Work Related Foot or Ankle Injury - San Francisco Podiatrist Union Square CA

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Work Related Foot or Ankle Injury - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses treatment plan for Foot or Ankle Injury.  

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ABOUT US

The doctors and staff of The Foot and Ankle Institute of San Francisco provide comprehensive care of the foot, ankle, and lower leg. Our practice philosophy emphasizes both conservative and surgical care, with all conservative options being exhausted prior to surgical intervention.

Podiatric Foot and Ankle Surgeons are Doctors of Podiatric Medicine (DPMs) who specialize both medically and surgically in the diagnosis, care, and treatment of patients with disorders of the musculoskeletal system of the foot and ankle and associated structures.

This includes the bones, joints, ligaments, muscles tendons, nerves, and skin. Podiatric foot and ankle surgeons use medical, physical, and rehabilitative methods as well as surgery to treat patients of all ages.

The highly qualified foot and ankle surgeons of the Institute consult with a variety of specialists in the fields of renal/endocrine, rheumatology, pediatrics, vascular, orthopedics, and plastic surgery, to develop a comprehensive treatment plan for patients.

All our staff has completed surgical residency programs in different parts of the country, bringing their expertise in elective, reconstructive and traumatic surgery. Other areas of expertise include sports related injuries, pediatric deformities and surgery (flatfoot, club foot, etc.), rheumatoid surgery, and diabetic limb salvage with charcot reconstruction.

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Tarsal Tunnel Syndrome Treatment - San Francisco Podiatrist Union Square CA

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Tarsal Tunnel Syndrome Treatment - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments for Tarsal tunnel syndrome.

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What is Tarsal tunnel syndrome? Tarsal tunnel syndrome (TTS) is a type of compression neuropathy in the ankle and foot. Compression neuropathy is a nerve disease due to compression.

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Enriched Plasma Protein - San Francisco Podiatrist Union Square CA

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Enriched Plasma Protein - San Francisco Podiatrist Union Square CA

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San Francisco Podiatrist Union Square CA - What Is Enriched Plasma Protein (PRP)?

Dr. Bill Metaxas discusses how enriched plasma protein can help promote faster healing for various foot and ankle conditions.

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Enriched Plasma Protein harnesses your body's own unique protein-based growth factors to mend tendon, ligament, bone and cartilage.

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Plantar Wart Treatment - San Francisco Podiatrist Union Square CA

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Plantar Wart Treatment - San Francisco Podiatrist Union Square CA

Dr. Bill Metaxas discusses the symptoms, causes and treatments for Plantar Warts.  

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PLANTAR WART (VERRUCA PLANTARIS)

 

What is a Plantar Wart?

A wart is a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, and the elderly.

There are two types of plantar warts:

• A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional "satellite" warts.
• Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.

Signs and Symptoms

The signs and symptoms of a plantar wart may include:

• Thickened skin. Often a plantar wart resembles a callus because of its tough, thick tissue.
• Pain. A plantar wart usually hurts during walking and standing, and there is pain when the sides of the wart are squeezed.
• Tiny black dots. These often appear on the surface of the wart. The dots are actually dried blood contained in the infected capillaries (tiny blood vessels).

Plantar warts grow deep into the skin. Usually this growth occurs slowly-the wart starts off small and gets larger over time.

What Causes a Plantar Wart?

Plantar warts are caused by direct contact with the human papilloma virus (HPV). This is the same virus that causes warts on other areas of the body. Typically, the plantar wart virus is acquired in public places where people go barefoot, such as locker rooms, swimming pools, and karate classes. It can also be acquired at home if other family members have the virus.

Diagnosis and Treatment

To diagnose a plantar wart, the foot and ankle surgeon will examine the patient's foot and look for signs and symptoms of a wart.

The Foot and Ankle Institute offers numerous treatment modalities for the treatment of plantar warts. These include the typical treatment options of cutting-out the warts, freezing the warts, shaving the warts, using chemicals/acid on the warts, burning the warts and prescription medication to be applied by the patient.

The Weil Foot and Ankle Institute is one of the few practices in the country which offers 2 types of laser removal of warts along with radiofrequency ablation of the warts.

The CO 2 laser is used with local anesthetic and typically one treatment is needed to eradicate the warts. This is followed by daily soaking of the foot until the area is healed. The advantage of the CO 2 laser is that only one treatment is needed to remove the warts.

The pulsed-dye laser may be used with or without anesthesia and may include a series of treatments to eradicate the warts, however, it is less painful than the CO 2 laser or cutting out the warts. The biggest advantage of the pulsed-dye laser is that it allows the patient to return to full activity immediately.

