Contact our main office at 401-305-3800 or info@rifootcare.com

Our Services

The following is information that elaborates on the problem you may have.

Please click on your topic of interest to find out more.

Bunion Deformity

More than half the women in America have bunions, a common deformity often blamed on wearing tight, narrow shoes. Bunions cause the base of your big toe (Metatarsophalangeal Joint) to enlarge and protrude. The skin over it may be red and tender. Wearing any type of shoe may be painful. This joint flexes with every step you take. The bigger your bunion gets, the more it hurts to walk. Bursitis may set in. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful.

Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. If your bunion gets too severe, it may be difficult to walk. Your pain may become chronic and you may develop arthritis.

Bunions
Most bunions can be treated without surgery by wearing protective pads to cushion the painful area, and of course, avoiding ill-fitting shoes in the first place.

Bunion surgery, or bunionectomy, realigns the bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position. Many bunion surgeries are performed on a same-day basis (no hospital stay) using an ankle-block anesthesia.

Diabetic Foot Care

Individuals with Diabetes Mellitus are encouraged to become patients at RIFC. Periodic professional monitoring and foot care are vital to prevent the development of complications (i.e. ulcers, infection) which can be limb threatening. RIFC doctors are able to assess circulation, neurological status, skin condition and provide shoe wear recommendations to help ensure good foot health.

Diabetic patients are encouraged to schedule regular visits for examination and the care of nails and lesions.

Ball of Foot Pain

Metatarsalgia

Pain in the area between the arch and toes, or ball of the foot, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this mid-portion of the foot. Also known as dropped metatarsal heads, metatarsalgia can cause abnormal weight distribution due to overpronation.

Metatarsalgia occurs when one of the metatarsal joints becomes painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia also can be caused by arthritis, foot injury (from sports, a car accident, or repeated stress), hard surfaces (cement or tile floors), and specific footwear (rigid-soled work boots).

A simple change of shoes may solve the problem. In more severe cases, custom orthotics may be prescribed to alleviate the pain and prevent overpronation.

Plantar Fibroma

Plantar fibromas are benign tissue tumors or growths on the plantar, or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band of ligaments, called the plantar fascia. The presence of the tumor can cause pain or pressure on other parts of the foot structure that can lead to other foot problems.

Nonsurgical measures used in treating plantar fibromas such as custom orthotics or steroid injection may provide adequate relief of symptoms. Surgical correction can be successful under certain conditions, however complications, such as plantar nerve entrapment or recurrent fibromas can occur that may be worse than the original problem.

Sesamoiditis

Sesamoids are small bones that are connected only to tendons or are embedded in muscle. This structure appears in only a few places in the human body, one of which is the foot. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the big toe-one on the outer side of the foot and the other closer to the middle of the foot. Sesamoids provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. In the foot, sesamoids assist with weight-bearing and help elevate the bones of the big toe.

Like other bones, sesamoids can fracture. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed, which is called sesamoiditis and is a form of tendonitis. Sesamoiditis is a common condition among ballet dancers, runners, and baseball catchers because of the pressures placed on their feet.

Symptoms include:

Pain under the big toe or on the ball of the foot
Swelling and bruising
Difficulty and pain in bending and straightening the big toe
Surgery is usually not required to treat sesamoiditis. Treatments generally include:

Discontinuation of the activity causing the pain and inflammation
Over-the-counter pain medications and anti-inflammatories, such as ibuprofen and aspirin.
Note: Please consult your physician before taking any medications
Icing the sole of the foot
Wearing shoes that are stiff-soled and low-heeled
Using cushioning in shoes to relieve stress
Injection of a steroidal medication to reduce swelling
If symptoms persist, you may need to wear a removable brace on the leg for four-to-six weeks to give the inflammation time to subside and the bones to heal.

Neuroma

Morton”s Neuroma is a common, painful foot condition that affects women more commonly than men and becomes very chronic if left untreated. The pain and numbness that affects the toes makes walking unbearable at times, necessitating people to stop, take off their shoes and massage their foot. This particular condition becomes even worse when wearing heels or narrow fitting shoes.

