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Foot pain

Highlights

Overview

The foot is a complex structure of 26 bones and 33 joints, layered with an intertwining web of more than 120 muscles, ligaments, and nerves. Pain can occur anywhere along the foot, including in the toes, front of the foot, heel, or bottom of foot.

Causes

There are many causes of foot pain. They include:

Treatment

Most cases of foot pain can be treated with conservative measures. These include:

For certain conditions, physical therapy can be helpful. In severe cases, surgery may be needed.

Prevention

Introduction

Foot pain is very common. The foot is a complex structure of 26 bones and 33 joints, layered with an intertwining web of more than 120 muscles, ligaments, and nerves. It serves the following functions:

Foot pain generally starts in 1 of 4 places: the toes, the forefoot, the midfoot, or the hindfoot.

Toes: Toe problems often occur because of the pressure imposed by ill-fitting shoes. Conditions include:

Forefoot: The forefoot is the front of the foot. Pain originating here usually occurs in the metatarsal bones, the 5 long bones that extend from the front of the arch to the bone in the toe. Conditions include:

Midfoot: The midfoot is the middle of the foot that is in front of the ankle but behind the toes. Pain originating here usually occurs in the tarsal or base of the metatarsal bones. Conditions include:

Hindfoot: The hindfoot is the back of the foot. Pain originating here can extend from the heel, across the sole (known as the plantar surface), to the middle of the foot (base of the metatarsal bones). Conditions include:

Arch problems can also cause foot pain:

Causes

Foot pain can be due to a number of reasons. Common causes include:

Arthritic conditions affect and damage joints, including those in the feet and ankles:

Diabetes is an important cause of serious foot disorders:

Charcot foot is a special concern for people with diabetes. Charcot foot or Charcot joint (medically referred to as neuropathic arthropathy) is a degenerative condition that affects the bones and joints in the feet. It is associated with the nerve damage that occurs with neuropathy. A person with Charcot foot cannot feel the injuries and the joint will deteriorate quickly even without the person noticing it until significant damage has occurred.

Early changes appear similar to an infection, with the foot becoming swollen, red, and warm and can be caused by twisting the foot or ankle while walking or stepping off a stair. Gradually, the affected foot can become deformed. The bones may crack, splinter, and erode, and the joints may shift, change shape, and become unstable.

Charcot foot typically develops in people who have neuropathy to the extent that they cannot feel sensation in the foot and are not aware of an existing injury. Instead of resting an injured foot or seeking medical help, the person often continues normal activity, causing further damage.

Prostate

 Click the icon to see an image of foot inspection.

Risk Factors

A risk factor is anything that increases your chances of getting a disease or condition. The following are factors that increase your risk for foot pain.

Older people are at high risk for foot problems. As you age, your feet widen and flatten, and the fat padding on the sole of the foot wears down. The skin on the feet also becomes dryer. Foot pain in older adults may be the first sign of age-related conditions, such as arthritis and circulatory disease. Foot problems can also impair balance and gait and interfere with daily functioning.

Women are at higher risk than men for severe foot pain, likely because of high-heeled shoes and weaker ligaments.

Gaining weight puts added stress on the feet and can lead to foot or ankle injuries. The added pressure on the soft tissues and joints of the foot in overweight people increases the likelihood of developing tendinitis and plantar fasciitis.

Pregnant women have an increased risk of foot problems due to weight gain, swelling in their feet and ankles, and the release of certain hormones that cause ligaments to relax. These hormones help when bearing the child, but they can weaken the feet.

People who engage in regular high-impact aerobic exercise are at risk for plantar fasciitis, heel spurs, sesamoiditis, Achilles tendinitis, and stress fractures. Women are at higher risk for stress fractures than men.

People who spend long amounts of time on their feet at work often experience foot problems.

Taking fashion to extreme limits, some people turn to cosmetic surgery as a drastic way to fit into high-heeled shoes. Procedures include surgical shortening of the toes, narrowing of feet, or injecting silicone into the pads of the feet. Such methods may increase your risk for future foot pain.

