Foot Pain

Arthritis of the Great Toe and Surgical Fusion: The First MPJ Arthrodesis Procedure. 

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Arthritis of the big toe is one of the most common joints of the foot to get arthritis in. If caught early enough, the joint can be cleaned out surgically to remove the arthritic areas and fragments. Later stage and more severe great toe arthritis involves either replacing the joint or fusing it.

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What is an ingrown toenail?

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An ingrown toenail is when the border or side of your toenail breaks through the skin next to it which eventually leads to a skin infection or cellulitis. The skin becomes swollen, red and painful. Sometimes you will see pus draining from underneath the nail. 

Treatment at home consists of soaking the foot or toe in warm water and a tablespoon of Epsom salts or antibacterial soap twice a day for fifteen minutes. The area should be covered with a bandaid and antibiotic ointment at all times. 

If home therapy doesn’t resolve the infection the border will need to be removed surgically. This is a simple procedure performed in the office with local anesthesia to numb the toe. Recovery involves soaking for 7-10 days and wearing a bandaid and antibiotic ointment. 

More serious cases may require taking oral antibiotics and sometimes the entire nail needs to be removed temporarily. 

If it is a recurrent situation where the nail continues to become ingrown every six months or more, then a permanent procedure is performed to prevent regrowth of the nail border. 

Here’s a video of Dr. Campitelli performing the procedure in the office. 

Varicose veins can be cause of foot pain

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Foot pain while walking is not always caused by plantar fasciitis, a clinical surgeon in Taipei said, adding that varicose veins can also cause pain when walking and are more common in women.

Shu Tien Clinic Vascular Surgery division head Yu Tarng-jenn (游堂振) said that a 55-year-old woman who had foot pain, especially when walking, thought she had plantar fasciitis, but her symptoms did not ease after undergoing extracorporeal shock wave therapy several times.

The woman underwent a magnetic resonance imaging scan showing she had varicose veins.

Most people think that varicose veins form in the calves, but when they occur on the sole of the foot the symptoms can be similar to plantar fasciitis, Yu said, adding that the condition is called atypical plantar fasciitis.

He said most people think that varicose veins are visible red, purple, or blue vessels that twist and can also cause pain, numbness, swelling and other easily noticeable symptoms.

“However, because people get sufficient nutrition, collagen below the skin’s surface is usually thicker and the veins are hidden,” Yu said.

Yu said that about 33 percent of women and about 15 percent of men develop varicose veins, which are most often found in people who stand for long hours, such as teachers, healthcare personnel and service industry workers.

Atypical plantar fasciitis can be treated by compression therapy, sclerotherapy or surgery, and patients should discuss with their doctors which method is best for their condition, Yu said.

People who stand or sit for long durations every day should move their legs or let them rest for a while every hour, and seek medical treatment if similar symptoms occur, Yu said.

What’s the Best Running Shoe?

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I am asked this question everyday.  Sometimes I feel like my answer would  best be served by placing an audio player in my office and pressing play each time it is asked!  That may not be a bad idea…

“Shoes do no more for the foot than a hat does for the brain.”

—Dr. Mercer Rang, legendary orthopedic surgeon and researcher in pediatric development

That’s a pretty hard statement to swallow? The American Academy of Pediatrics recommends children not wearing shoes until it is nessecitated by the environment. Why, you may ask? Functioning barefoot enables the foot to become stronger by utilizing the muscles that attach to the toes as well as within the arch. This helps the foot become more stable during a child’s developmental years which will be beneficial later in life. 

Analogies are a great way to get one’s point across, so here’s something to consider. If you were to do a push up, chances are when you place your hands on the ground, you will splay your fingers and “grip” the ground. Your fingers have muscles and tendons that begin in the forearm and cross your wrist and by activating these muscles, the fingers flex and extend to make the hand more stable against the ground. If you were to try to perform a push-up by making a fist, your hand will be unstable and your arms will wobble.  The same holds true for your feet. If your toes are jammed into tight socks, followed by snug fitting shoes (because most people in our society feel that their shoes and socks need to fit tight) your toes lose their ability to function and grip the ground making them practically useless when it comes to providing stability for our feet.

What does all this have to do with selecting shoes?  One first must realize how our feet work properly, or they will not believe or understand my advice when it comes to selecting shoes. 

Wide Toe Box 

The shoes should allow your toes to move freely and your feet to feel the ground. If the toe box is too narrow, the toes will squished together.  

Example of the toebox in an Altra Running shoe.

Focus on finding a shoe with a wide toe box.

