Foot and Ankle Archive Questions

Below are Dr. Farber’s answers to Foot and Ankle questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 15 of 28.

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Q : 1 06/03/2010	Do you do surgery for pes cavus in adults? My husband has had pain all of his life in his feet presumably from a form of polio that has resulted in high arches/claw feet. He is considering amputation rather than trying a more conservative approach. He is depressed and has been dealing with chronic fatigue and pain for a long time. Can you help him? I do perform surgery for cavus feet. There are many components to correcting the feet and addressing the pain that depend on the deformity and the areas where he is experiencing pain. I'd be more than happy to evaluate him. If you like, please call our scheduling center at 410-448-6400.
Q : 2 04/14/2010	I was pushed off balance by my powerful dog and twisted my ankle, popped my knee, and hurt my foot. The next morning the ankle and knee felt fine, but my foot has been hurting for about a week now. The pain is worse in the morning, or after sitting for awhile, then walking. The pain is about two inches from the prominent ankle bone, on the top of my foot. It feels better with a supporting shoe, but pops or "catches" if I walk "normally". If I walk more to the inside of my foot, or with my big toe crunched up, the pain is less. I pay for everything out of pocket, so I don't want an x-ray if it is likely not broken, or if broken would be treated with supportive shoes. Pain on the top of the foot after an injury as you described, may be a small avulsion fracture (the ligament or capsule of the ankle pulled off a little piece of bone.) This will likely settle down with rest and protection (lace-up brace or walking boot). However, with the popping and catching, it may be safest to check an x-ray.
Q : 3 04/14/2010	I am a 41-year-old male. I have osteoarthritis in both ankles. The cartilage has all but disappeared in both ankle joints between the tibia and the talus. The pain has become unbearable. I have tried many of the medications and have had Cortozone injections in the past. Now I just take OTC pain relievers. My orthopedist has recommended one of three options: 1. Do nothing and hold out as long as I can. 2. Ankle Fusion 3. Total Ankle anthrplasty My job requires that I be on my feet about 8 hours a day and I am somewhat active outside of work (as active as I can be). Any opinion on the options or are there other options I have yet to discover? Ankle arthritis is a difficult problem. From a conservative standpoint, some people do well with a custom-molded brace. This doesn't fix the arthritis, but the stability often helps decrease some of the pain. Sometimes if the pain is primarily from contact of bone spurs on the front of the ankle, cleaning these out with an arthroscopy or an open procedure can be helpful. Otherwise, the options if ankle fusion or ankle replacement are appropriate to explore.
Q : 4 04/10/2010	I was having swelling and pain in my left foot two months ago and had high uric acid levels. I was put on Naproxen 550.mg (which does not help with the pain) and Allopurinol 300mg. All weak I have been having wrist pain, foot, toe, and leg pain mostly in left foot, and lower back pain. I have a chronic kidney disease, hypothyroidism, and NAFLD. My mom has SLE lupus (skin type). How bad will the gout pain get and can it be disabling? Gout pain can be quite severe but is usually only temporary. However, repeated attacks can cause arthritis. The key is likely proper management of your kidney issues, medications to prevent the incidence of gout and often alteration in your diet to avoid foods that can bring on gouty attacks. With your family history, I would suggest that you see a rheumatologist.
Q : 5 04/08/2010	I am having severe pain in the right front and side of foot (from the small toe area all the way down the outside of my foot). What could be causing it? I had plantar faciitis, started wearing Walk-fit inserts and the heel was no longer an issue but the side of my foot began to hurt, even when I am in bed and there is pressure on it. What should I try to help it? This sounds either like a stress reaction or fracture of the fifth metatarsal or perhaps an irritation/injury to the sural nerve (which lives on the outside of the ankle). If it's an electric or burning type pain, you may have some nerve irritation. If it's a sharper pain or aching with some swelling, then it's more likely the fracture. The fracture will benefit from rest and offloading (crutches). The nerve may benefit from NSAIDS (Ibuprofen, etc) and gentle massage in the area that sparks the pain. Trying these will give your doctor some good information when they evaluate you.
Q : 6 04/07/2010	I have had four surgeries on my right foot due to complications from bunion surgery. I have had two bone grafts done. I now have a big lump or what I consider a knot between the second and third toe. When I walk it feels like I have a stone on the bottom of the foot that I am walking on. Could you possible tell me if there is anything that can be done. With four prior surgeries, it is hard to know what has been done to know what might be going on in that area. You could have a neuroma there, it could be scar tissue or calcified tissue, or could be from overload due to the big toe no longer doing it's job. There is still much hope for you, but I recommend getting another opinion. Try aofas.org to find a foot and ankle orthopaedist near you.
Q : 7 04/06/2010	I get these uncomfortable electric shock feeling in the heel of my foot. I'm concerned it has something to do with nerve damage as I've had back aches for a while now. Can you advise? "Electric" type pain is often nerve pain. The first step is to determine where the nerve is being irritated. Back problems can lead to nerve injury, so that is the best place to start. Your primary care doctor may be able to sort that out; otherwise, any good orthopaedist should be able to evaluate your back. If it's not your back, then a thorough exam may help to pinpoint the area. If it's still not clear then a nerve conduction study is often helpful in the right circumstance. Hope this helps to get you started. A simple thing to try right away is a regular course of an anti-inflammatory (Ibuprofen, Naprosyn, etc) taken on a regular basis for 10-14 days. That can often decrease the intensity of the pain by decreasing the inflammation around the nerve wherever it is irritated.