The final treatment available is the Topaz by Arthrocare, which utilizes radiofrequency waves with local anesthesia to eradicate the warts. The advantage of the Topaz is that it is minimally invasive, with no need for soaking after the procedure. Usually the patient is able to return to full activity within a few days.

 

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Morton’s Neuroma Treatment - San Francisco Podiatrist Union Square CA

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Morton’s Neuroma Treatment - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments for Morton’s Neuroma.  

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MORTON'S NEUROMA

The term "neuroma" means a "tumor of a nerve". It is an abnormal growth of cells within a nerve, and the majority of them are benign, but a few rare tumors are cancerous. These true neuroma's generally occur in the larger nerve trunks of the ankle and lower leg, and in other parts of the human body. They can occur in the smaller nerves of the foot, but this is very uncommon.

Over 100 years ago, a British physician named a benign tumor of the foot after himself and called it "Morton's neuroma". Modern medicine has shown that this tumor, which most often occurs between the bases of the 3rd and 4th toes, should be more accurately termed "perineural fibrosis" because it is a build up of scar tissue (fibrosis) around, not within, the small nerves between the metatarsal heads. This scar tissue becomes enlarged and causes compression on the nerve, which results in decreased blood and oxygen to the affected nerve segment, resulting in pain. This neoplasm or tumor can occur between any of the metatarsal heads of the foot.

Causes

Morton's neuroma, or perineural fibrosis, is caused by local irritation of a segment of a nerve in the front part of the foot which rubs up against a thick ligament beneath the metatarsal heads. There is an initial inflammatory reaction resulting in scarring or fibrosis around the nerve segment. As this scarring enlarges, compression of the nerve segment occurs. Flat-feet, high arched feet, high heel shoes, narrow shoes, pointed shoes, and certain repetitive physical activities can result in the formation of a Morton's neuroma. Frequently as this type of tumor enlarges, patients will experience pain and then remove their shoe and massage the foot, which will temporarily relieve the symptoms.

Symptoms

• Sharp or achy pain in the front part of the foot at the base of the toes.
• Numbness, tingling, or a "pins and needles" feeling of the toes.
• A sensation of feeling a "lump" on the bottom of the forefoot.
• A feeling as if the sock is "bunched up" beneath the foot.
• Feeling a "clicking" sensation when walking.
• No signs of redness or swelling.

Treatment

A proper history and physical examination by your Podiatric physician is necessary to be sure that the diagnosis is accurate. Other conditions such as arthritis, synovitis, tendinitis, metatarsalgia, or other types of tumors may mimic the symptoms of Morton's neuroma.

Certain diagnostic tests such as Ultrasound or an MRI may be necessary to clearly make the diagnosis of Morton's neuroma.

Traditional conservative medical treatments include changes or modifications of shoe gear, orthoses, injections, foot padding, and the use of anti-inflammatory medication. Many of these treatments will provide temporary relief, but since we have no way of reversing the scar tissue formation, then ultimately surgical treatment by a Podiatric surgeon may be necessary in order to alleviate the symptoms.

 

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Ingrown Toenail Treatment - San Francisco Podiatrist Union Square CA

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Ingrown Toenail Treatment  - San Francisco Podiatrist Union Square CA

Dr. Bill Metaxas discusses the symptoms, causes and treatments for Ingrown Toenails.  

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INGROWN TOENAIL

The nail, or nail plate, is made up of the same type of cells that makes up our skin, which is the largest organ of the human body. Like every other organ in the body, there can be problems. By far, the most common problem with human toenails are when they become embedded in the surrounding skin, or nail fold. This is known as an ingrown toenail.

The surrounding skin and nail plate become red, swollen, and painful. As this process continues there can be drainage, odor, and eventually an infection with pus. As the infection becomes more severe the pain may subside because the bacteria change the environment in which they are breeding, and can cause numbness to the local nerves. In the more advanced cases of ingrown toenail "proud flesh" will develop, and this is known medically as a granuloma. In the most severe neglected cases the ensuing infection can lead to cellulitis, and even an infection of the underlying bone.

Causes

The most common cause of ingrown toenail is improper cutting, trimming, or tearing of the toenail. Injury, genetic irregularity, severe curvature of the nail plate, sports, improperly fit shoes, improper pedicures, and occasionally chemotherapy can lead to deformity of the nail plate and result in an ingrown toenail.

Treatment

Since the most common cause of ingrown toenails is the improper cutting of the nail, it leads the patient to attempt self treatment, thus becoming what is known as a "bathroom surgeon". This is especially true in the case of adolescents and young adults.

