Foot Pain

What are the symptoms of addiction to pain pills?

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Pain medicine addiction has become an epidemic in our society. It is common to prescribe this medication after surgical procedures to control pain in our patietns. This pain is usually only severe for the first several days after a surgery and the medication should not be needed or used for weeks after your procedure. Doing so could lead to addiction and with that comes many horrible side effects. Here is a short video that National Geogrpahic recently posted on their website.

Will I have pins in my foot to fix a hammer toe?

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More than likely the answer is “No”, you will not need to have pins to fix your hammer toes.

Many of my patients fear having their hammer toes fixed surgically because they are worried about having pins sticking out of their toe following surgery. This is an outdated way of fixing hammer toes as we now have many new options available for fixating the deformity.   Read More

When can I get my foot wet after bunion surgery?

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How soon can you shower or take a bath after having bunion surgery?  The average time it takes for a foot incision to heal can be anywhere from 7 to 21 days.   During this time the incision needs to stay dry.  The toe may also be splinted through this early recovery phase which prohibits the bandages from being removed. Think of it as a cast.

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Keep your incision dry. 

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It is very common for patients to think they need to put Neosporin on their incision site after surgery or following a trip to the ER that required stitches.  It is not true, and can actually be bad to put any type of antibiotic ointment on an incision.  Incisions should be kept dry to allow the body’s normal process of repairing the skin edges.  When any type of ointment, be it Neosporin or evenVaseline, the skin edges can become moist and actually open up or dehisce.   The best scenario to allow your incision to heal adequately on your foot is to keep it dry.  Foot incisions typically take 10-21 days to heal.  The foot takes longer on average to heal over average becuase it’s blood supply is not as abundant as others areas on the body, especially the face.  

Are cortisone injections bad for you?

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I recently blogged about plantar fasciitis and cortisone injections on my running blog and received a lot of comments back about cortisone being “harmful” or a “bandaid”.  I would like to elaborate more on this controversial topic and help guide others to understand how cortisone can play a role in the healing process – SAFELY.

Consider that if someone struck your arm with a hammer, you would have pain and swelling.  Any anti-inflammatory would reduce the pain and inflammation.  If they continue to strike you arm with the hammer, the pain and inflammation will return.  With plantar fasciitis, the challenge is finding out what the “hammer” is.  Sometimes the hammer could have been an isolated event, and the cortisone fixes it. Other situations are chronic and it can be a challenge to find the problems or source of the reoccurring inflammation.

I have and continue to help many patients with the use of cortisone injections.  When used correctly, it is a safe and effective way of treating and resolving inflammation.  It can even be much safer then using NSAIDS such as Ibuprofon which can create stomach irritation. 

What to do if you “smash” your toenail. 

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Toenail trauma is very common and can create panic to many people. The biggest question is “what do you do to the toenail?”. Here are some guidelines on what to do if you injure your toenail.

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Wounds do not need to be “aired out “

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There are many misconceptions about wound care which still exist today and are not helpful in healing wounds.  One of the most common ones is to let your wound air out. Each week I have a patient ask me the question, “shouldn’t I let this get air to help it heal faster?”.  The answer is no.  Wounds do need oxygen to heal, but this oxygen comes from blood flow, not the outside air. As long as the body has healthy blood blow that is not being comprimised by peripheral vascular disease, the would will be getting sufficient oxygen. The next step is to keep the wound moist to maintain a healthy and homeostatic environment. This is usually accomplished with a variety of wound hydrogels or antibiotic ointments.

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What causes hammertoes?

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What is a hammertoe?  Its basically when your toe contracts so much that it assumes a curled or flexed position.  This can happen in the form of a flexible hammertoe or a rigid hammertoe. A flexible hammertoe can straighten out of you try to manually place it in a normal position.  A rigid hammertoe is one that is fixed or bony. Why does this happen? The answer isn’t this simple, but here is a quick explanation.