The American Orthopaedic Foot and Ankle Society (AOFAS) and other foot-related medical associations have expressed concern over this trend. The AOFAS strongly advises against cosmetic foot surgery and urges consumers to carefully consider the relative risks and benefits of undergoing unnecessary surgical procedures.

Corns and Calluses

A corn is a protective layer of dead skin cells that forms due to repeated friction. It is cone-shaped and has a knobby core that points inward. This core can put pressure on a nerve and cause sharp pain.

Corns can develop on the top of, or between, toes. If a corn develops between the toes, it may be kept pliable by the moisture from perspiration and is therefore called a soft corn.

Corns develop as a result of friction from the toes rubbing together or against the shoe. They often occur from:

Calluses are composed of the same material as corns. Calluses, however, develop on the ball or heel of the foot. The skin on the sole of the foot is ordinarily about 40 times thicker than the skin anywhere else on the body, but a callus can even be twice as thick.

A protective callus layer naturally develops to guard against excessive pressure and chafing as people get older and the padding of fat on the bottom of the foot thins out. If calluses get too big or too hard, they may pull and tear the underlying skin.

Risk factors for calluses include:

Preventing Corns and Calluses and Relieving Discomfort. To prevent corns and calluses and relieve discomfort if they develop:

Removing Corns and Calluses. To remove a corn or callus, soak it in very warm water for 5 minutes or more to soften the hardened tissue, then gently sand it with a pumice stone. Several treatments may be necessary. Do not trim corns or calluses with a razor blade or other sharp tool unless done by a medical professional. Unsterile cutting tools can cause infection, and it is easy to slip and cut too deep, causing excessive bleeding or injury to the toe or foot.

Medicated Solutions and Pads. There are numerous over-the-counter pads, plasters, and medications for removing corns and calluses. These treatments commonly contain salicylic acid, which may cause irritation, burns, or infections that are more serious than the corn or callus. Use caution with these medications. Do not use them if you have:

Bunions

A bunion is a deformity that usually occurs at the end of one of the five long bones (the metatarsal bones) that extend from the arch of the foot and connect to the toes.

Most often bunions develop in the first metatarsal bone (the one that attaches to the big toe). A bunion may also develop in the bone that joins the little toe to the foot (the fifth metatarsal bone), in which case it is known as either a bunionette or a tailor's bunion.

A bunion typically develops in the following way:

One important bunion deformity, hallux valgus, causes the bone and joint of the big toe to shift and grow inward, so that the second toe crosses over it. The second toe may grow over or under the big toe as they cross over. This can cause more corn to develop

People born with abnormal bones in their feet are more likely to form a bunion. In addition, wearing narrow-toed, high-heeled shoes, which put enormous pressure on the front of the foot, may also lead to a bunion formation. The condition may become painful as extra bone and a fluid-filled sac grow at the base of the big toe.

Flat feet, gout, arthritis, and occupations (such as ballet) that place undue stress on the feet can also increase the risk for bunions.

Shoes and Protective Pads. Pressure and pain from bunions and bunionettes can be relieved by wearing appropriate shoes, such as:

A thick doughnut-shaped, moleskin pad can protect the protrusion. In some cases, an orthotic can help redistribute weight and take pressure off the bunion. Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may offer some pain relief.

Surgery. If discomfort persists, surgery may be necessary, particularly for more serious conditions, such as hallux valgus. There are different surgical approaches, ranging from removing the bump to realigning the toes.

The most common surgery, an office procedure known as bunionectomy, involves shaving down the bone of the big toe joint. Surgery can help, but it may not completely cure all symptoms if the condition is severe.

Bunion removal - series

Click the icon to see an illustrated series detailing bunion removal.

More extensive surgeries may be required to realign the toe joint. Although there are variations of each, they generally involve one or more of the following:

In severe cases, surgeons may use bone grafts to restore bone length in people who have had previous bunion surgeries or damage from osteoarthritis.

Complications, though uncommon in even the most complex procedures, can include:

Recovery from more invasive procedures, such as arthrodesis or osteotomy, may take 4 to 6 months, and it can be up to 6 to 8 weeks before a person can put full weight on the foot. In such cases, the person will need to wear a cast or use crutches or a wheelchair.