The condition is a result of nerves that are irritated or pinched between the bones in the ball of the foot. There are five metatarsal bones that comprise the ball of the foot. These are the long bones that extend back from the toes. Nerves course between these metatarsal bones on their way to providing sensation to the corresponding toes. Walking and wearing tight shoes squeezes the two metatarsals together sending a painful sensation into the two affected toes. The sensation can be sharp, electric shock like, burning, pins/needles and/or numbness. The affected nerve can become irritated and inflamed. Over time it becomes scared and enlarged. A number of treatments are currently available to treat neuromas. Sometimes the pain is relieved by taking off the offending shoe and massaging the ball of the foot. Cortisone injections, custom orthotics and anti-inflamatory measures have also been successful in treating this disorder. Approximately fifty percent of Morton”s Neuromas can be effectively treated with conservative therapy. While conservative treatment can sometimes relieve the symptoms, a large percentage of patients require surgical intervention.

Skin Disorders

Athletes Foot Infection

Athlete’s Foot, also known as tinea pedis, is a skin disease caused by a fungus that usually occurs between the toes. The fungus attacks the feet because shoes create a warm, dark, and humid environment that encourages fungus growth. Warm, damp areas around swimming pools, showers, and locker rooms, are also breeding grounds for fungi.

Symptoms of Athlete’s Foot include drying skin, itching, scaling, inflammation, and blisters on and between the toes. Athlete’s Foot can spread to the soles of the feet and to the toenails as well as other parts of the body, which is why timely treatment is so important.

You can prevent Athlete’s Foot by:

Not walking barefoot, particularly in public pools and locker rooms
Reducing foot perspiration by using talcum powder
Wearing light and airy shoes
Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily
While fungicidal and fungistatic chemicals are usually used to treat Athlete’s Foot problems, they often fail to contact the fungi in the lower layers of the skin. For persistent Athlete’s Foot, a prescription topical or oral antifungal drug may be needed.

Note: Please consult your physician before taking any medications.

Warts

Plantar warts, also known as verrucas, appear on the soles of the feet and are one of several soft tissue conditions that can be quite painful. Most foot warts are harmless, even though they may be painful. They are often mistaken for corns or calluses, which are layers of dead skin that build up to protect an area which is being continuously irritated. A wart, however, is caused by a viral infection which invades the skin through small or invisible cuts and abrasions. Foot warts are generally raised and fleshy and can appear anywhere on the foot or toes. Occasionally, warts can spontaneously disappear after a short time, and then, just as frequently, they recur in the same location. If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of warts. Children, especially teenagers, tend to be more susceptible to warts than adults. Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries. They are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. Plantar warts are often contracted by walking barefoot on dirty surfaces or littered ground. The virus that causes plantar warts thrives in warm, moist environments, making infection a common occurrence in public pools and locker rooms.

Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading. Plantar warts that develop on the weight-bearing areas of the foot (the ball or heel of the foot) can cause a sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

To prevent the spread of warts, follow these tips:

Avoid direct contact with warts, both from other persons or from other parts of the body
Avoid walking barefoot, except on sandy beaches
Change your shoes and socks daily
Check your children’s feet periodically
Keep your feet clean and dry
It is important to note that warts can be very resistant to treatment and have a tendency to reoccur. Over-the-counter foot wart treatments are usually ineffective because their use can inadvertently destroy surrounding healthy tissue. Please contact our office for help in effectively treating warts. Our practice is expert in recommending the best treatment for each patient, ranging from prescription ointments or medications to, in the most severe cases, laser cautery.

Blisters

Most blisters on the feet are caused by friction and do not require medical attention. New skin will form underneath the affected area and the fluid built up in the blister is simply absorbed back into the tissue. You can soothe ordinary blisters with vitamin E ointment or an aloe-based cream.

Do not puncture a blister unless it is large, painful, or likely to be further irritated. If you have to pop a blister, use a sterilized needle or razor blade. Wash the area thoroughly, then make a small hole and gently squeeze out the clear fluid. Apply a dab of hydrogen peroxide to help protect against infection. Do not remove the skin over a broken blister. The new skin underneath needs this protective cover. Cover the area with a bandage and mild compression.

If the fluid is white or yellow, the blister is infected and needs medical attention.

Burning Feet

Burning feet refers to a foot sensation that is most frequently experienced by adults over age 50 and those who are diabetic. Thyroid dysfunction, gastric restriction in morbidly obese people, and heavy use of alcohol also have been linked with burning feet. Nerve problems, such as neuromas and tarsal tunnel syndrome, may also be associated with the sensation of burning feet.

It is not unusual for feet to ache or burn at the end of a long day. However, on an ongoing basis, burning feet can be a symptom of a more serious health problem. Please consult our office and schedule an appointment if you experience persistent burning feet.