If the cardinal signs of infection – pain/ redness/ swelling/ local heat/ drainage – persist for more than 2 – 3 days then you should consult with a Podiatric Physician. Simple debridement or trimming of the ingrown toenail may be all that is required to relieve your symptoms. In the more advanced cases, a local anesthetic will need to be administered in order to properly remove the offending portion of the ingrown toenail. If there is a severe infection involved, then oral antibiotics may be prescribed by your Podiatric Physician.

In cases where there are repeated episodes of a recurrent ingrown toenail then surgery may be recommended as a more permanent treatment.

Recommendations:

• Always cut your toenails straight across.
• Avoid cutting the toenails too short.
• Cutting a "V" notch in the center of the nail plate will not prevent ingrown toenails.
• Avoid shoe gear that is too short.
• Avoid using the over-the-counter ingrown toenail solutions which will NOT correct the underlying problem.
• Self treatment of a painful ingrown toenail is not recommended.
• Cut the nails, don't tear them.

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Union Square Podiatrist San Francisco, CA - Bill Metaxas, DPM

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Union Square Podiatrist San Francisco, CA - Bill Metaxas, DPM

Meet Podiatrist Dr. Bill Metaxas as he discusses foot care at The Foot and Ankle Institute of San Francisco

http://www.footankleinstitutesf.com

The doctors and staff of The Foot and Ankle Institute of San Francisco are dedicated to using the latest research and advanced technology to deliver complete podiatric care to people of the San Francisco Bay Area and beyond.

Our doctors treat a variety of common and rare conditions of the foot and ankle, including heel pain, hammertoe, bunion, flat feet, plantar fasciitis, neuroma, wellness care of diabetic feet, including amputation prevention, sports medicine for casual and professional athletes, as well as advanced foot and ankle deformity planning and correction.

While providing exceptional care for the most common ailments like ingrown nails, fungus and ankle sprains, our doctors also take pride in pioneering new evidence-based treatment technologies.

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Heel Pain Treatment - San Francisco Podiatrist Union Square CA

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Heel Pain Treatment - San Francisco Podiatrist Union Square CA

Dr. Bill Metaxas discusses the symptoms, causes and treatments Heel Pain.  

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HEEL PAIN/ PLANTAR FASCIITIS

Heel pain is most often caused by plantar fasciitis — a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst. Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is best trained to distinguish between all the possibilities and determine the underlying source of your heel pain.

What is Plantar Fasciitis?

Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed-resulting in heel pain.

The Symptoms of Plantar Fasciitis Are:

• Pain on the bottom of the heel
• Pain that is usually worse upon arising
• Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they've been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

Causes of Plantar Fasciitis

The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches-either overly flat feet or high-arched feet-are more prone to developing plantar fasciitis.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when a person's job requires long hours on their feet. Obesity also contributes to plantar fasciitis.

Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays, a bone scan, or magnetic resonance imaging (MRI) may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Treatment Options

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home.

Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.

Long-Term Care

No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. If you are overweight, it is important to reach and maintain an ideal weight. For all patients, wearing supportive shoes and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

 

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Sprain Ankle Treatment - San Francisco Podiatrist Union Square CA

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Sprain Ankle Treatment - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments for Sprain Ankle.  

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SPRAINS

Injuries to the outside of the ankle associated with rolling of the foot are known as ankle sprains.

The ankle ligaments provide stability to the ankle by helping to hold the ankle bone within the ankle joint. The ankle ligaments usually involved in an ankle sprain are also known as the lateral collateral ligaments of the ankle. The lateral collateral ligaments of the ankle are comprised of the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament.

The lateral ligaments provide stability to the ankle throughout the gait cycle as the foot bends up and down. Therefore total lateral stability of the ankle is provided by these three ligaments.

The most anterior (front) and most frequently injured of these ligaments is the anterior talofibular ligament. This ligament is intracapsular, or blended and contiguous with the lining of the anterior lateral aspect of the ankle capsule (joint). It can be seen as a fibrous thickening of the lining of the joint and courses from the front of the fibula to the front of the lateral surface of the talus.

The main function of the anterior talofibular ligament is the prevention of axial or rotational instability of the ankle. During gait as the heel is coming down, the foot is held in a dorsiflexed (up) position. Essentially the foot is pivoting on the edge of the heel only. Any irregularity in the ground, or laterally directed force, will cause the foot to twist in or out depending on the orientation of the force. Similarly, when we push off, the foot is in a plantar flexed (down) position. As the foot is plantar flexed, the position of the foot increases the long axis of the leg and increases the torque on the ankle region. Any ground irregularity or laterally directed force will cause the foot to twist in or out depending of the orientation of the force.