Hammertoe

A hammertoe is a permanent deformity of the toe joint, in which the toe bends up slightly and then curls downward, resting on its tip. When forced into this position long enough, the tendons of the toe shrink, and the toe stiffens into a hammer- or claw-like shape.

Hammertoe is most common in the second toe, but it can develop in any or all of the three middle toes if they are pushed forward and do not have enough room to lie flat in the shoe. The risk is increased when the toes are already crowded by the pressure of a bunion. Conditions that increase the risk of hammertoe include:

Hammertoe

 Click the icon to see an image of a hammertoe.

Treatment for Hammertoe. At first, a hammertoe is flexible, and any pain it causes can usually be relieved by putting a toe pad, sold in drug stores, into the shoe. To help prevent and ease existing discomfort from hammertoes, shoes should have a deep, wide toe area. As the tendon becomes tighter and the toe stiffens, other treatments, including exercises, splints, and custom-made shoe inserts (orthotics) may help redistribute weight and ease the position of the toe.

Surgery. People with severe cases of hammertoe may need surgery. If the toe is still flexible, only a simple procedure that releases the tendon may be needed. If the toe has become rigid, more extensive surgery involving the bone may be required. .

Ingrown Toenails

Ingrown toenails can occur on any toe, but they are most common on the big toes. They usually develop when tight-fitting or narrow shoes put too much pressure on the toenail and force the nail to grow into the flesh of the toe. Incorrect toenail trimming can contribute to the risk of developing an ingrown toenail. Other causes include:

Ingrown toenail

An ingrown toenail is a condition in which the edge of the toenail grows into the skin of the toe. The big toe is most commonly affected. Symptoms include pain, redness, and swelling around the toenail.

Caring for Toenails. Trim toenails straight across and keep them long enough so that the nail corner is not visible. If the nail is cut too short, it may grow inward. If the nail does grow inward, do not cut the nail corner at an angle. This only trains the nail to continue growing inward. When filing the nails, file straight across the nail in a single movement, lifting the file before the next stroke. Do not saw back and forth. A cuticle stick can be used to clean under the nail.

Treatments. To relieve pain from ingrown toenails, try wearing sandals or open-toed shoes. Soaking the toe for 5 minutes twice a day in a warm water solution of salt, Domeboro or Betadine can help. People who are at increased risk for infections, such as those with diabetes, should have professional treatment.

Antibiotic ointments may help treat ingrown toenails that are infected. Apply the ointment by working a wisp of cotton under the nail, especially the corners, to lift the nail up and drain the infection. The cotton will also help force the toenail to grow out correctly. Change the cotton daily, and use the antibiotic consistently.

In severe cases, more intensive treatments are needed. Surgery involves simply cutting away the sharp portion of ingrown nail, removing the nail bed, or removing a wedge of the affected tissue. Orthonyxia is a technique that implants a small metal brace into the top of the nail.

Some of the nail bed or tissue may be removed without making incisions. Nonsurgical methods include using cauterization (heating), or lasers, to remove the skin.

Recurrence is typically higher after simple, more temporary procedures to relieve pain. A review of 24 studies (nearly 3,000 patients) evaluating treatments for ingrown nails found that surgical procedures are more effective than non-surgical therapies in preventing recurrences.

Forefoot Pain

Forefoot pain refers to pain and discomfort felt toward the top of the foot. The rate of forefoot pain and deformity increases with age. When a cause cannot be determined, any pain on the ball of the foot is generally referred to as metatarsalgia.

Forefoot pain may be due to:

A neuroma usually means a benign tumor of a nerve. However, Morton neuroma, also called interdigital neuroma, is not actually a tumor. It is a thickening of the tissue surrounding the nerves leading to the toes.

Morton neuroma usually develops when the bones in the third and fourth toes pinch together, compressing a nerve. It can also occur in other locations. The nerve becomes enlarged and inflamed. The inflammation causes a burning or tingling sensation and cramping in the ball of the foot. Other causes of this condition include:

Treatment for Neuromas. Pain from Morton neuroma can be reduced by massaging the affected area. Roomier shoes (box-toed shoes), pads of various sorts, and cortisone injections in the painful area are also helpful.