There are some simple ways to mitigate burning feet:

Make sure you wear shoes that fit properly and provide support for your unique foot structure
Take foot baths daily to treat hot and sweaty feet
Wear socks of cotton, versus synthetic, fibers as they are lighter and cooler
Avoid long periods of standing
Try cushioned or shock-absorbing insoles in your shoes to make standing more comfortable
In some cases, orthotics may be helpful to correct any underlying mechanical imbalances which may be responsible for your burning feet

Callus

A callus, also known as hyperkeratosis, is an area of hard, thickened skin that can occur across the ball of the foot, on the heel, or on the outer side of the big toe. Although many consider them a skin problem, they are indicative of a problem with the bone.

Calluses form from repeated friction and pressure, as the shoe (or ground) rubs against a bony prominence (bone spur) on the toe or foot. The skin thickens in response to this pressure. Small amounts of friction or pressure over long periods of time cause a corn or callus. A great deal of friction or pressure over shorter periods of time can cause blisters or open sores. Calluses typically develop under a metatarsal head (the long bone that forms the ball of the foot). Calluses have painful nerves and bursal sacs (fluid-filled balloons that act as shock absorbers) beneath them, causing symptoms ranging from sharp, shooting pain to dull, aching soreness.

Calluses can be treated with over-the-counter callus removers, which use strong acids to peel this excess skin away after repeated application. Be careful using these products as they can cause chemical burns when misapplied or used in excess. Alternatively, treat calluses as follows: Begin by soaking the foot or feet in warm soapy water and gently rubbing away any dead skin that loosens. Next, use a pumice stone or emery board to file away the thickened skin. Apply a good moisturizer to the hardened areas to keep them softer and relieve pain. Nonmedicated corn pads or moleskin (a thin fuzzy sheet of fabric with an adhesive back) are available in stores and can relieve pain caused by calluses. However, use caution removing pads or moleskins to avoid tearing the skin.

If you need assistance relieving calluses, please contact our office. We can trim and apply comfortable padding to the painful areas. In more severe cases, we may prescribe medication to relieve inflammation, or inject cortisone into the underlying bursal sac to rapidly reduce pain and swelling.

A plantar callus forms on the bottom of the heel over time where one metatarsal bone is longer or lower than the others. This structure causes the one metatarsal to hit the ground first and with more force than it is equipped to handle. As a result, the skin under this bone thickens. In most cases, plantar calluses can be treated without surgery. In some recurring cases, however, a surgical procedure, called an osteotomy, is performed to relieve the pressure on the bone.

A condition called Intractable Plantar Keratosis (IPK) is a deep callus directly under the ball of the foot. IPK is caused by a “dropped metatarsal,” which happens when the metatarsal head drops to a lower level than the surrounding metatarsals and protrudes from the bottom of the foot. This results in more pressure being applied in this area and causes a thick callus to form. A dropped metatarsal can either be a congenital abnormality, a result of a metatarsal fracture, or a structural change that may have occurred over time.

You can prevent calluses by:

Switching to better-fitting shoes or using an orthotic device to correct an underlying cause
Buying socks with double-thick toes and heels or nylon hose with woven cotton soles on the bottom of the foot

Corns

Corns are calluses that form on the toes because of bones that push up against shoes and build up pressure on the skin. The surface layer of the skin thickens, irritating the tissues underneath. Hard corns are usually located on the top of the toe or on the side of the small toe. Soft corns resemble open sores and develop between the toes as they rub against each other.

Improperly fitting shoes are a leading cause of corns. Toe deformities, such as hammertoe or claw toe, also can lead to corns. Self-care for corns includes soaking feet regularly and using a pumice stone or callus file to reduce the size of the corn. Special over-the-counter, non-medicated, donut-shaped foam pads can be worn to help relieve the pressure and discomfort. For large or lasting corns, please contact our office. We can safely and painlessly remove the corns using special instruments.

Heel Fissures

Heel fissures is the term for cracking of the skin of the heels. This can be a painful condition that can cause bleeding. Walking barefoot or using open-backed sandals / shoes that allow more slippage around the heel while walking are often culprits that cause heel fissures. Skin conditions, such as eczema and psoriasis, can also lead to heel fissures. The skin thickens as a result of the friction. As the skin thickens, fissures will form around the periphery of the heel. These fissures or cracks can become deep and be very painful. Treatment involves removing the callus. Wearing proper shoes and the use of deep skin moisturizers and lotions can reduce the dryness associated with the condition and allow the foot to heal.

Smelly Feet and Foot Odor

The feet and hands contain more sweat glands than any other part of the body, with roughly 3,000 glands per square inch. Smelly feet are not only embarrassing, but can be physically uncomfortable as well.