Q : 8 04/01/2010	My husband is on his feet all day at work where there is a concrete floor. By the time he gets home, his feet are hurting. He also has a hammer toe. What medciations can he use to relieve the pain all day? Any of the anti-inflammatories (Aleve, Motrin, etc) are reasonable as long as he doesn't have a medical reason to avoid those types of medications. More importantly is to make sure he has proper shoe-wear with good cushioned insoles.
Q : 9 03/31/2010	I have moderate to severe knee,shin, and ankle pain. I also have slight swelling of the knee. I have elevated, iced, heated, taken ibuprophen and rested. Should I see my doctor since it's not getting better? I run track and field, but I was not involved in a serious injury. From your short description, I suspect you might have shin splints or a tibial stress fracture. I would see your doctor for some x-rays and would expect that you'll need to rest this leg from impact activities for at least 1-2 months.
Q : 10 03/30/2010	I have pain in my foot pad when wearing any sort of elevation in my shoe with some swelling. I also recently have pain/soreness in the back of my heal. Would inserts help? Inserts certainly can help in many situations. From what you describe, I would try hapad.com and get a sports replacement orthotic and a metatarsal pad to put on top of it. Try that out (it's relatively inexpensive). If you're still having troubles, then see an orthopaedist for a more thorough evaluation.
Q : 11 03/30/2010	I have had flat feet since I was very young and since my mid to late teens (I am now in my early 20s) have had a dull aching pain on the outside of the arch of my right foot, especially if pressure is applied to the navicular area. It is usually worst first thing in the morning, but wearing shoes as opposed to going barefoot also makes it somewhat worse. What would be the most likely causes and best treatments? Should I contact a doctor? Many people have flat feet. Sometimes it is just normal, but sometimes there are underlying bone or soft tissue problems that cause it. In many people a proper orthotic (sometimes off-the-shelf instead of custom) combined with a stretching and strengthening proper can help substantially. So first, I would find a good off the shelf orthotic (Wrymark's First Step, or Lynco's) and work on Achilles and gastrocnemius muscle stretches. If that doesn't help, then it's appropriate to see an orthopaedist.
Q : 12 03/15/2010	In your posting of February 4 of this year, you said that swelling in both feet and ankles is usually caused by fluid imbalance in the body. What if the swelling is just in one foot? If the swelling is localized to one foot, then it is important to look for an underlying cause in that foot for the swelling. There are anatomic reasons for one foot to swell more than another, but if it's only one side then I want to be sure there's not a specific reason for it (i.e., fracture, tendon injury, arthritis, etc.)
Q : 13 03/10/2010	I have had forefoot pain for 8 months after receiving new orthotics with more arch support to alleviate the pain there. I have been to a podiatrist and pedorthist and been through 3-4 pairs of orthotics at an expense greater than $2000 and still get this burning pain in the ridge under my toes of both feet, more centrally located though under the middle toe bone area. The pedorthist so far can't resolve my pain even after about 5 adjustments. It is so bad that by 2-3pm I have to ice that area on both feet and have to spend 1/2hr in the morning icing my feet. I do not have diabetes, am 59 and am fairly active. All I want is to be able to get through the day without this burning pain! Can you advise me? This sounds like a morton's neuroma. That is a scar lesion of a nerve that runs between the bones of the feet. It is most commonly associated with burning pain and sometimes the sensation of walking on a stone. A metatarsal pad can often help, but sometime a cortisone injection can help to clarify the diagnosis and provide more prolonged pain relief. Some patients may even choose surgery for this. I would investigate this first as it is the most likely problem. Good luck and hope you feel better soon!
Q : 14 03/07/2010	I think I have Plantar fasciitis. I exercise five days a week and it never bothers me too much. I took 2 days off from exercise routine and now the pain runs from my heel, up my calf, behind the knee and up into the back thigh (hamstrings). What can I do to fix this or at least take away the pain? The radiating pain that you have is not typical of plantar fasciitis. Plantar fasciitis pain is usually limited to the heel with some radiates along a specific nerve in the foot. I suspect you have some sciatic irritation which can be from a stretch type injury or even a herniated disk. If you tolerate medicines like ibuprofen, then I would try that on a regular basis (three times a day) for 4-7 days to see if this settles down on its own. If it doesn't go away or is getting worse or associated with any weakness in the leg then you should see an orthopaedic surgeon or your primary care doctor to be evaluated.
Q : 15 03/03/2010	I have had foot problems for a long time. I roll inward when I step and flatten out my arch, so I got custom orthotics in 2003 which lessened the foot, knee, leg back pain a little, but it still bothered me. Also, it was not full length and it was very hard, so the balls of my feet were sore from the hardness of the shoe, and eventually under my feet became numb/tingly at times. So last year I got new orthotics - full length with a little more cushion and narrower, since the other ones were too wide. The numbness in my arch seemed to continue, so I stopped wearing them. I got a pair of Fitflops which surprisingly, I can wear without orthotics and experience no pain. Whenever I wear my New Balance sneakers with the orthotics in them (or any other shoe), my arch starts to tingle from the contact on the orthotic within 1/2hr. Also, the back/bottom of my heel hurts when I drive (only with the orthotics). Usually the pain/numbness/problems is with my right foot, but sometimes it is also on the left. What do I do? The real question here is what is your underlying diagnosis. I suspect you have failure of a tendon on the inside of your foot with development of a flatfoot and likely tension being placed on your tibial nerve. Orthotics are reasonable, but sometimes in their attempt to do good they push too hard on the tissues of the foot and cause pain and irritation. There are other types of orthotics or braces (although they are more bulky) that may help and sometimes there are surgical solutions. If the fitflops work well for you then you may want to try the skechers shoe version of the same technology. Otherwise a thorough evaluation by an orthopaedic foot and ankle surgeon may be in order.

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