If these treatments are not effective, surgery may be an option. Surgical techniques involve removing a portion of the nerve or tissue surrounding the nerve. Occasionally, the nerve tissue may re-grow and form another neuroma.

Sesamoiditis is an inflammation of the tendons around the small, round bones that are embedded in the head of the first metatarsal bone, which leads to the big toe. Sesamoid bones bear much stress under ordinary circumstances, but excessive stress can strain the surrounding tendons. Often there is no clear-cut cause, but sesamoid injuries are common among people who participate in jarring, high-impact activities, such as ballet, jogging, and aerobic exercise.

Treatment for Sesamoiditis. Rest and reducing stress on the ball of the foot are the first lines of treatment for sesamoiditis. A low-heeled shoe with a stiff sole and soft padding inside is all that is usually required. In severe cases, surgery may be necessary.

A stress fracture in the foot, also called fatigue or march fracture, usually results from a break or rupture in any of the five metatarsal bones (mostly the second or third). These fractures are caused by overuse during strenuous exercise, particularly jogging and high-impact aerobics. Women are at higher risk for stress fracture than men.

A fracture in the first metatarsal bone, which leads to the big toe, is uncommon because of the thickness of this bone. If it occurs, however, it is more serious than a fracture in any of the other metatarsal bones because it dramatically changes the pattern of normal walking and weight bearing.

Treatment for Stress Fractures. You should seek treatment if pain persists for 3 weeks. Treatment after that time may reduce the chances of returning to previous level of functioning. Surgery may be needed if conservative measures fail. Conservative treatment usually include protected weight bearing with crutches or boots.

In most cases, stress fractures heal by themselves if you avoid rigorous activities. Some health care providers recommend moderate exercise, particularly swimming and walking. It is best to wear low-heeled shoes with stiff soles. Occasionally, a health care provider may recommend wearing a walking "boot" (brace) to reduce pain and facilitate healing.

Heel Pain

The heel is the largest bone in the foot. Heel pain can occur in the front, back, or bottom of the heel. Types of heel pain include:

Shoe inserts, medications, and stretching are generally first line of therapy for heel pain. If these treatments fail, prescription heel orthotics and extended physical therapy are recommended. Surgery may be an option if other methods have failed.

Achilles tendinitis, also called Achilles tendinosis, is an inflammation of the tendon that connects the calf muscles to the heel bone. It is caused by small tears in the tendon from overuse or injury. This condition is most common in people who engage in high-impact exercise, particularly jogging, racquetball, and tennis.

People who have a shortened Achilles tendon are at high risk for this disorder. Such people tend to roll their feet too far inward when walking, and may bounce when they walk. A shortened tendon can be due to an inborn structural abnormality, or it can develop from regularly wearing high heels. Tight calf muscles can also increase the risk for Achilles tendinitis.

Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning. The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.

The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.

Conservative treatments include:

Your health care provider may refer you to physical therapy. A physical therapist can prescribe exercises to help stretch and strengthen your calf muscles and Achilles tendon. The therapist may also apply modalities such as ultrasound to help break down any scar tissue.

The exercises used for Achilles tendinitis treatment are called eccentric training. They involve standing on the balls of your feet at the edge of a low stool or block, raising the heels and then gently allowing one heel at a time to reach toward the floor.

It is important to wear shoes that give you good support. Shoes that are slightly raised in the back are helpful for people with Achilles tendinitis. Your provider may also give you a prescription for a custom-made orthotic to fit inside your shoe.

If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon. Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.

Achilles tendinitis may make you more likely to have an Achilles rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick. Surgical repair may be necessary, but it is difficult because the tendon is not normal.

Bursitis of the heel is an inflammation of the bursa, a small sack of fluid beneath the heel bone. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil), and steroid injections will help relieve pain from bursitis. Applying ice and massaging the heel are also beneficial. A heel cup or soft padding in the heel of the shoe reduces direct impact when walking.

Pronation is the normal motion that allows the foot to adapt to uneven walking surfaces and to absorb shock. Excessive pronation occurs when the foot has a tendency to turn inward and stretch and pull the fascia. It can cause not only heel pain but also hip, knee, and lower back problems.

