal when he was the intended target on a quick rollout pass on third-and-goal and a fade on fourth-and-goal that went over his head as he was defended by Ravens cornerback Jimmy Smith. Harbaugh wanted a pass-interference call on both plays but was denied by referees. 

Reference: USA Today.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

Visit our website, like our page on Facebook, and follow our tweets on Twitter.


The os trigonum is an extra (accessory) bone that sometimes develops behind the ankle bone (talus). It is connected to the talus by a fibrous band. The presence of an os trigonum in one or both feet is congenital (present at birth). It becomes evident during adolescence when one area of the talus does not fuse with the rest of the bone, creating a small extra bone. Only a small number of people have this extra bone.

Often, people don't know they have an os trigonum if it hasn't caused any problems. However, some people with this extra bone develop a painful condition known as os trigonum syndrome.

Os trigonum syndrome is usually triggered by an injury, such as an ankle sprain. The syndrome is also frequently caused by repeated downward pointing of the toes, which is common among ballet dancers, soccer players, and other athletes.

For the person who has an os trigonum, pointing the toes downward can result in a "nutcracker injury". Like an almond in a nutcracker, the os trigonum is crunched between the ankle and heel bones. As the os trigonum pulls loose, the tissue connecting it to the talus is stretched or torn and the area becomes inflamed.

The signs and symptoms of os trigonum syndrome may include:

  • Deep, aching pain in the back of the ankle, occurring mostly when pushing off on the big toe (as in walking) or when pointing the toes downward
  • Tenderness in the area when touched
  • Swelling in the back of the ankle

Os trigonum syndrome can mimic other conditions such as Achilles tendon injury, ankle sprain, or talus fracture. Diagnosis of os trigonum syndrome begins with questions from the doctor about the development of the symptoms. After the foot and ankle are examined, x-rays or other imaging tests are often ordered to assist in making the diagnosis.

Relief of symptoms is often achieved through treatments that can include a combination of the following:

  • Rest. It is important to stay off the injured foot to let the inflammation subside.
  • Immobilization. Often a walking boot is used to restrict ankle motion and allow the injured tissue to heal.
  • Ice. Swelling is decreased by applying a bag of ice covered with a thin towel to the affected area. Do not put ice directly against the skin. 
  • Oral medication. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
  • Injections. Sometimes cortisone is injected into the area to reduce the inflammation and pain. 

Most patients' symptoms improve with non-surgical treatment. However, in some patients, surgery may be required to relieve the symptoms. Surgery typically involves removal of the os trigonum, as this extra bone is not necessary for normal foot function.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

Visit our website, like our page on Facebook, and follow our tweets on Twitter.


Haglund's Deformity, also known as "pump bump" or "retrocalcaneal bursitis" is a painful enlargement of the back of the heel bone that becomes irritated by shoes.

It normally appears as a red, painful, swollen area in the back of the heel bone. Women tend to develop the condition moreHaglund's Deformity than men because of irritation from rigid heel counters of shoes rubbing up and down on the back of the heel bone.

Haglund's Deformity presents as a red, painful, and swollen area in the back of the heel bone (calcaneus). Patients may also develop pain upon motion of the ankle joint and after activity due to irritation of the Achilles tendon. The syndrome usually occurs in females in the 2nd to 3rd decade, due to the irritation of the rigid heel counter of the shoe rubbing up and down on the back of the heel bone.

A podiatric physician will attempt one of a few simple therapies. In the mild cases, padding of the area may be indicated. Your doctor may recommend alternative shoe styles, including open back shoes. Oral anti-inflammatory medications and cortisone injections may also help diminish the acute inflammation of the heel. Orthotics or arch supports may also be fabricated to prevent recurring symptoms. If conservative therapy fails, surgery will be utilized to correct this painful condition. Surgery consists of removal of the excess bone.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

Visit our website, like our page on Facebook, and follow our tweets on Twitter.