Next Step: Foot Care In Connecticut

Posts for: June, 2013

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel- arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.

Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.

Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:

  • A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with fallen arches can produce strain and compression on the nerve.
  • An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
  • An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
  • Systemic disease such as diabetes or arthritis can cause swelling, thus compressing the nerve.

Patients with tarsal tunnel syndrome experience one or more of the following symptoms:

  • Tingling, burning, or a sensation similar to an electrical shock.
  • Numbness.
  • Pain, including shooting pain.

Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.

Sometimes the symptoms of the syndrome appear suddenly. Often they are brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.

It is very important to seek early treatment if any of the symptoms of tarsal tunnel occur. If left untreated, the condition progresses and may result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated.

The foot and ankle surgeon will examine the foot to arrive at a diagnosis and determine if there is any loss of feeling. During this examination, the surgeon will position the foot and tap on the nerve to see if the symptoms can be reproduced. He or she will also press on the area to help determine if a small mass is present.

Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Studies used to evaluate nerve problems- electromyography and nerve conduction velocity (EMG/NCV)- may be ordered if the condition shows no improvement with non-surgical treatment.

A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:

  • Rest. Staying off the foot prevents further injury and encourages healing.
  • Ice. Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
  • Physical therapy. Ultrasound therapy, exercises, and other physical therapy modalities may be prescribed to reduce symptoms.
  • Injection therapy. Injections of a local anesthetic provide pain relief, and an injection corticosteroid may be useful in treating the inflammation. 
  • Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
  • Shoes. Supportive shoes may be recommended.
  • Bracing. Patients with flat foot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount pressure on the foot.

Sometimes surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate proceudre or procedures based on the cause of the condition.

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.

 

Ligaments surrounding the joint at the base of the second toe form a capsule, which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed.

Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort, and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis- also referred to as predislocation syndrome- is a common condition that can occur at any age.

It is generally believed that capsulitis of the second toe is a result of abnormal foot mechanics, where the ball of the foot beneath the toe joint takes an excessive amount of weight-bearing pressure.

Certain conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of the foot. These most commonly include a severe bunion deformity, a second toe longer than the big toe, an arch that is structurally unstable, and a tight calf muscle.

Because capsulitis of the second toe is a progressive disorder and usually worsens if left untreated, early recognition and treatment are important. In the earlier stages- the best time to see treatment- the symptoms may include:

  • Pain, particularly on the ball of the foot. It can feel like there's a marble in the shoe or a sock is bunched up.
  • Swelling in the area of pain, including the base of the toe.
  • Difficultly wearing shoes.
  • Pain when walking barefoot.

In more advanced stages, the supportive ligaments weaken leading to failure of the joint to stabilize the toe. The unstable toe drifts toward the big toe and eventually crosses over and lies on top of the big toe- resulting in crossover toe, the end stage of capsulitis. The symptoms of crossover toe are the same as those experienced during earlier stages. Although the crossing over of the toe usually occurs over a period of time, it can appear more quickly if caused by injury or overuse.

An accurate diagnosis is essential because the symptoms of capsulitis can be similar to those of a condition called Morton's neuroma, which is treated differently from capsulitis.

In arriving at a diagnosis, the foot and ankle surgeon will examine the foot, press on it, and maneuver it to reproduce the symptoms. The podiatrist will also look for potential causes and test the stability of the joint. X-rays are usually ordered, and other imaging studies are sometimes needed.

The best time to treat capsulitis of the second toe is during the early stages, before the toe starts to drift toward the big toe. At that time, non-surgical approaches can be used to stabilize the joint, reduce the symptoms, and address the underlying cause of the condition.

The podiatrist may select one or more of the following options for early treatment of capsulitis:

  • Rest and ice. Staying off the foot and applying ice packs helps reduce the swelling and pain. Apply an ice pack, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
  • Taping/splinting. It may be necessary to tape the toe so that it will stay in the correct position. This helps relieve the pain and prevent further drifting of the toe.
  • Stretching. Stretching exercise may be prescribed for patients who have tight calf muscles.
  • Shoe modifications. Supportive shoes with stiff soles are recommended because they control the motion and lessen the amount of pressure on the ball of the foot.
  • Orthotic devices. Custom shoe inserts are often very beneficial. These include arch supports or a metatarsal pad that distributes the weight away from the joint.

Once the second toe starts moving toward the big toe, it will never go back to its normal position unless surgery is performed. The podiatrist will select the procedure or combination of procedures best suited to the individual patient.