Flexible Shoe

Yes. Flexibe. Not a stiff and rigid shoe as we were all taught many years ago which includes a supportive arch and motion control. A flexible shoe allows the foot to work the way it was intended to with being interfered with from a shoe. A rigid shoe will inhibit  joint motions that are normal and helpmwith shock absorption.  When you hear the term “pronantion”, runners think it is bad and leads to injury. Pronation is actually a normal part of running and walking mechanics and leads to natural shock absorption. So that orthotic that you’ve been wearing for the past “X” number of years probably isn’t necessary. 

The flexibility of a TopoAthletic shoe.

A flexible shoe to allow our foot to undergo normal shock absorbing mechanisms

Minimal or No Cushioned Heel

Back in the early 1980s, Nike created a shoe known as the Air Max which had a very high cushioned heel which was thought to help reduce injury. We have since proven this to be untrue. When a large heel is placed under the heel of our foot, it places the foot in an abnormal position and then forces the body to function around this abnormal position. Basically it leads to abnormal mechanics and can create injury not prevent it. 

The heel in a traditional running shoe will place the foot in an abnormal position predisposing the foot and legs to injury.

A cushioned heel shoe can promote heel striking which is an abnormal way to run and will eventually lead to injury. 

The aforementioned three points are what defines the ideal running shoe. The challenge is finding the shoe that perfectly incorporates all three of these principles. Many of the popular shoe companies make a shoe in this category since the industry was redefined when minimalist shoes became popular.  Some of my favorites are TopoAthletic, Altra Running, Nike Free, New Balance Minimus, and Merrell to name a few.  If you’re trying TopoAthletic or Altra then you are probably fine with any model you choose. With the others, you’ll need to do your research to make sure it’s not an outdated motion control shoe which, by the way, are still being made. 

Good luck! Let me know if you have any questions!

In office surgery for Bunions?

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I wouldn’t let someone talk you into foot surgery in their office as most surgical procedures are now being performed in outpatient surgery centers. With that being said, there are some simple minimally invasive procedures which can resolve a painful contracted or dislocated toe. I have performed an overwhelming majority of these types of procedures in my office providing relief to patients who have suffered many years with toe pain but didn’t want the long recovery periods that many orthopedic surgeons offer which require outdated use of complicated external pins. 

Here is an example of a recent procedure performed on a patient with a dislocated second toe that was rubbing on her shoe creating severe pain and wound from irritation. She was told by other surgeons that this type of deformity would require a fusion of her big toe which she did not want to undergo as her previous foot surgeries had failed which created this problem. 


A simple tendon release was performed in office requiring only a small incision and a single suture. A gauze splint is applied for 2 days and a follow up visit is required to remove the suture. At this point return to full unrestricted activity is allowed. 

How can you tell if if this will work for you?

This will not work for every dislocated toe as I also perform fusion procedures to realign toes in more chronic and severe situations.  If you are able to manually relocate your toe to a normal or straight position, than you may be a candidate for this surgery. 

Medical Treatments of the Past

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Here’s and interesting look at some old remedies as well some real life medical treatments we once used! 

How can you tell if you have a melanoma?

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Melanomas on the feet are rare, but I have seen multiple instances of them occur. Some we were able to excise early enough while others were too advanced and amputation was needed.

Here are some simple rules to follow when looking at a suspicious mole or lesion on your skin.

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Surgery for a bunion: How old is too old?

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I have corrected bunions on all ages ranging from 14 year olds up to almost 90 year old patients. As long as the patient is healthy and has no health conditions that would prevent a risk for undergoing surgery or for recovery, then age is really not a factor.

Here’s the foot of a 74 year old who recently underwent successful bunion correction.

Why does stepping on a Lego hurt so bad?

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Here’s an interesting video explaining what happens when we step on a sharp object such as a lego.  Very interesting for those curious minds!

How to determine if you have a plantar wart. 

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One of the most common questions I’m asked about skin conditions on the foot is, “Is this a wart?”.

Here’s a quick way to tell if you have a wart.

The lesion will appear as a callus but will have interruption of the skin tension lines – your fingerprints. Or, in this case, toe prints!  Look close and see if there are no skin lines running through the lesion. You will also possibly see small black dots. These dots are areas of blood from microscopic blood vessels in the warts. They’re not seeds or viral particles as some people say!!  Finally, warts are painful. If you squeeze the lesion from the sides it will typically be very painful. More so than a callus. 
Treating warts can be as simple as destructing with an acid or more severe requiring surgical excision.  We offer both treatment options in our offices. More severe cases may require surgical excision in an outpatient surgical setting which we can determine after an office visit.

