The Foot Doc Blog – Leading Blog on foot and ankle pain
Many people think the black tiny dots on a plantar wart are the “seeds” or viral particles present within the wart. They’re actually blood vessels within the wart. Plantar warts are extremely vascular and contain very tiny blood vessels or capillaries. The end of the capillaries extend to the surface of the wart and will “rupture” and cause micro bleeding which then dries resulting int he brownish or black looking dots on the wart. So, they are not “SEEDS” or “VIRAL” particles as you may have been told!!
Do all bunions require surgery? Not really. The point that I make to all of my patients is to consider fixing it when it’s painful. I do stress, however, that bunions are STRUCTURAL, deformities and will not improve without surgery. Toe spacers, bunion splints, and other contraptions to realign the toe will only work while the patient is wearing them. As soon as it is removed, the deformity will go back to an abnormal position.
A bunion is actually a dislocation of the great toe joint cause the head of the metatarsal to become prominent on the side of the foot. So, it’s basically the “knuckle” (as my patients say!) popping out of the side of the foot. Fixing it involves realigning the joint which in turn straightens the toe and reduces the prominent bump.
The sooner the deformity is fixed, the less likely one is to cause more damage to the cartilage of the joint. If one waits too long, the damage to the cartilage will make it difficult to get a good surgical result because there will be “bone on bone” in the great toe joint which limits motion and causes pain i.e. arthritis.
I’m excited to now offer Minimally invasive bunion surgery to our patients which greatly reduces recovery time and is a better option for many patients. It has allowed me to offer bunion surgery to patients who I normally wouldn’t have considered surgery on.
Chances are, the bump you’re referring to is arthritis of the big toe joint. Many people will call this a bunion, which it is not. A bunion is a bump on the side of your great toe joint that is the result of a dislocation of the joint. The bump that can occur on top of the big toe joint is the result of arthritis from cartilage erosion in the joint. As the cartilage erodes, bone will rub against bone in the joint causing more bone to form in response to the stress. Fragments can also start to occur which can cause grinding to occur.
Wha causes this?
It’s typically a genetic predisposition that you are born with and it worsens over time.
Treatment
Treatment early in is to reduce the motion to the toe which causes the condition to worsen. This is difficult. Sometimes rigid inserts help but most patients see little relief. Cortisone injections can buy time before the inevitable surgical intervention occurs. Surgery can involve cleaning out the joint, replacing the joint, or fusing it.
Questions? Ask them in the comments section below or search my YouTube channel for more information and surgical videos!
Plantar warts are viral and sometimes do respond to topical acid therapy if they’re superficial. In this example the patient had plantar warts for 2 years and failed acid therapy and excision was recommended. Excision is simple and performed in the office. If acid therapy fails, this is the simplest treatment method to get rid of plantar warts.
Athletes foot infections are a fungal infections of the skin on the feet that causes severe itching and dry flaky skin to occur. There are two types of athletes foot infections. One that involves the skin on the entire sole of the foot, and the other which involves the web spaces between the toes. The condition occurs more commonly when the foot is exposed moist environments such as from sweating in your shoes or if your socks become wet from environmental conditions. Fungus tends to grow in warm, dark, and moist environments and our socks and shoes can often created this ideal situation.
Fungus infections of the foot will often present with dry, flaking, and itchy skin with small red pimples or pustules than can sometimes appear. It will occur in what is referred to as a moccasin like distribution involving the sole of the foot. As previously mentioned, the condition can sometimes only effect the skin between the toes where one will see what is described as white and macerated tissue in the web spaces. This can often by overlooked and not noticed as initially it is not symptomatic. It is frequently caused by not drying well between the toes after bathing or showering. If this type of athletes foot infection is left untreated it can lead to a secondary bacterial infection from bacteria entering the cracks in the skin. This can become a medical emergency if one develops cellulitis or skin infection from the bacteria and may require hospitalization.
It is important to treat athletes foot infections when they occur as to avoid leading to more serious chronic infections which are difficult to manage. Prevention is often the best treatment by controlling the warm, dark moist environments that lead to the infection. When the dry and itching skin is present, it is crucial to see a podiatrist to begin a prescription antifungal to fix the problem.
Many people do not realize that skin cancer can occur on the foot. While it is rare, I do see it in my office. I do my best to educate my patients on what to look for, and explain that there is only one person who can tell if it is skin cancer – that person is a pathologist. You need to look at the cells under a microscope to determine if it is malignant, or cancerous.
Watch the video below to hear Dr. Campitelli discuss skin cancer on the foot:
There are four major things we look at to help determine if it needs biopsied. They are easily remembered by the acronym ABCD’s of skin cancer.
A – Asymmetry
B – Border
C- Color
D – Diameter
Asymmetry – If you were to draw a line through the skin lesion, the sides should look the same.
Border – The borders should be regular and not jagged or irregular.
Color – The color should be regular and equal throughout
Diameter – The diameter or size of the lesion should be no larger than that of a pencil eraser.