Feet smell for two reasons:

Shoe Wear, and
Sweating of the Feet
The interaction between the perspiration and the bacteria that thrive in shoes and socks generates the odor. Therefore, any attempt to reduce foot odor has to address both sweating and footwear.

Smelly feet or excessive sweating can also be caused by an inherited condition, called hyperhidrosis, which primarily affects men. Stress, some medications, fluid intake, and hormonal changes also can increase the amount of perspiration our bodies produce.

In general, smelly feet can be controlled with a few preventive measures:

Always wear socks with closed shoes
Avoid wearing nylon socks or plastic shoes. Instead, wear shoes made of leather, canvas, mesh, or other materials that let your feet breathe
Bathe feet daily in lukewarm water, using a mild soap. Dry thoroughly
Change socks and shoes at least once a day
Check for fungal infections between toes and on the bottoms of your feet. If any redness or dry, patchy skin is observed, get treatment right away
Don’t wear the same pair of shoes two days in a row. If you frequently wear athletic shoes, alternate pairs so that the shoes can dry out. Give your shoes at least 24 hours to air out between wearings; if the odor doesn’t go away, discard the shoes
Dust your feet frequently with a nonmedicated baby powder or foot powder. Applying antibacterial ointment also may help
Practice good foot hygiene to keep bacteria levels at a minimum
Wear thick, soft socks to help draw moisture away from the feet. Cotton and other absorbent materials are best
Treating Foot Odor

The best home remedy for foot odor is to soak feet in strong black tea for 30 minutes a day for a week. The acid in the tea kills the bacteria and closes the pores, keeping your feet dry longer. Use two tea bags per pint of water. Boil for 15 minutes, then add two quarts of cool water. Soak your feet in the cool solution. Alternately, you can soak your feet in a solution of one part vinegar and two parts water.

Persistent foot odor can indicate a low-grade infection or a severe case of hereditary sweating. In these cases, a prescription ointment may be required to treat the problem.

Treating Excessive Sweating

A form of electrolysis, called iontophoresis, has been shown to reduce excessive sweating of the feet. However, it is more difficult to administer. In the worst cases of hyperhidrosis, a surgeon can cut the nerve that controls sweating. Recent advances in technology have made this surgery much safer, but may increase sweating in other areas of the body.

Ulcers

Ulcers are skin wounds that are slow to heal. In the foot, as prominent metatarsal heads on the plantar (bottom of the foot) are subjected to increased pressure, the skin begins to become callused. When subjected to shearing forces, there is a separation between the layers on this callused skin, which fills with fluid and becomes contaminated and infected. The result is a foot ulcer.

Ulcers are classified in four stages, according to how deeply they penetrate the layers of skin they have broken through.

The four stages of ulcers are:

Stage 1 – Characterized by reddening wounds over bony areas. The redness on the skin does not go away when pressure is relieved
Stage 2 – Characterized by blisters, peeling, or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin
Stage 3 – Characterized by broken skin and sometimes bloody drainage. There is a full thickness skin loss involving subcutaneous tissue (the tissue between the skin and the muscle.)
Stage 4 – Characterized by breaks in the skin involving skin, muscle, tendon, and bone and are often associated with a bone infection (osteomyelitis)
The are also four major cause of foot ulcers:

Neuropathic – Related to the nerves and characterized by a loss of sensation in the feet
Arterial – Related to poor blood circulation to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel, and top of the foot. It can very easily become infected
Venous – Related to compromised veins. These ulcers are often seen around the inside of the ankle and are slow to heal
Decubitus – Derived from excessive and prolonged pressure on one area of the foot. The most common type of decubitus ulcer of the feet is bed sores on the backs of the heels of people confined to bed for long periods of time
Foot ulcers are a common problem for diabetics. Contact casts are sometimes applied to the diabetic foot to relieve the bony prominent areas of pressure, allowing ulcers to heal.

Tendonitis

Achilles Tendonitis

The Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. It also is the most frequently ruptured tendon, usually as a result of a sports injury. Both professional and weekend athletes may suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.

Events that can cause Achilles tendonitis may include:

Hill running or stair climbing
Overuse, stemming from the natural lack of flexibility in the calf muscles
Rapidly increasing mileage or speed when walking, jogging, or running
Starting up too quickly after a layoff in exercise or sports activity, without adequately stretching and warming up the foot
Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort, such as in a sprint
Improper footwear and/or a tendency toward overpronation
Achilles tendonitis often begins with mild pain after exercise or running that gradually worsens.