What is Raynaud’s Disease: Diagnosing And Treating

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With winter’s arrival, many of us will begin seeing patients with weather-related injuries present to our offices. One of the most common conditions tends to be Raynaud’s disease. It is important to distinguish between Raynaud’s disease and Raynaud’s phenomenon as they are two clinically different presentations that are characterized by the severity of the symptoms. Raynaud’s disease is the milder of the two conditions as it presents with vasospasm alone and has no association with other systemic diseases.1

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Ganglion cyst on the big toe.

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Have a big lump on your toe and not sure what it is?  Most likely it’s a plantar’s wart or ganglion cyst.  Here’s a few examples of ganglion cysts which presented recently to my office.  Ganglions cysts are soft and filled with thick viscous fluid.  If you were to rupture one of these cysts, they ill express a fluid that is thick and sticky like.  To you it may feel firm or even “bony” but if you were to squeeze it firmly, you will notice it is fluid filled.   Most ganglion cysts can be drained or aspirated in the office for initial treatment, but they have a high reoccurrence rate requiring excision.  See the following examples which required excision.

great-toe-cyst

Small Ganglion cyst which required surgical excision.

 

 

 

 

 

 

 

 

 

 


The following example is a larger cyst that was extending from the joint of the great toe.

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Sac of the cyst after the fluid was expressed from it.

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Larger ganglion cyst extending into the joint of the great toe.

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Sac of the cyst measuring 4 cm.

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Closure with sutures.

 

Surgery for flatfoot deformities.

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It’s common to hear patients tell me they have foot pain because they have “flat feet”.  An overwhelming majority of the patients who tell me this actually don’t have flat feet at all.  They have a normal arch.  Some of them may have a variant of a foot type which makes them a appear to have a lower arch, but it’s not what we would refer to as a pathologic flat foot.  A pathologic flat foot is one that is severely deformed which many times can make a patient unable to run or even perform daily activities without pain.  Lesser degrees of the deformity also exist which may be symptomatic occasionally depending on ones activity level.

The following is an example of a severe flatfoot deformity which was limiting the ability of the patient to walk and function at work.  He was experiencing severe pain to his midfoot (arch) region with an associated callus.

campitelli-flatfoot-akron-2 campitelli-flatfoot-akron-1campitelli-flatfoot-akron-3

campitelli-flatfoot-preopcampitelli-flatfoot-post-op

The important concept to understand about flatfoot deformity is that although it is not as common as most people think, it’s important to treat or address early. The longer one waits to treat a flatfoot deformity, the more it will collapse and then treatment options become more complicated which will lead to fusion of joints.  If you think you may have a flatfoot, it’s crucial to have it evaluated.  Also, if notice that only one foot is flat, that is more indicative of a pathologic or problematic flatfoot that needs addressed.

When Should You Wear Minimalist Running Shoes?

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What’s a minimalist shoe?  It’s lightweight,flexible and offers not support. More importantly, it will allow your foot to become stronger the more you wear it and ultimately help in preventing injury. Read this new study which demonstrates how the foot becomes stronger by wearing a minimalist shoe. Read More

Money often buys higher-quality goods, but not when it comes to running shoes.

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You don’t always get what you pay for when it comes to running shoes.  Yes, you may get higher quality material and shoes that may last longer, but the extra money won’t necessarily fix your injury.  I routinely explain to my patients that “good” shoes aren’t  always dictated by how much you pay for them.  As an example, Dansko makes an expense clog that is very popular amongst nurses and surgeons in the operating room.  The problem is they’re not good for your feet. They’re heavy, rigid, unforgiving, and have a heel that places the foot in an inclined position which is anatomically incorrect.  Simply put- they don’t belong on our feet.  I often tell my patients (non runners as well), if you wouldn’t  run in this shoe,  you shouldn’t be wearing it.  Read More

Heel pain in a child? Most likely it’s Sever’s disease – Growing Pains.

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Now that fall sports are back in season, I’m seeing a significant increase in children with heel pain that is secondary to a condition called Sever’s Disease. It’s not actually a disease, but an inflammatory condition of the growth plate on the heel bone (calcaneous) medically termed calcaneal apophysitis.  This occur’s most often in children aged 8-13 for girls and 10-15 for boys.

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Are you buying the wrong size shoes? Most Likely.

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Many who know my feelings on shoes or those who follow my blog will understand my belief that our feet work best in their natural state and not relying on shoes or orthotics. With that said, there are times when we need to equip our feet with shoes to protect them. Read More

Do Runners Need Orthotics? 

