Foot Pain

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.

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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.

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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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General Foot Pain? You May Have an Entrapped Nerve

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If you’ve ever heard of carpal tunnel syndrome, there is a very similar condition that exists in the foot and leg.  The condition is commonly referred to as tarsal tunnel syndrome.  Symptoms vary but typical are burning and numbness in the foot, heel, and toes.  Tingling and shooting sensations can also radiate up the leg to the knee. Read More

Bunion Surgery in 84 year old

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It’s never too late to fix your bunion.  Too often patients will present with a severe bunion deformity asking for possible options to reduce the pain so they can be more functional and do the activities they would like to do, but will not consider surgery.  Sometimes they think they are simply “just too old“.  This is not true.

If the patient a is healthy enough to undergo anesthesia and has no serious medical conditions that would put them at risk, then even patients who are in their 80s can have corrective surgery to fix their bunion.

Here are two examples of patients who were in their 80’s and had undergone what is known as a Keller procedure to fix their deformity.

The surgery is out-patient and takes roughly 45 in a hospital or surgery center and the patient can bear weight in the foot in a walking boot the same day.  The foot is kept in bandages which are changed weekly for 3 weeks.  During this period the patient will keep a surgical shoe or walking boot on. By 4-6 weeks an athletic or casual shoe Can be worn.

So how do you know if you need to fix your bunion? If it’s preventing you from doing the things in life you want to do and enjoy doing, then it’s certainly an option.

Hallux Limitus

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Hallux limitus is the medical word for arthritis of the great toe which is the most common area to encounter arthritis in the foot.  Symptoms typically consist of lack of motion and pain to the joint with associated bony formation present to the top of the joint.  When you compare your great toe joints you may see the painful one not bending as far upward as the uninvolved joint.  There may also be grinding associated with this.

Treatment consists of flatter shoes to decrease the amount of motion to the joint, NSAIDS such as ibuprofen, cortisone injections, and surgical correction.   Surgical correction may consist of cleaning out the fragments and arthritis from the joint, inserting an implant, or fusing the joint.  Most of the times if this is caught early enough, cleaning out the joint or performing a cheilectomy will resolve the problem.

Flexor Tenotomy

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flexortenomy flexor tenotomy 2

Arthritis of The Great Toe

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One of the most common places for arthritis to occur in the foot is the big toe join. The condition can present in several different ways. A bunion deformity, which is a dislocation of the great toe joint resulting in a large bump in the inside of the foot, can lead to arthritic changes in the joint causing pain and grinding. Osteoarthritis of the great toe joint is the result of chronic grinding and eroding of the cartilage surfaces leading to “bone-on-bone” and eventually a large bump on the top of the toe joint.

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Treatment
When the deformity becomes painful there are several pathways that we follow to treat this. One is reducing the inflammation by either taking anti-inflammatories such as ibuprofen or naproxen, or cortisone injections into the joint. This can last anywhere from a few weeks to several years depending on the severity of the deformity.

Orthotics can be implemented to reduce motion but rarely are they effective at reducing pain.

Surgery is the most advantageous option in treating this condition and the procedure is dependent on the severity of the arthritis.  For mild cases, simply “cleaning out” the joint by removing fragments and remodeling the head of the metatarsal can provide relief. This will also stop the progression of the condition and prevent further joint damage which could cause more pain and irreversible damage.

Moderate cases can sometimes be treated by inserting an implant into the joint which can preserve the motion as well as reduce pain.  The implants have a good prognosis but do sometimes come with pain and swelling. Choosing the appropriate deformity for inserting the implant will offer the best outcome.

More severe cases will need to be fixed by fusing the great toe joint. Fusing the joint will prevent motion but had the best prognosis for stopping the pain.

Each option has its own recovery period ranging from 2 weeks to 6-8 weeks.

Evaluation and X-rays can be done the same day to provide the patient how severe their arthritis is.

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