Classification of Injury

Rolling in of the foot (inversion), with the sole of the foot towards the opposite leg, is defined as a lateral ankle sprain. There are several classifications of this injury. A simple definition of injury breaks the injury down in terms of physiologic injury: sprain, strain or rupture which define the extent of stretching and A second classification of injury of the lateral collateral ligaments of the ankle is known as Grades 1, 2, or 3. This classification describes the functional loss of the ankle and the resultant grade or level of injury.

The end result of injury of one or more of the lateral collateral ligaments of the ankle is ankle instability. This instability can show up initially as a result of the severity of the injury or later as a result of chronic ankle instability.

During the moment of injury, due to the instability caused by the injury, movement and twisting of the Talus (ankle bone) in the ankle joint resulting in bone to bone compaction and twisting of other ligaments, tendons and nerves may occur. Injuries beyond the level of the ligaments themselves can occur and will occur depending of the level of injury. MRI, CT scans, bone scans and electro-diagnostic testing may be recommended to evaluate for these secondary injuries.

Chronic Ankle instability occurs much later than then original injury. Once the lateral collateral ankle ligaments are injured, they no longer provide the ability to stop ankle twisting and to hold the Talus within the ankle joint. As you walk or run with an unstable ankle, the talus can twist within the joint and partially come out of the joint. This movement is unnatural and abnormal and redirects force to the outside of the joint. With an increase in joint load to the outside, the foot will roll to the inside producing further tearing of the ligament and further injury.

Treatment

Conservative treatment for this condition depends on the necessity to stabilize the foot to restore the anatomical position of the ankle ligaments. The often noted RICE formula (rest, ice, compression elevation) is the standard initial treatment. Any treatment provided is to allow the ligaments to heal in the correct position and at the correct length. Depending on which ligaments are injured and to what degree the ligaments are injured, your doctor can provide you with the best ankle brace to stabilize your ankle.

Supplemental treatment for secondary injuries incurred at the time of injury will be diagnoses and treated at the same time as the treatment for the ankle ligaments.

Surgical Treatment

Surgical treatment of the ankle ligaments or associated injury conditions are performed when instability develops later or the injury is severe enough initially that stabilization must be done to allow for proper healing.

 

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Bunion and Hammertoe Treatment - San Francisco Podiatrist Union Square CA

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Bunion and Hammertoe Treatment - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments of Bunions and Hammertoes.  

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What are the Treatment Options for Bunions?

When bunions are causing mild to moderate pain, the simplest solution to try is a wider, more accommodating shoe. This includes lower heels, softer leather, wider toe boxes and gym shoes. Cushions may provide relief from shoe pressure over the prominence. Anti-inflammatory medication may also provide relief.

When the bunion is painful despite the conservative therapy options or you cannot find shoes that are comfortable, surgical correction should be discussed with your podiatric physician. The longer surgery is delayed in a symptomatic foot, the greater the amount of arthritis that develops, and the more complicated the surgery becomes. Patients who have their symptomatic bunion corrected earlier tend to have greater satisfaction after the procedure.

 What are the Treatment Options for Hammertoes?

When hammer toes and claw toes are causing mild to moderate pain, the simplest solution to try is a wider, more accommodating shoe to allow room for the toes to move. This includes lower heels, softer leather, wider toe boxes, and gym shoes. Use of a pumice stone to thin any corns and callouses is sometimes helpful. Cushions and various soft pads may provide relief from shoe pressure over the toes. Never use a "medicated" corn pad since these contain a strong acid which does not know the difference between the bad and good skin and can lead to a chemical burn or deep open sore which can become infected.

When the hammer toes and claw toes are painful despite the conservative therapy options, or you cannot find shoes that are comfortable, surgical correction should be discussed with your podiatric physician. The longer surgery is delayed in a symptomatic foot, the greater the amount of deformity that develops, and the more complicated the surgery becomes. Patients who have their symptomatic hammer toes and claw toes corrected earlier tend to have greater satisfaction after the procedure. When these treatment options are no longer providing the comfort you need, consultation with your podiatric physician is advised to discuss surgical options.

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Foot and Ankle Fracture Treatment - San Francisco Podiatrist Union Square CA

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Foot and Ankle Fracture Treatment - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments for Foot and Ankle Fracture.  

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FRACTURE REPAIR

The structure of your foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.

What is a Fracture?

A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.