Broken toes are extremely common and can be very painful. The most common way to break a toe involves tripping over an object or accidentally kicking a piece of furniture. Many patients present to my office with a broken toe that occurred by kicking the bedpost in the middle of the night while getting on to use the bathroom, or by catching their pinky toe on table or chair causing the toe to fracture and dislocate.
While many people think there is “nothing you can do for a broken toe”, this is not always true. If one of the smaller toes is fractured and dislocated, it is important to have it reduced or put back into place to allow for proper healing and to maintain an anatomically straight toe. The only way to accurately diagnose a toe fracture is by getting an x-ray. Just because you are able to still ”walk” is not justification for the bone not being fractured!
If the toe is fracture and dislocated, it can be easily reduced in the office by numbing the toe and putting in back into place. More severe toe fractures will sometimes need to be surgically aligned and repaired.
If the big toe is injured this can be more severe and should definitely be x-rayed and examined for a fracture. Fractures of the big toe can lead to chronic pain and arthritis if left untreated.
Achilles tendinitis is a painful inflammation of the Achilles’ tendon with pain occurring to the back of the Achilles’ Achilles tendinitis is a painful inflammation of the Achilles’ tendon with pain occurring to the back of the Achilles’ tendon behind the ankle joint. With Achilles tendonitis, the pain will usually occur within the tendon itself as opposed to bursitis which is a similar condition that effects the back of the heel bone. The pain can present with sharp stabbing pain to the tendon that will be worse in the morning and then improve as you walk around and the tendon “warms up”. Pain will then occur later in the day as the tendon begins to become tired from being on your feet all day. You may feel a “creaking” in the tendon when moving your foot up and down if the sheath overlying the tendon becomes swollen. As the condition becomes chronic one will begin to see thickening or enlargement of the tendon itself. This can take months to resolve and will be painful for a long time if left untreated.
Treatment for Achilles tendonitis begins with rest from aggravating activity, taking anti inflammatories, and beginning stretching exercises. If this fails, immobilizing the ankle in a cam walker to reduce the motion to the tendon and take the stress off of it is the next step. Patients will sometimes need to be immobilized for 6 weeks in a cam walker to all the tendon to heal. After resting the tendon and allowing the inflammatory phase to resolve, strengthening with physical therapy is the next step. One can try eccentric strengthening exercises at home, but going to a physical therapist and receiving hands on treatment will provide more predictable results.
When conservative treatment options fail, the next step is surgical intervention. Surgery can involve an minimally invasive technique where a needle like probe is inserted into the Achilles’ tendon and the chronic inflammatory tissue is broken up and removed. This is a great option for patients who present with thickening of the central portion of the Achilles’ tendon that is not responding to conservative therapy. Severe cases of tendonitis that develop tears within the tendon itself that are seen on MRI may eventually require open repair and augmentation with adjacent tendons.
It is important to treat Achilles tendonitis before the condition becomes so severe that the tendon ruptures. Ruptured Achilles’ tendons can take months or even years to recover from, and will often leave patients with life long symptoms. Ruptured Achilles’ tendons are now being repaired with a minimally invasive technique that Dr. Campitelli performs and allows for a faster recovery.
behind the ankle joint. With Achilles tendonitis, the pain will usually occur within the tendon itself as opposed to bursitis which is a similar condition that effects the back of the heel bone. The pain can present with sharp stabbing pain to the tendon that will be worse in the morning and then improve as you walk around and the tendon “warms up”. Pain will then occur later in the day as the tendon begins to become tired from being on your feet all day. You may feel a “creaking” in the tendon when moving your foot up and down if the sheath overlying the tendon becomes swollen. As the condition becomes chronic one will begin to see thickening or enlargement of the tendon itself. This can take months to resolve and will be painful for a long time if left untreated.
Treatment for Achilles tendonitis begins with rest from aggravating activity, taking anti inflammatories, and beginning stretching exercises. If this fails, immobilizing the ankle in a cam walker to reduce the motion to the tendon and take the stress off of it is the next step. Patients will sometimes need to be immobilized for 6 weeks in a cam walker to all the tendon to heal. After resting the tendon and allowing the inflammatory phase to resolve, strengthening with physical therapy is the next step. One can try eccentric strengthening exercises at home, but going to a physical therapist and receiving hands on treatment will provide more predictable results.
When conservative treatment options fail, the next step is surgical intervention. Surgery can involve an minimally invasive technique where a needle like probe is inserted into the Achilles’ tendon and the chronic inflammatory tissue is broken up and removed. This is a great option for patients who present with thickening of the central portion of the Achilles’ tendon that is not responding to conservative therapy. Severe cases of tendonitis that develop tears within the tendon itself that are seen on MRI may eventually require open repair and augmentation with adjacent tendons.
It is important to treat Achilles tendonitis before the condition becomes so severe that the tendon ruptures. Ruptured Achilles’ tendons can take months or even years to recover from, and will often leave patients with life long symptoms. Ruptured Achilles’ tendons are now being repaired with a minimally invasive technique that Dr. Campitelli performs and allows for a faster recovery.
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