Other symptoms include:

Recurring localized pain, sometimes severe, along the tendon during or a few hours after running.
Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone
Sluggishness in your leg
Mild or severe swelling
Stiffness that generally diminishes as the tendon warms up with use
Treatment normally includes:

A bandage specifically designed to restrict motion of the tendon
Taking nonsteroidal anti-inflammatory medication for a period of time.
Note: Please consult your physician before taking any medication
Orthotics, which are corrective shoe inserts designed to help support the muscle and relieve stress on the tendon. Both nonprescription orthoses (such as a heel pads or over-the-counter shoe inserts) and prescribed custom orthotics may be recommended depending on the length and severity of the problem
Rest and switching to exercises that do not stress the tendon (such as swimming)
Stretching and exercises to strengthen the weak muscle group in front of the leg, calf, and the upward foot flexors, as well as massage and ultrasound
In extreme cases, surgery is performed to remove the fibrous tissue and repair any tears.

Peroneal Tendonitis

Peronealtendons support two important foot muscles (Peroneus Brevis and Peroneus Longus) that originate on the outside of the calves. These two muscles allow you to roll to the outside of your foot while standing.

Peroneal tendons are also called stirrup tendons because they help hold up the arch of the foot. The two muscles are held in place by a band of tissue, called the peroneal retinaculum. Injury to the retinaculum can cause this tissue to stretch or tear. When this happens, the peroneal tendons can dislocate from their groove on the back of the fibula. The tendons can be seen to roll over the outside of the fibula, which damages the tendons.

Skiing, football, basketball, and soccer are the most common sports activities leading to peroneal tendon dislocation. In some cases, ankle sprains also have caused this condition. Patients usually have to use crutches after such an injury, in order to allow the retinaculum tissue to heal and the tendons to move back to their natural position on the fibula. Sometimes a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice are often part of the treatment.

Note: Please consult your physician before taking any medications.

In moderate to severe cases of injury, when the peroneal retinaculum is torn or severely stretched and susceptible to dislocation, surgery may be required.

Tibialis Posterior Tendonitis

Painful progressive flatfoot, otherwise known as tibialis posterior tendonitisor adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.

Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive flatfoot.

Note: Please consult your physician before taking any medications.

In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

Digital Deformity

Many disorders can affect the joints of the toes, causing pain and preventing the foot from functioning as it should. People of all ages can have toe problems, from inherited to acquired.

Toe deformities in adults result mainly from an imbalance of the tendons, causing them to stretch or tighten abnormally. People with abnormally long toes, flat feet, or high arches have a greater tendency to develop toe deformities. Arthritis is another major cause of discomfort and deformity. Toe deformities also can be aggravated by poorly fitting footwear, or if a fractured toe heals in a poor position.

The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, and overlapping and underlapping toes.

Hammertoe Deformity

Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Causes of hammertoe include improperly fitting shoes and muscle imbalance.

Treatment for the condition typically involves wearing shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions, or non-medicated corn pads may also relieve symptoms. In severe cases, hammertoe surgery may be recommended to correct the deformity.

Clawtoe Deformity

Claw toe is caused by nerve damage from diseases like diabetes or alcoholism, which can weaken muscles in the foot. The term stems from the toes’ appearance-toes that look like claws digging down into the soles. Claw toe may lead to the formation of painful calluses. Claw toe worsens without treatment and may become a permanent deformity over time.

Common symptoms of claw toe include:

Toes bent upward from the joints at the ball of the foot
Toes bent downward at the middle joints toward the sole of the shoe
Corns on the top of the toe or under the ball of the foot
Claw toe deformities are easier to repair when detected early. Splints or tape is used to hold the toes in correct position.

Overlapping /Underlapping Toes

Clawtoe Deformity
Overlapping toes are characterized by one toe lying on top of an adjacent toe. The fifth toe is the most commonly affected. Overlapping toes may develop in the unborn fetus. Passive stretching and adhesive taping is most commonly used to correct overlapping toes in infants, but the deformity usually recurs. Sometimes they can be surgically corrected by releasing the tendon and soft tissues about the joint at the base of the fifth toe. In some extreme cases, a pin may be surgically inserted to hold the toe in a straighten position. The pin, which exits the tip of the toe, may be left in place for up to three weeks.

Nail Problems

Ingrown Toenails

Ingrown nails are nails whose corners or sides dig painfully into the skin, often causing infection. They are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity, and poor foot structure.