Traumatic Fractures

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact-like seriously stubbing your toe. Traumatic fractures can be displaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required.

Signs and symptoms of a traumatic fracture include:

• You may hear a sound at the time of the break.
• "Pinpoint pain" (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
• Deviation (misshapen or abnormal appearance) of the toe.
• Bruising and swelling the next day.
• It is not true that "if you can walk on it, it's not broken." Evaluation by the foot and ankle surgeon is always recommended.

Stress Fractures

Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated.

Symptoms of stress fractures include:

• Pain with or after normal activity
• Pain that goes away when resting and then returns when standing or during activity
• "Pinpoint pain" (pain at the site of the fracture) when touched
• Swelling, but no bruising

Is it a Fracture, or a Sprain?

Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your foot and ankle surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis.

Consequences of Improper Treatment

Some people say ,"the doctor can't do anything for a broken bone in the foot." This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

• A deformity in the bony architecture, which may limit the ability to move the foot or cause difficulty in fitting shoes.
• Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn't been properly corrected.
• Chronic pain and long-term dysfunction.
• Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.

Treatment of Toe Fractures

Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself.

Treatment of Metatarsal Fractures

Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.

 

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Flat Feet (Flatfoot) Treatment - San Francisco Podiatrist Union Square CA

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Flat Feet (Flatfoot) Treatment - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments for Flat Feet.   

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What is Flat Feet?

Flat feet is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flat feet, all of which have one characteristic in common-partial or total collapse (loss) of the arch.

Other characteristics shared by most types of flat feet include:

• "Toe drift," where the toes and front part of the foot point outward.
• The heel tilts toward the outside and the ankle appears to turn in.
• A short Achilles tendon, which causes the heel to lift off the ground earlier when walking and may act as a deforming force.
• Bunions and hammertoes may occur in some people with flat feet.
• Health problems such as rheumatoid arthritis or diabetes sometimes increase the risk of developing flat feet. In addition, adults who are overweight frequently have flat feet.

Flexible Flat Feet

Flexible flat feet is one of the most common types of flat feet. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and generally progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.

The term "flexible" means that while the feet are flat when standing (weight-bearing), the arch returns when not standing. In the early stages of flexible flat feet, arthritis is not restricting motion of the arch and foot, but in the later stages arthritis may develop to such a point that the arch and foot become stiff.

Symptoms, which may occur in some persons with flexible flat feet, include:

• Pain in the heel, arch, ankle, or along the outside of the foot.
• "Turned-in" ankle.
• Pain associated with a shin splint.
• General weakness/fatigue in the foot or leg

Diagnosis of Flexible Flat Feet

In diagnosing flat feet, the foot and ankle surgeon examines the foot and observes how it looks when you stand and sit. X-rays are usually taken to determine the severity of the disorder. If you are diagnosed with flexible flat feet but you don't have any symptoms, your foot and ankle surgeon will explain what you might expect in the future.

Treatment Options

If you experience symptoms with flexible flat feet, the foot and ankle surgeon may recommend various treatment options.

Flat Feet Surgery

A variety of surgical techniques is available to correct flexible flat feet. Your case may require one procedure or a combination of procedures. All of these surgical techniques are aimed at relieving the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, joint fusions, or insertion of implant devices.

In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the X-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

 

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Diagnostic Ultrasound - San Francisco Podiatrist Union Square CA

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Diagnostic Ultrasound - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses how Diagnostic Ultrasound is used for foot problems.  

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ULTRASOUND IMAGING

What is diagnostic ultrasound?

Diagnostic ultrasound or musculoskeletal ultrasound is a non-invasive test used to evaluate the soft-tissues (tendons, ligaments, nerves, muscles, etc.) of the foot and ankle. It is similar to sonar used on submarines by the military and fetal ultrasound used by OB-GYN doctors to evaluate the developing baby. In experienced hands, the images and information obtained from the ultrasound can provide as much information as much more expensive and time-consuming tests such as MRI and CT-Scans.

What is involved?

Diagnostic ultrasound is quick and painless. The entire process can usually be completed during your regular office visit and involves simply placing some gel over the areas to be inspected and using a small probe to explore the tissues. Since the ultrasound waves are harmless (otherwise they would not be used on developing babies) this test never causes any pain at all.

What is diagnostic ultrasound used for?

We use this test to evaluate and document problems such as tendonitis, heel pain, pinched nerves and neuromas, puncture wounds caused by stepping on glass or wood, and deep infections in the foot and ankle regions.

We utilize diagnostic ultrasound to visualize soft tissue problems that cannot be seen on x-ray, generally prior to ordering an MRI.