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.


bone spur is a bony growth formed on normal bone. Most people think of something sharp when they think of a spur, but a bone spur is just extra bone. It's usually smooth, but it can cause wear and tear or pain if it presses or rubs on other bones or soft tissues such as ligaments, tendons, or nerves in the body.

A bone spur forms as the body tries to repair itself by building extra bone. It typically forms in response to pressure, rubbing, or stress that continues over a long period of time.

Some bone spurs form as part of the aging process. As we age, the slippery tissue called cartilage that covers the end of the bones within the joint breaks down and eventually wears away. Over time, this leads to pain and swelling, and in some cases, bone spurs forming along the edge of the joint. Bone spurs due to aging are especially common in the feet.

Bone spurs form in the feet in response to tight ligaments, to activities such as dancing and running that put stress on the feet, and to pressure from being overweight or from poorly fitting shoes. For example, the long ligament on the bottom of the foot, the plantar fascia, can become stressed or tight and pull on the heel, causing the ligament to become inflamed. As the bone tries to mend itself, a bone spur can form on the bottom of the heel, known as a heel spur. Pressure on the back of the heel from frequently wearing shoes that are too tight can cause a bone spur. This is sometimes called pump bump, or Haglund's Deformity, because it is seen in women who wear high heels.

Many people have a bone spur without ever knowing, because most bone spurs cause no symptoms. But if the bone spurs are pressing on the bones or tissues or are causing a muscle or tendon to rub, they can break that tissue down over time, causing pain, swelling, and tearing. Bone spurs in the foot can also cause corns and calluses when tissue builds up to provide added padding over the bone spur.

A bone spur is usually visible on an X-ray. But since most bone spurs do not cause problems, it would be unusual to take an X-ray just to see if you have a bone spur. If you had an X-ray to evaluate one of the problems associated with bone spurs, such as arthritis, bone spurs would be visible on that X-ray.

Bone spurs do not require treatment unless they are causing pain or damaging other tissues. When needed, treatment may be directed at the causes, symptoms, or the bone spurs themselves.

Treatment directed at the cause of bone spurs may include weight loss to take some pressure off the joints (especially when osteoarthritis or plantar fasciitis is the cause) and stretching the affected area, such as the heel cord and bottom of the foot. Seeing a physical therapist for ultrasound or deep tissue massage may be helpful for plantar fasciitis.

Treatment directed at the symptoms could include rest, ice, stretching and non-steroidal anti-inflammatory drugs, such as ibuprofen. Education in how to protect your joints is helpful if you have osteoarthritis. When the spur is in the foot, changing footwear or adding an orthotic may help. If the spur is causing corns or calluses, padding the area or wearing different shoes can help. A podiatrist is the best trained in helping your bone spur and may also recommend a cortisone injection to reduce pain and inflammation of the tissues near the spur.

Bone spurs can be surgically removed or treated as part of a surgery to repair or replace a joint when osteoarthritis has caused considerable damage and deformity. Examples might include repair of a bunion or heel spur in the foot.

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.


Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.

Charcot foot is a very serious condition that can lead to severe deformity, disability, and even amputation. Because of its seriousness, it is important that patients with diabetes- a disease often associated with neuropathy- take preventive measures and seek immediate care if signs or symptoms appear.

Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain, or trauma. Because of diminished sensation, the patient may continue to walk- making the injury worse.

People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot.

The symptoms of Charcot foot may include:

  • Warmth to the touch (the affected foot feels warmer than the other).
  • Redness in the foot.
  • Swelling in the area.
  • Pain or soreness.

Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays and other imaging studies and tests may be ordered.

Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.

It is extremely important to follow the surgeon's treatment plan for Charcot foot. Failure to do so can lead to the loss of a toe, foot, leg, or life.

Non-surgical treatment for Charcot foot consists of:

  • Immobilization. Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the weakened bones can repair themselves. Complete non-weightbearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the surgeon determines it is safe to do so. During this period, the patient may be fitted with a cast, removable boot, or brace, and may be required to use crutches or a wheelchair. It may take the bones several months to heal, although it can take considerably longer in some patients.
  • Custom shoes and bracing. Shoes with special inserts may be needed after the bones have healed to enable the patient to return to daily activities- as well as help prevent recurrence of Charcot foot, development of ulcers, and possibly amputation. In cases with significant deformity, bracing is also required.
  • Activity modification. A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet.

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 posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.

PTTD is often called "adult acquired flatfoot" because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn't treated early.

Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change.

For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen.

Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward.

As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.

Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested.

In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases of PTTD, treatment can begin with non-surgical approaches that may include:

  • Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe. 
  • Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while. 
  • Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support.

In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.

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.