Toenails should be trimmed straight across, slightly longer than the end of the toe, with toenail clippers.

If they become painful or infected, contact our office. We may remove the ingrown portion of the nail and if the condition reoccurs frequently, may permanently remove the nail.

Fungal Nail Infection

Many people don’t realize they have a fungal nail problem and, therefore, don’t seek treatment. Yet, fungal toenail infections are a common foot health problem and can persist for years without ever causing pain. The disease, characterized by a change in a toenail’s color, is often considered nothing more than a mere blemish. Left untreated, however, it can present serious problems.

Also referred to as onychomycosis, fungal nails are infections underneath the surface of the nail, which may also penetrate the nail. Fungal nail infections are often accompanied by a secondary bacterial and/or yeast infection in or about the nail plate, which ultimately can lead to difficulty and pain when walking or running. Symptoms may include discoloration, brittleness, loosening, thickening, or crumbling of the nail.

A group of fungi, called dermophytes, easily attack the nail and thrive on keratin, the nail’s protein substance. In some cases, when these tiny organisms take hold, the nail may become thicker, yellowish-brown, or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.

Nail bed injury may make the nail more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of Athlete’s Foot or excessive perspiration.

You can prevent fungal nail infections by taking these simple precautions:

Exercise proper hygiene and regularly inspect your feet and toes
Keep your feet clean and dry
Wear shower shoes in public facilities whenever possible
Clip nails straight across so that the nail does not extend beyond the tip of the toe
Use a quality foot powder (talcum, not cornstarch) in conjunction with shoes that fit well and are made of materials that breathe
Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to “wick” away moisture faster than cotton or wool socks, especially for those with more active lifestyles
Disinfect home pedicure tools and don’t apply polish to nails suspected of infection
Depending on the type of infection you have, over-the-counter liquid antifungal agents may not prevent a fungal infection from recurring. A topical or oral medication may need to be prescribed, and the diseased nail matter and debris removed, a process called debridement.

Note: Please consult your physician before taking any medications.

In severe cases, surgical treatment may be required to remove the infected nail. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured and prevents the return of a deformed nail.

Heel Pain

Plantar Fasciitis

Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.

Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy.

Note: Please consult your physician before taking any medications.

In persistent cases, surgery may be used to treat the heel pain.

Haglund Deformity

Haglund’s Deformity (also known as pump bump or retrocalcaneal bursitis) is a painful enlargement on the back of the heel bone that becomes irritated by shoes. It normally appears as a red, painful, and swollen area in the back of the heel bone. Women tend to develop the condition more than men because of irritation from rigid heel counters in shoes that rub up and down on the back of the heel bone.

Changing shoes, soaking feet, and anti-inflammatory medications often mitigate the symptoms of this problem.

Note: Please consult your physician before taking any medications.

Diabetic Wounds

Ulcers

Ulcers are skin wounds that are slow to heal. In the foot, as prominent metatarsal heads on the plantar (bottom of the foot) are subjected to increased pressure, the skin begins to become callused. When subjected to shearing forces, there is a separation between the layers on this callused skin, which fills with fluid and becomes contaminated and infected. The result is a foot ulcer.

Ulcers are classified in four stages, according to how deeply they penetrate the layers of skin they have broken through.

The four stages of ulcers are:

Stage 1 – Characterized by reddening wounds over bony areas. The redness on the skin does not go away when pressure is relieved
Stage 2 – Characterized by blisters, peeling, or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin
Stage 3 – Characterized by broken skin and sometimes bloody drainage. There is a full thickness skin loss involving subcutaneous tissue (the tissue between the skin and the muscle.)
Stage 4 – Characterized by breaks in the skin involving skin, muscle, tendon, and bone and are often associated with a bone infection (osteomyelitis)
Ulcers
The are also four major cause of foot ulcers:

Neuropathic – Related to the nerves and characterized by a loss of sensation in the feet
Arterial – Related to poor blood circulation to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel, and top of the foot. It can very easily become infected
Venous – Related to compromised veins. These ulcers are often seen around the inside of the ankle and are slow to heal
Decubitus – Derived from excessive and prolonged pressure on one area of the foot. The most common type of decubitus ulcer of the feet is bed sores on the backs of the heels of people confined to bed for long periods of time
Foot ulcers are a common problem for diabetics. The doctors at Rhode Island Foot Care are experts with all the latest technologies in wound care including the use of skin graft substitutes, wound vac therapy, orthomechanical bracing, and specialized surgical techniques that can help ulcers to heal.