Medical Care

Diagnostic Procedures

Computed Tomography

Computed tomography (CT) examination (also known as a CAT scan) is used in podiatry to help diagnose and treat foot or ankle problems. A CT is a kind of X-ray device that takes cross sectional images of a part of the body, giving the physician a three-dimensional image.

CT scans are often superior to conventional X-rays because they can more accurately pinpoint a suspected problem. Common foot problems a CT exam can help diagnose include: arthritis, deformities, flat feet, foreign bodies, fractures, infection, and tumors.

Pregnant women, especially those in their first trimester, are advised against having a CT exam or any X-ray examination because the radiaiton may harm the unborn child.

X-Rays

X-rays help determine whether a bone has been fractured or damaged by conditions such as an infection, arthritis, or other disease.

Other reasons for conventional X-rays on your feet are to:

Evaluate changes in the bones from infections, arthritis, or other bone disease.
Assess whether a child's bones are growing normally.
Locate foreign objects (such as pieces of glass or metal) in a wound.
Determine whether bones are properly set after treating a fracture.

Pregnant women, especially those in their first trimester, are advised against having X-rays because the radiation may harm the unborn child.

MRI

Magnetic resonance imaging (MRI) is sophisticated diagnostic equipment used to diagnose an array of health problems or conditions, including:

Arthritis
Fractures
Infections
Injuries of the tendons, ligaments, or cartilage.
Tumors

MRIs use no radiation like conventional X-rays or CT scans. They employ large magnet and radio waves to produce three-dimensional images. MRIs are very good at portraying soft tissues and bones in your feet and ankles.

People with the following conditions may not be good candidates for a MRI:

Conditions that requires a heart pacemaker.
Artificial heart valves.
Electronic inner ear implants.
Electronic stimulators.
Implanted pumps.
Metal fragments in eyes.
Surgical clips in the head (particularly aneurysm clips).

Individuals with dental fillings or bridges, a replacement hip or knee, or tubal ligation clips are generally safe to have a MRI.

In most cases, a full exam of the foot and ankle via MRI lasts between 60 and 90 minutes.

Ultrasound

Ultrasound is a very effective tool for diagnosing a wide variety of foot and ankle problems, particularly soft tissue problems. Ultrasound uses sound waves on the body in a way much like radar uses sound waves. The waves hit a targeted area and are bounced back to a recording device, which produces an image. Ultrasound is a completely safe, noninvasive, and painless diagnostic procedure.

Common problems for which ultrasound may be prescribed include:

Bursitis
Heel spurs or plantar fasciitis.
Injuries of the ligaments, tendons, or cartilage.
Morton's neuroma.
Presence of foreign bodies.
Soft tissue masses.
Tarsal tunnel syndrome.
Tendonitis or tears in a tendon.

Orthotics

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 orthotics 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.

Rigid Orthotics

Rigid orthotic devices are designed to control function and are used primarily for walking or dress shoes. They are often composed of a firm material, such as plastic or carbon fiber. Rigid orthotics are made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot. Rigid orthotics control motion in the two major foot joints that lie directly below the ankle joint and may improve or eliminate strains, aches, and pains in the legs, thighs, and lower back.

Soft Orthotics

Soft orthotics are generally used to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. They are usually effective for diabetic, arthritic, and deformed feet. Soft orthotics are typically made up of soft, cushioned materials so that they can be worn against the sole of the foot, extending from the heel past the ball of the foot, including the toes. Like rigid orthotics, soft orthotics are also made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot.

Semi-Rigid Orthotics

Semi-rigid orthotics provide foot balance for walking or participating in sports. The typical semi-rigid orthotic is made up of layers of soft material, reinforced with more rigid materials. Semi-rigid orthotics are often prescribed for children to treat flatfoot and in-toeing or out-toeing disorders. These orthotics are also used to help athletes mitigate pain while they train and compete.

Surgical Procedures - General Information

Surgery on the foot, ankle, or lower leg is usually performed by podiatric surgeons and orthopedic surgeons specializing in the foot and ankle.

Foot and ankle surgeries address a wide variety of foot problems, including:

Sprains and fractures.
Arthritis and joint disease.
Benign and malignant tumors.
Birth deformities.
Bunions
Calluses and warts.
Corns and hammertoes.
Flatfeet.
Heel or toe spurs.
Neuromas (nerve tumors).