Haglund's deformity, known medically as posterior calcaneal exostosis, is a bony growth surrounded by tender tissue on the back of the heel bone. It develops when the back of the shoe repeatedly rubs against the back of the heel, aggravating the tissue and the underlying bone. It is commonly called "pump bump" because it is often linked to wearing high heels. (It can also develop in runners.)

Applying ice followed by moist heat will help ease discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil), will also reduce pain. Your provider may recommend an orthotic device to control heel motion.

In severe cases, surgery may be necessary to remove or reduce the bony growth. Studies suggest, however, that recovery from surgery is very long, and success rates vary. It is best to try conservative measures before considering surgery.

The plantar fascia is the thick tissue on the bottom of the foot. It connects the heel bone to the toes and creates the arch of the foot. When this tissue becomes swollen or inflamed, it is called plantar fasciitis. Plantar fasciitis is one of the most common orthopedic foot complaints.

You are more likely to get plantar fasciitis if you:

Plantar fasciitis was commonly thought to be caused by a heel spur. However, research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.

Most people with plantar fasciitis experience pain in the heel with their first steps in the morning. The pain also often spreads to the arch of the foot. The condition can be temporary, or it may become chronic if ignored. Resting can provide relief, but only temporarily.

Treatment of plantar fasciitis focuses on relieving pain, reducing inflammation, and restoring flexibility. Initial treatments include:

If these methods do not work, your health care provider may recommend other treatments such as corticosteroid injections into the heel, a boot cast, or custom-made orthotics. Sometimes, foot surgery may be needed.

Your provider may also refer you to a physical therapist. A physical therapist can show you exercises to help increase strength and flexibility. The therapist may also use treatments, such as ultrasound, to decrease inflammation. A typical stretching exercise involves:

With stretching treatments, the plantar fascia nearly always heals by itself but it may take as long as a year, with pain occurring intermittently. You need to be careful not to overdo activity or reinjure yourself while your foot is healing. In rare situations, you may need surgery to address the problem.

Arch Problems

"Flat foot," or pes planus, is a defect of the foot that eliminates the arch. Flat feet occur because the tissues holding the joints in the foot together (called tendons) are loose. Babies are born with flat feet but the tissues tighten and form an arch as children grow older. Most people have normal arches by the time they are adults. However, the arch may never develop in some people.

Flat feet can also develop in adulthood. In most cases, flat feet do not cause pain but certain conditions associated with flat feet may be painful.

A common cause of adult acquired flat feet is a condition called posterior tibial tendon dysfunction (PTTD). The posterior tibial tendon connects the calf muscles to bones in the feet. In PTTD, the tendon weakens and no longer supports the arch. Over time, the arch can collapse, causing pain around the ankle that worsens with activity. Risk factors for PTTD include:

Tarsal Tunnel Syndrome: People with flat feet are at increased risk for tarsal tunnel syndrome. This condition results from compression of the posterior tibial which, that runs through a narrow passage behind the inner ankle bone down to the heel. It can cause tingling, numbness, and pain along the inside of the ankle or bottom of the foot.

Treatment for pain associated with flat feet conditions generally involves rest, ice, pain relief medications, and insoles or custom-made orthotics to support the foot and prevent progression. In severe cases, corticosteroid injections may be needed to reduce inflammation. Physical therapy may be recommended.

An overly-high arch ("hollow foot") can also cause problems. High arch is an arch that is raised more than normal. The arch runs from the toes to the heel on the bottom of the foot. It is also called pes cavus. High foot arches are less common than flat feet. They are more likely to be caused by a bone (orthopedic) or nerve (neurological) condition.

Unlike flat feet, highly arched feet tend to be painful because more stress is placed on the section of the foot between the ankle and toes (metatarsals). This condition can make it difficult to fit into shoes. People who have high arches usually need some type of foot support with corrective shoes or inserts. They should also be checked for nerve and bone conditions.

Clawfoot, or pes cavus, is a deformity of the foot marked by very high arches and very long toes. The toes are pointed down and the arch is high, making the foot appear claw-like. Clawfoot is a hereditary condition, but it can also occur when muscles in the foot contract or become unbalanced due to nerve or muscle disorders.