What is Diagnostic Ultrasound Imaging?

Ultrasound imaging is the use of sound waves to visualize the body. An ultrasound image is very effective way to examine the musculoskeletal system of the body to detect problems with muscles, tendons, ligaments, joints and soft tissue. Ultrasound images occur in real time, so they can often show movement, function and anatomy, as well as enable our doctors to diagnose a variety of conditions and assess damage after an injury. Ultrasound is very safe and does not involve ionizing radiation.

What can be diagnosed with ultrasound?

Ultrasound images can be useful in diagnosing:

• Plantar fasciitis, plantar fibroma, and Tear of plantar fascia
• Neuromas
• Achilles tendontendonitis or rupture
• Posterior tibialis tendon dysfunction or rupture
• Bone injuries-fractures-stress fractures
• Ankle sprains- strains
• Retrocalcaneal bursitis
• Ganglions
• Cystic masses
• Rheumatoid arthritis- capsular erosion- nodules
• Foreign bodies – glass or wood

What procedures can the ultrasound be used for?

Because the structures of the foot and ankle can often be small, Ultrasound can be used to precisely guide a needle when injections. Ultrasound guided injections allow for such precise placement of medication that a lower dose of the medication is may often be used. Some areas where we use guided injections include:

What are the risks and benefits?

• Ultrasound scanning is noninvasive and painless
• Ultrasound is much less expensive than MRI, CT scan or bone scans
• Unlike x-rays, ultrasound imaging uses no radiation
• Ultrasound provides real-time imaging, making it a great tool for guiding injections or aspirations of fluid in joints or elsewhere. This allows our doctors to place injections more precisely in order to achieve better outcomes and avoid potential complications.
• Unlike the magnetic field of MRI units, ultrasound is not affected by cardiac pacemakers or implants within the body.
• Ultrasound may actually have advantages over MRI in seeing tendon structure, which is better appreciated by ultrasound than MRI at a fraction of the cost.
• For diagnostic ultrasound there are no known harmful effects on humans.

What are the limitations of ultrasound imaging?

Ultrasound does not penetrate bone well, so only the outer surface of bone can be visualized.

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Diabetic Amputation Prevention - San Francisco Podiatrist Union Square CA

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Diabetic Amputation Prevention - San Francisco Podiatrist Union Square CA

Dr. Bill Metaxas discusses the Diabetic Complications and Amputation Prevention.  

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DIABETIC COMPLICATIONS AND AMPUTATION PREVENTION

People with diabetes are prone to many foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor blood circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.

When you have diabetes, you need to be aware of how foot problems can arise from disturbances in the skin, nails, nerves, bones, muscles, and blood vessels. Furthermore, in diabetes, small foot problems can turn into serious complications.

You can do much to prevent amputation by taking two important steps:

• Follow the proactive measures discussed below
• See your foot and ankle surgeon regularly.

Your Proactive Measures

You play a vital role in reducing complications. Follow these guidelines and contact your foot and ankle surgeon if you notice any problems:

• Inspect your feet daily. Skin or nail problems-Look for cuts, scrapes, redness, drainage, swelling, bad odor, rash, discoloration, loss of hair on toes, injuries, or nail changes (deformed, striped, yellowed or discolored, thickened, or not growing). Signs of fracture-If your foot is swollen, red, hot, or has changed in size, shape, or direction, see your foot and ankle surgeon immediately. (If your eyesight is poor, have someone else do it for you.)
• Observe for changes in circulation. Pay attention to the color of your toes. If they turn red, pink, or purplish when your legs hang down while sitting, poor circulation may be a problem.
• Don't ignore leg pain. Pain in the leg that occurs at night or with a little activity could mean you have a blocked artery. Seek care immediately.
• Nail cutting. If you have any nail problems, hard nails, or reduced feeling in your feet, your toenails should be trimmed professionally.
• No bathroom surgery. Never trim calluses or corns yourself, and don't use over-the-counter medicated pads.
• Keep floors free of sharp objects. Make sure there are no needles, insulin syringes, or other sharp objects on the floor.
• Don't go barefoot. Wear shoes, indoors and outdoors.
• Check shoes and socks. Shake out your shoes before putting them on. Make sure your socks aren't bunched up.
• Have your sense of feeling tested. Your foot and ankle surgeon will perform various tests to see if you've lost any feeling.

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Treatment for Ankle Arthritis - San Francisco Podiatrist Union Square CA

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Treatment for Ankle Arthritis - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments for Ankle Arthritis.  