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Reoccurrence of an ingrown toenail – A Nail Spicule

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If you have every had an ingrown toenail removed and developed a reoccurent small portion of nail in the corner, it is called spicule.  This small sliver of nail will grow at the same rate of the full sized nail plate but will be a small detached portion of nail.  While it is nothing to worry about, it can be irritable and bleed if pulled out.  Many patients also describe that it catches on their socks and clothes and is painful.   Read More

Foot pain on the “outside” of your foot. 

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One of the most common complaints for foot pain is the result of tendonitis which occurs when a patient compensates from another foot problem. There are two tendons known as the peroneous longus and peroneous brevis which prevent the foot from inverting or turning in when walking. Essentially they are stabilizers and prevent you from spraining your ankle. If anything occurs to your foot that causes you to “limp”, these tendons work harder as you compensate. This leads to the common complaint of pain to the outside or lateral aspect of your foot. So when your body tells you it’s in pain and you are forced to “limp” something is wrong and you need to get off your foot. If not, this lateral foot pain or tendonitis can become a chronic problem taking months to get over. 

Do Not Buy Any Diabetes Shoes Before You Read This Guide – TheDiabetesCouncil.com

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It is very common amongst people with diabetes to develop foot problems. Per year, the American Diabetes Association indicates that 600,000 people with diabetes get foot ulcers which can result in over 80,000 amputations.

Neuropathy is when there is a nerve damage in the foot which can then lead to foot problems. Neuropathy causes tingling, pain, burning or stinging sensations, weakness in the foot. The worst is when you injure your foot, you may not even feel it due to loss of feeling. If you do not have any feeling in your feet, then it may make your injury or illness worse than it was before.

Click here to read the entire article  

Source: Do Not Buy Any Diabetes Shoes Before You Read This Guide – TheDiabetesCouncil.com

Plantar Fasciitis. Is it a heel spur or muscle strain?

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The following article discusses how professional baseball player Addison Russell was sidelined for plantar fasciitis.  What’s interesting is, this is one of the few times that it was actually correctly reported as being a “strained” muscle.  Plantar fasciitis has long been referred to as a heel spur or simply put- heel pain.

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Surgical Removal of a Painful Toenail

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Suffering from a severely painful toenail that is constantly irritated with shoes and impossible to cut?  Surgical removal is most likely the best option.  Toenail deformities can be the result of trauma to the nail plate which can occur from dropping something on your toe, or simply through years of irritation of the nail plate on a shoe.  Nail fungus can also be the cause of a deformed toenail, so it is imperative to first have the nail tested for fungus before making any decisions to permanently remove the toenail.

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Early detection is the best treatment for skin cancer.

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Skin cancer can present in places where you don’t always think to look.  Dr. Campitelli not only encounters cancerous lesions on the foot, but also treats them on the hand as well. 

This patient had a skin lesion under his finger nail that was present for over a year and eventually started draining and caused loosening of the toenai.  The nail was removed and several samples of tissue were taken from the suspicious lesion.  

If you have something that is new or looks out of the ordinary, don’t wait to get it biopsied.  The only person who can tell weather or not it is skin cancer is the pathologist who looks at it under the microscope. 

Infected toenail or nail fungus?

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An ingrown toenail is typically the result of the nail plate growing into the adjacent nail fold or skin next to the toenail. The break in the skin allows bacteria to enter and an infection occurs. 

Sometimes a toenail can acquire a bacterial infection under the nail plate itself. Examples of this can be due to a deformed toenail (which could be from nail fungus or trauma to the toe) causing the toenail to become loose and allowing bacteria to collect under the nail plate and eventual form an abscess. The abscess usually occurs in the eponycium or “cutical” area. 

Here is an example of a nail deformity in which the patient presented with severe pain and drainage from the toenail. Under these circumstances the nail needs to be removed to allow the infection to be drained.  An antibiotic is initiated and recovery is usually two weeks. It’s is important to catch this soon as neglect can lead to a bone infection in the toe. 

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.

surgery-toe-cyst

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.

Dr. Campitelli one comments

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

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