Foot Injury

If you suspect that you have broken or fractured bones in a toe or foot, call your health care provider, who will probably order x-rays. Even if you can walk, you still might have a fracture. People are often able to walk even if a foot bone has been fractured, particularly if it is a chipped bone or a toe fracture.

The acronym RICE stands for rest, ice, compression, and elevation -- the four basic elements of immediate treatment for an injured foot.

Early treatment of injury

Minor injuries like sprains may be treated at home if broken bones are not suspected. The acronym RICE is helpful for remembering how to treat minor injuries: "R" stands for rest, "I" is for ice, "C" is for compression, and "E" is for elevation. Pain and swelling should decrease within 48 hours, and gentle movement may be beneficial, but don't put pressure on a sprained joint until the pain is completely gone (one to several weeks).

Prevention

The American Podiatric Medical Association offers the following tips for preventing foot pain:

When choosing shoes:

Skin creams can help maintain skin softness and pliability. A pumice stone or loofah sponge can help get rid of dead skin.

Taking a warm footbath for 10 minutes two or three times a week will keep the feet relaxed and may help prevent mild foot pain caused by fatigue. Adding 1/2 cup of Epsom salts may increase circulation and add other benefits. Taking footbaths only when the feet are painful is not as helpful.

The first year of life is important for foot development. Parents should cover their babies' feet loosely, allowing plenty of opportunity for kicking and exercise. Change the child's position frequently.

Children generally start to walk at 10 to 18 months. They should not be forced to start walking early. Wearing just socks or going barefoot indoors helps the foot develop normally and strongly and allows the toes to grasp. Going barefoot outside, however, increases the risk for injury and other conditions, such as plantar warts.

Children should wear shoes that are light and flexible, and since their feet tend to perspire, their shoes should be made of materials that breathe. Replace footwear every few months as the child's feet grow. Footwear should never be handed down. Protect children's feet if they participate in high-impact sports.

Shoes

In general, the best shoes are well cushioned and have a leather upper, firm heel counter, and flexible area at the ball of the foot. The heel area should be strong and supportive, but not too stiff, and the front of the shoe should be flexible.

New shoes should feel comfortable right away, without a breaking-in period. If shoes do need breaking in, place moleskin pads next to areas on the skin where friction is likely to occur. Once a blister occurs, moleskin is not effective. Change shoes during the day, and rotate between different pairs of shoes. As soon as the heels show noticeable wear, replace the shoes or their heels.

Well-fitted shoes are the best way to prevent many problems with the feet. The sole should be shock absorbent and the upper should be constructed of breathable material. Shoes with laces are good since they can be easily adjusted to accommodate width.

Shoes should be purchased in the afternoon or after a long walk, when the feet have swelled. There should be 1/2 inch of space between the longest toe and the tip of the shoe (remember, the longest toe is not always the big toe), and the toes should be able to wiggle upward. It is important that the front of the shoe provide adequate space for the toes.

Stand when being measured, and have both feet sized, buying shoes that fit whichever foot is largest. Wear the same socks as you would regularly wear with the new shoes. Women who are accustomed to wearing pointed-toe shoes may prefer the feel of tight-fitting shoes, but with wear their tastes may adjust to shoes that are less confining and properly fitted.

Shoes purchased for exercise should be specifically designed for a person's preferred sport. For instance, a running shoe should especially cushion the forefoot, while tennis shoes should emphasize ankle support. Athletic socks are almost as important as shoes. Experts often recommend padded acrylic socks.

Aerobics

Sufficient cushioning to absorb shock and pressure, which should be many times greater than shock from walking. Arches that maintain side-to-side stability. Thick upper leather support. Box toe. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to prevent collapse during pedaling. Heel lift. Cross-training or combo hiking/cycling shoes may be sufficient for the casual biker. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance the forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Fully bendable at the ball of the foot. Enough traction on the sole to prevent slipping. Consider insole or orthotic with arch support for problem feet.

Tennis

Allows side-to-side sliding. Low-traction sole. Snug fitting heel with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch anklebone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.