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OSTEOARTHRITIS OF THE FOOT AND ANKLE

What is Osteoarthritis?

Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage-the connective tissue found at the end of the bones in the joints-protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one's ability to easily perform daily activities.

Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Many people refer to osteoarthritis simply as arthritis, even though there are more than 100 different types of arthritis.

Osteoarthritis appears at various joints throughout the body, including the hands, feet, spine, hips, and knees. In the foot, the disease most frequently occurs in the big toe, although it is also often found in the midfoot and ankle.

Signs and Symptoms

People with osteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following:

• Pain and stiffness in the joint
• Swelling in or near the joint
• Difficulty walking or bending the joint
• Some patients with osteoarthritis also develop a bone spur (a bony protrusion) at the affected joint. Shoe pressure may cause pain at the site of a bone spur, and in some cases blisters or calluses may form over the surface of the bone spur. Bone spurs can also limit the movement of the joint.

Causes

Osteoarthritis is considered a "wear and tear" disease because the cartilage in the joint wears down with repeated stress and use over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint.

An injury may also lead to osteoarthritis, although it may take months or years after the injury for the condition to develop. For example, osteoarthritis in the big toe is often caused by kicking or jamming the toe, or by dropping something on the toe. Osteoarthritis in the midfoot is also often caused by dropping something on it, or by a sprain or fracture. In the ankle, osteoarthritis is usually caused by a fracture and occasionally by a severe sprain.

Sometimes osteoarthritis develops as a result of abnormal foot mechanics. People who have flat feet or high arches are at increased risk for developing osteoarthritis in the foot. A flat foot causes less stability in the ligaments (bands of tissue that connect bones), resulting in excessive strain on the joints, which can cause arthritis. A high arch is rigid and lacks mobility, causing a jamming of joints that creates an increased risk of arthritis.

Diagnosis

In diagnosing osteoarthritis, the foot and ankle surgeon will examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. In some cases, deformity and/or enlargement (spur) of the joint may be noted.

In addition to the foot examination, x-rays may be ordered to help the doctor diagnose osteoarthritis and evaluate the extent of the disease in the foot and ankle.

Treatment: Non-Surgical Options

To help relieve symptoms, the surgeon may begin treating osteoarthritis with one or more non-surgical approaches.

When is Surgery Needed?

If non-surgical treatment fails to adequately reduce the pain associated with osteoarthritis, surgery may be recommended. The goal of surgery is to decrease pain and improve function. The foot and ankle surgeon will consider a number of factors when selecting the procedure best suited to the patient's condition and lifestyle.

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Treatment for Bunions and Hammertoes - San Francisco Podiatrist Union Square CA

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Treatment for Bunions and Hammertoes - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments of Bunions and Hammertoes.  

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What Causes a Bunion?

A bunion is a prominence on the side of the foot by the big toe joint. The big toe may also be leaning over towards the smaller toes.You are usually born with the foot type that predisposes you to bunions. People with flat feet or really flexible feet are more prone to develop problems with bunions. Other causes are injury, rheumatoid arthritis and neurovascular disease. Over time, the mechanics of your foot and shoe gear increases the deformity of the bunion. Woman are more frequently affected, probably because of the types of shoes they wear.

What Causes Hammer Toes and Claw Toes?

The most common toe deformities are hammer toes, claw toes, and bone spurs. These involve the lesser toes (2nd through 5th toes). In a hammer toe, the toe is bent at the middle knuckle of the toe, while in a claw toe the toe is bent at both the middle knuckle and tip of the toe. A bone spur can occur anywhere on the toes but most commonly affects the 4th and 5th toes. Each of the deformities can create corns on the toes and in more severe cases redness, swelling, and even an open sore can develop. It is important to note that the corns are not a skin problem! They develop because the skin is being crushed and irritated between the bones in your toes and your shoe.

You are usually born with the foot type that predisposes you to hammer and claw toes. People with flat feet, high-arched feet, or really flexible feet are more prone to develop these problems. Other causes are excessively long toes, tendon imbalance, injury, rheumatoid arthritis, and neuromuscular disease. Over time, the mechanics of your foot and shoe gear increases the deformities. Women are more frequently affected, probably because of the type of shoe they wear and the use of tight stockings.

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Bunion Surgery - San Francisco Podiatrist Union Square CA

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Bunion Surgery - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments of Bunions.

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BUNIONS

What Causes a Bunion?