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I routinely have runners present to our office demanding orthotics for their shoes. Even more common is the request for replacement orthotics. The question is: Should they even be running in an orthotic?  Read my article below that was featured in Podiatry Today to see the latest evidence on using orthotics for running

Source: Do Runners Need Orthotics? | Podiatry Today by Dr. Nicholas Campitelli

Surgery to repair a ruptured Achilles Tendon: A Surgical Video

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The following are real examples of a achilles tendon ruptured that was surgically repaired by Dr. Campitelli.  The video is of a patient that who had ruptured their tendon while playing basketball and presented for repair 2 weeks later. The repair was performed by augmenting the Achilles Tendon with the flexor tendon to the great toe. The Achilles was then wrapped with Arthroflex human tissue graft. Read More

Improve your plantar fasciitis with strengthening exercises. NOT orthotics or shoes.

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Here’s a post from Dr. Nick’s Running Blog that reviews some exercises which can help plantar fasciitis.  It’s important to realize that orthotics and supportive running shoes aren’t always the answer to resolving plantar fasciitis.  Read the follow post on my running blog that explains how strengthening the foot far outweighs shoe inserts or orthotics. Read More

One reason not to delay having bunion surgery. 

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A bunion is nothing more than a dislocation of the great toe joint. As this happens, the joint articulates in an abnormal manner which eventually results in eroding of the joint cartilage- otherwise known as “bone on bone”.   Read More

How to permanently resolve a “corn”.

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What is a corn? Most people think it’s a callus that can simply be cut out.  Not exactly. It is a callus, but making it go away isn’t as simple as you may think. And no, you can’t just put acid on it or cut it out.  Well, you can, but more than likely it will come back.

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SUBUNGUAL HEMATOMAS (RUNNER’S NAIL)

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Subungual hematomas frequently occur in distance runners and I tend to see a lot of them in my practice. While it can be a controversial topic in regard to either draining or removing the entire nail, I learned early in my career that it is best to remove the entire nail.
Read one of my posts on Dr. Nicks Running Blog that gives a detailed approach on the benefits of removing a painful toenail to relieve the pressure from bleeding. 

Training errors and achilles pain – Dr. Nick’s Running Blog

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The following article, or blog post, is a great read for any runner who has been suffering Achilles tendinitis. I see this scenario played out over and over in my office. It’s training patterns that lead to the problem. Too many speed workouts. Running easy runs too hard. Running your long runs at race pace. […]

Source: Training errors and achilles pain – Dr. Nick’s Running Blog

Dislocation of the second toe caused by a bunion deformity.

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Patients routinely present to the office with a painful second toe (especially on the bottom of the joint) not realizing the cause of the pain or deformity.  The toe is typically resting higher then the others and the patients complain that the toe is starting to “pop” up in the air.

Below is an example of a bunion correction and relocation of the 2nd toe that is 6 weeks post surgery.  She was back to work and in a regular shoe at this point functioning well with no pain.

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Melanoma under the toenail?

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It is very common for patients to present with a discoloration of a toenail and are concerned about a melonoma. The above picture is an example of a patient who presented to me with discoloration to the right great toenail as a resulted of concern by the family doctor.

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Ingrown Toenails: Example of the infamous “hidden” nail.

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If you ever had an ingrown toenail that never responded to your “bathroom” surgery then you may want to read this to see why.

Typically when the nail plate irritates the surrounding nail fold, it breaks the king and gets covered by the inflamed nail fold.  When one tries to “cut the corner” out, they typically miss the entire side and cut a portion of the nail and apply pressure to pull it out.  A spike of nail is left behind and continues to grow and eventually is stuck into the nail fold which complicates the situation even further.  Now bacteria is enabled to enter the skin and an infection occurs.  When this occurs, the only way to remove the nail is through surgical excision and excising the entire side of the nail.

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Plantar Warts

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Plantars warts are caused by a virus that invades the skin on the bottom of the foot and creates thick callus like lesions that can be very painful.  They are more common in children and adolescents, but can occur in adults.  You can differentiate them from calluses by the interruption of skin tension lines and occasional appearance of tiny black dots which are small ruptured vessels as they are very vascular.

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The contracted or “curled” toe. Can I get rid of it?

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Hammertoes

It is very common to be born with or acquire a contracted or curled toe.  I see these routinely in the office and they’re really easy to fix as long as they’re still “flexible” in nature.  In other words, don’t wait until the deformity is so far advanced that the toes are “rigid” and no longer able to bend or straighten.

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Fracture Blisters: How this can indicate a broken bone.

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Fracture blisters occur when a bone is fracture which leads to swelling that has no where to go and eventually ends up accumulating in the skin forming a blister.  Sometimes when these blisters are seen after trauma, it is very likely to find a fracture on X-ray.

Here’s an example of a woman who had dropped a picture frame on her toe and ended up with a severely swollen toe and blister that formed 3 days later. The toe was found to be fractured after X-rays were taken.

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Topical Nail Solution to soften and clear discolored toenails.
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