Insoles and Orthotics

Insoles are flat cushioned inserts that are placed inside the shoe. They are designed to reduce shock, provide support for heels and arches, and absorb moisture and odor. In general, they can be very helpful for many people.

People respond very differently to specific insoles. What may work for one person may not work for another. Consider the thickness of socks when purchasing insoles to be sure they do not squeeze the toes up against the shoes. Insoles can be purchased in athletic and drug stores. Shoe stores that specialize in foot problems often sell customized, but more expensive, insoles. Most well-known brands of athletic shoes have built-in insoles.

There are many types of insoles available. They are composed of various materials, such as cork, leather, plastic foam, and rubber. Many insoles are now made from viscoelastic polymers, which are gel-like materials that act both as liquids and solids.

People who have developed short, tightened Achilles tendons should consider using heel cushions. Like insoles, heel cushions are inserted inside the shoes. They should be at least 1/8 inch thick, but not more than 1/4 inch thick.

For certain conditions, your health care provider may give you a prescription for a custom-made orthotic. Custom orthotics (also called orthoses) are individually designed to fit your specific foot and foot problem. The orthotic provider will evaluate your gait and stance and do a custom casting of your feet. These molds are then used to create your personal orthotics.

Custom orthotics are much more expensive than store-bought shoe inserts. They are not usually covered by insurance. However, if you have severe foot problems they can be much more effective. They also last longer (usually for several years).

Orthotics fit into your regular shoes. (If wearing athletic shoes, you should first remove any existing insoles.) They can be made of different materials but are usually categorized as rigid, soft, or semi-rigid:

Resources

References

Asplund C, Best T. Achilles tendon disorders. BMJ. 2013;346:f1262.

Chohan S. Hallux valgus, bunion, bunionette, and other painful conditions of the toe. In: Waldman SD, ed. Pain Management. 2nd ed. Elsevier Saunders; 2011:chap 118.

Del Toro, DR. Tibial Neuropathy (Tarsal Tunnel Syndrome). In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Elsevier Saunders; 2015:chap 94.

Eekhof JA, Van Wijk B, Knuistingh Neven A, van der Wouden JC. Interventions for ingrowing toenails. Cochrane Database Syst Rev. 2012;4:CD001541.

Goff JD. Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82.

Irwin TA. Tendon injuries of the foot and ankle. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed. Elsevier Saunders; 2015:chap 117.

Kadakia AR. Heel pain and plantar fasciitis. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed. Elsevier Saunders; 2015:chap 119.

Kigner S, Scardina RJ. Metatarsalgia. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Elsevier Saunders; 2015:chap 90.

Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW. Plantar and medial heel pain: diagnosis and management. J Am Acade Orthop Surgery. 2014 Jun;22(6):372-80.

LeCursi N. Sports shoes and orthoses. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed. Elsevier Saunders; 2015:chap 115.

Lee SM, Scardina RJ. Morton neuroma. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Elsevier Saunders; 2015:chap 91.

Montero DB. Hammer toe. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Elsevier Saunders; 2015:chap 88.

Orchard J. Plantar fasciitis. BMJ. 2012;10;345:e6603.

Park D, Singh D. The management of ingrowing toenails. BMJ. 2012;344:e2089.

Pasquina PF, Foster LS. Miller ME. Plantar fasciitis. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Elsevier Saunders; 2015:chap 92.

Price MD, Chiodo CP. Foot and ankle pain. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Elsevier Saunders; 2013:chap 49.

Redmond AC. The ankle and foot. In: Hochberg MC, Silman AJ, Smolen JS, et al, eds. Rheumatology. 6th ed. Elsevier Mosby; 2015:chap 78.

Richter M, Kwon JY, DiGiovanni CW. Foot injuries. In: Browner BD, Jupiter JB, Krettek C, et al, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 5th ed. Elsevier Saunders; 2015:chap 67.

Stretanski MF. Achilles tendonopathy. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Elsevier Saunders; 2015:chap 81.

Wexler D, Grosser DM, Kile TA. Bunion and bunionette. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Elsevier Saunders; 2015:chap 84.



Review Date: 6/13/2015
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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