A bunion is a prominence on the side of the foot by the big toe joint. The big toe may also be leaning over towards the smaller toes.You are usually born with the foot type that predisposes you to bunions. People with flat feet or really flexible feet are more prone to develop problems with bunions. Other causes are injury, rheumatoid arthritis and neurovascular disease. Over time, the mechanics of your foot and shoe gear increases the deformity of the bunion. Woman are more frequently affected, probably because of the types of shoes they wear.

What are the Symptoms?

The severity of the deformity may not correlate to the degree of pain. For example, a bunion that looks severe may have no pain; while a mild looking bunion may be incapacitating. Pain usually develops over the large prominence due to the friction of the shoe in that area. This rubbing of the shoe may cause a red, inflamed sac of tissue called bursitis. As time goes on pain may develop deep in this joint, limiting walking, exercise or even just standing comfortably. High heeled or pointed shoes will exacerbate these symptoms.

When the joint has been in a mal-aligned position for many years, osteoarthritis will develop. Arthritis causes increased stiffness and pain within the joint.

Bunions may also effect the adjacent smaller toes. When the big toes start to angle over, the big toe may cause increased pressure on the second toe or the second toe may be pushed upwards out of the way. This causes hammertoes and/or callouses on the lesser toes.

What are the Treatment Options?

When bunions are causing mild to moderate pain, the simplest solution to try is a wider, more accommodating shoe. This includes lower heels, softer leather, wider toe boxes and gym shoes. Cushions may provide relief from shoe pressure over the prominence. Anti-inflammatory medication may also provide relief.

When the bunion is painful despite the conservative therapy options or you cannot find shoes that are comfortable, surgical correction should be discussed with your podiatric physician. The longer surgery is delayed in a symptomatic foot, the greater the amount of arthritis that develops, and the more complicated the surgery becomes. Patients who have their symptomatic bunion corrected earlier tend to have greater satisfaction after the procedure.

What Does Surgery Involve?

The goal of surgical correction is to restore normal alignment and function of the great toe joint. The large bony prominence is removed and a cut is made in the bone to move it back into a normal position. Screws and/or pins may be used to hold the bone in proper position. If the joint is destroyed from arthritis beyond repair, it may need to be replaced with an artificial joint.

Following surgery, the foot is bandaged and a post operative shoe is worn for one week. Athletic shoes may be worn after the first week. Exercise and prolonged standing are restricted for the first 6-8 weeks. A home exercise program is important for regaining the strength and flexibility. You may steadily resume activities and wear more fashionable shoe gear as healing occurs.

 

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Children's Feet - San Francisco Podiatrist Union Square CA

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Children's Feet - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas of San Francisco discusses pediatric foot care and why foot pain is not normal.

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PEDIATRIC FLATFOOT

Pediatric flatfoot occurs in children where there is a partial or total collapse of the arch of the foot.

Although the exact incidence of flatfoot in children is unknown, it is a common finding. All children have only a minimal arch at birth. This condition is not painful and generally resolves without treatment; very rarely is corrective casting necessary. Most children who present to a podiatrist for evaluation of flatfoot will have a flexible flatfoot that does not require treatment.

Common Signs and Symptoms:

• Pain when walking or running for any length of time
• Outward position of the heel while standing
• Awkwardness when walking or running
• Pain in shoes

The examining podiatrist must rule out the difference between "flexible" and "rigid" flatfoot. A flexible flatfoot is one that collapses while the child is standing, but the arch is visible when not standing. A rigid flatfoot is present whether or not the child is standing and often indicative of a more serious condition. Many infants have a "fat" foot and are mistaken to have flatfeet.

Diagnosis

Your podiatrist will examine the child while standing and take x-rays to determine the severity of the condition.

Treatment

Most often, if the flatfoot is asymptomatic, treatment is not required. At that time it is best to wait and observe. Custom made orthotics may be helpful in mild cases to prevent further problems from developing.

Surgical management is rarely indicated for a true flexible flatfoot. In severe cases, surgery may be necessary to relieve the symptoms and to correct the foot function. There are a variety of techniques to treat the painful pediatric flatfoot, depending on the foot type and degree of deformity.

 

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Custom Orthotics - San Francisco Podiatrist Union Square CA

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Custom Orthotics - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses how custom orthotics can help correct biomechanical problems of the foot to alleviate heel pain and other foot problems.

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Orthotics, also known as orthoses, refers to any device inserted into a shoe, ranging from felt pads to custom-made shoe inserts that correct an abnormal or irregular, walking pattern. Sometimes called arch supports, orthotics allow people to stand, walk, and run more efficiently and comfortably. While over-the-counter orthotic are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual's unique foot structure. Orthotic devices come in many shapes, sizes, and materials and fall into three main categories: those designed to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

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