Many foot and ankle surgeries today can be performed in the doctor's office or a surgical center on an outpatient basis. They frequently can be performed using local anesthesia, in some cases combined with sedation. Most foot surgeries require a period of immobilization after the procedures with protective devices, such as a bandages, splints, surgical shoes, casts, or open sandals. Limited weight bearing, elevating and icing the foot, and keeping the area dry are commonly required for the first two weeks following surgery until sutures are removed. Most surgeons will encourage post-operative exercise of the foot and legs to speed recovery. In addition, many patients need additional therapy or treatments after surgery in order to aid in the healing and recovery process. These may include physiotherapy, orthotic devices, and special footwear. After sufficient healing time, which varies from procedure to procedure, most patients can resume wearing their usual footwear.

Therapies

Athlete's Foot Treatment

If untreated, skin blisters and cracks caused by Athlete's Foot can cause serious bacterial infections. The treatment of Athlete's Foot depends on the type and extent of the fungal infection, so it is important to consult our practice before choosing a therapy.

Athlete's Foot can usually be treated with antifungal creams. Re-infection is common, so it is important to continue the therapy as prescribed, even if the fungus appears to have gone away. Lasting cases of Athlete's Foot may require foot soaks before applying antifungal creams. Severe infections that appear suddenly (acute) usually respond well to treatment. Toenail infections that develop with Athlete's Foot tend to be more difficult to cure than fungal skin infections.
Cryotherapy

Cryotherapy is a standard treatment for warts that uses a very cold substance (usually liquid nitrogen) to freeze and deaden the tissue. Cryotherapy can be done in a doctor's office and takes less than a minute.

During the procedure, the doctor applies the liquid nitrogen to the wart using a probe or a cotton swab. Liquid nitrogen can also be sprayed directly on the wart. The freezing liquid can cause discomfort or pain, which is why a numbing drug (local anesthetic) is sometimes used.

Most cryotherapy treatment requires return visits to ensure that the wart is completely removed.
Studies show that cryotherapy is successful about two-thirds of the time, and when combined with salicylic acid treatment, up to 78% of the time.
Extracorporeal Shock Wave

Extracorporeal Shock Wave Therapy (ESWT) is used to treat chronic heel pain (plantar fasciitis). "Extracorporeal" means "outside of the body." During this noninvasive procedure, sonic waves are directed at the area of pain using a device similar to that currently used in nonsurgical treatment of kidney stones.

Extracorporeal Shock Wave Therapy is prescribed for patients who have experienced plantar fasciitis for an extended period of time -- six months or more -- and have not benefited from other conservative treatments. The brief procedure lasts about 30 minutes and is performed under local anesthesia and/or "twilight" anesthesia. Strong sound waves are directed at and penetrate the heel area to stimulate a healing response by the body. ESWT is performed on an outpatient basis. Although there are no bandages, someone will need to drive the patient home.

People who are not candidates for ESWT include pregnant women and individuals with neurological foot disease, vascular foot disease, pacemakers, or people taking medications that interfere with blood clotting (such as Coumadin).

This therapy is a safe and effective alternative treatment for heel pain and only requires a short recovery time. Clinical studies show a 70 percent success rate for treatment of plantar fasciitis using Extracorporeal Shock Wave Therapy.

Iontophoresis

Iontophoresis is a procedure used to treat excessive sweating in the hands or feet. The procedure involves one or a series of short, 10- to 20-minute sessions in the doctor's office during which a light electrical current is passed through water into the feet. The current is gradually increased until the patient experiences a slight tingling sensation. It is believed, although not clinically proven, that this process plugs up the sweat glands.
Physical Therapy

Physical therapy can often help decrease the pain and swelling in a painful area of the foot or ankle. Heel spurs, bursitis, plantar fasciitis, bunions, corns and calluses, as well as many post-operative surgical conditions, respond well to physical therapy.

Common kinds of physical therapy may include hot packs, massage, paraffin baths, electrical stimulation, ultrasound, and diathermy (deep heating of tissues through use of electric current) to relieve pain and swelling, increase range of motion, prevent joint stiffening, rebuild muscle strength, and support the proper alignment of foot structures.
Neurolysis

Neurolysis is a therapeutic procedure used to treat neuromas. During this nonsurgical procedure, the affected nerve is chemically destroyed via seven weekly injections of ethanol mixed with a local anesthetic. Because nerve tissue has an affinity for ethanol, it absorbs the substance, which, after repeated exposure, becomes toxic and destroys the pain-causing nerve. Neurolysis has a success rate of more than 60 percent. However, this treatment modality is not widely accepted by insurance companies.