Part II Foot Disorders & Ailments

Bunions

Bunions are normally located on the joint of the medial side of the big toe. They tend to cause the big toe to lean against the next toe. The joint will stick out somewhat and become red and sore.

  • Causes are mostly narrow, tight shoes, but can be due to a defect of the foot’s structure.
  • Symptoms appear to be the same as arthritis, with constant or intermittent pain.
  • Treatment can begin with arch supports and custom made orthotics, but in more severe cases surgery will be required. It is wise to avoid improper shoe sizes and high heels. Physical therapy can prescribe braces and splints to help with alignment.


Brachymetararsia

Brachymetararsia is characterized by one of the metatarsals being shorter than the others. While it can affect any toe, it most often affects the fourth toe on each foot.

  • Causes are linked to Apert syndrome, which is a congenital defect.
  • Treatment is normally nothing, unless the individual finds the condition too difficult to live with. Wider shoes may be required for more comfort. Toe lengthening surgery may also be used as an elective or corrective surgery.
Brachymetararsia
Source: Foot & Ankle Alliance

Cavus Foot

Cavus foot is characterized by a high arch, which appears to put excessive weight on the ball of the foot, when standing and ambulating.

  • Symptoms may be few, but many individuals experience severe foot pain. Muscle, gait, and balance problems are also associated with this condition.
  • Treatment can range from nothing to orthotics that have been custom made to fit. Some individuals may be forced to undergo lateral ankle ligament repair (Brostrom Procedure), due to injuries or wear and tear.  

Charcot Foot

Charcot foot is often diagnosed in individuals that are plagued with neuropathy (nerve damage). Over time the bones become weakened to the point that they tend to fracture. This is a progressive condition that causes the joints to collapse and the foot to take on an abnormal shape (rocker-bottom).

  • Causes are linked to neuropathy, which may be worse due to the loss of sensation.
  • Complications are mostly trauma or injury, which is because of the lack of sensation.
  • Symptoms include pain, tenderness, edema, and inflammation.
  • Diagnosis normally begins with a physical exam, then moves toward x-rays, and magnetic resonance imaging.
  • Treatment is very important, in order to avoid amputation of a metatarsal or the entire foot. Custom shoes and orthotics are prescribed, reduction of activities, and in more severe cases immobilization.

It is vital that the individual maintain a normal glucose level, monitor diet, and get regular check-ups.

Clubfoot

Clubfoot is a congenital deformity, which involves one or both feet. The foot will appear twisted out of position. Walking can be nearly impossible in mild cases, but in more severe cases the child may have difficulty with mobility all together.

  • Causes are linked to a birth defect. The tendons are shorter than normal and the foot appears to be positioned at an extremely sharp angle.
  • Treatment will begin as early as a few weeks old, with the Ponseti Method. This involves weekly manipulation, with or without a plaster cast, which will hold the foot in its new position. This process will continue, until the baby’s foot is perfectly correct, but this may require two to three months. Surgery (Achilles Tenectomy) may also be prescribed in severe cases, the Achilles Tendon will be cut. This will require several small sutures and a new cast and requires about three weeks to heal completely.

Compartment Syndrome

Compartment syndrome is a life threatening condition, which is caused from an injury, burn, thrombosis, prolonged compression, or overly tight bandages. A buildup of blood and edema will occur in the affected tissues. Compartments are areas, where a group of organs and muscles are organized. Fascia (connective tissue) forms the compartment’s walls.

  • Symptoms include an accumulation of blood and edema in the compartments. The inflamed fascia will expand and cut off the blood flow to the tissues, within the compartments.
  • Complications can occur, if treatment is delayed. An amputation may be required, if the tissue become necrotic and gangrene.
  • Treatment involves emergency surgery (fasciotomy incisions) two dorsal, one calcaneal and one medial incision is used to relieve compartment pressures of 30 mm Hg or higher or 10 mm Hg to 30 mm Hg lower than the diastolic blood pressure. The compartments remain open for at least five days to reduce edema. A graft may be required to serve as a biologic dressing, which will allows free drainage.

To view the foot anatomy please click here.