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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 55.

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Q : 1

08/23/2013
I am a 60-year-old woman with Osteogenesis Imperfecta. I had a plate put in my ankle in 2001 and it is really bothering me. Have you ever dealt with any O.I. patients? I am thinking it may be time to have the plate removed and don't know what to do next. Thank you.

I have dealt with OI patients in the past. The biggest risk to removing the plate is the risk of fracture. In most patients that risk is significantly diminished after 6 weeks, but it may be longer for you. The first step is making sure that the plate is the problem. I'd be happy to see you. Just call our appointment line at 410-448-6400.


Q : 2

08/09/2013
I was diagnosed with an Achilles avulsion. I guess my lower Achilles tore away from the bone. My doctor is insisting that I need surgery, however I am reading that it may not be necessary. I am 41 and in shape. He basically said that I will have problems later. Do you have an opinion?

If you truly have an avulsion of the tendon off the bone or a fracture with the bone pulled away, then surgery is likely to be your best option as late reconstruction can be a complex problem. If you're unsure of how to proceed then get a second opinion. But do it soon as this is best fixed in the first week or two. Good luck.


Q : 3

11/13/2012
I have a plantar fibroma about the size of a large grape on the arch of my right foot. I've been reading about cryo treatments. Does your group offer such treatments? Or is surgery the recommended path?

We do not offer cryo treatments. I am unaware of any evidence of the success of this besides case reports. Conservative treatment is best with orthotics and offloading of the mass. If surgery is necessary, an extensive resection is needed and there is a significant risk of recurrence.


Q : 4

10/25/2012
I have severe hallux rigidus. I was told I need surgery now to clean things up then joint replacement in 10 years. I am 51. Are there new approaches that would avoid two surgeries?

The best approach to avoid two surgeries is a fusion of the joint to lock the two bones together. It is excellent for relieving pain and will last the rest of your life. A cleanout procedure may also be reasonable depending on your joint cartilage but another procedure might be needed down the road. I would advise against a joint replacement as they are fraught with complications. I would be happy to see you and make more specific recommendations. Our appointment line is 410-448-6400.


Q : 5

07/08/2012
Is percutaneous surgery an option for Achilles tears? I have a partial tear and chronic tendinitis with a lot of scar tissue which was confirmed via an MRI.

Percutaneous techniques are appropriate for acute tears of the tendon. However, for a chronic tear with extensive scar tissue, I believe you would likely be better served by an open approach. There are some injection type therapies that can be done with ultrasound, but you should be evaluated to determine whether or not that is an option.


Q : 6

06/04/2012
What is the difference between hallux varus and metatsus adductus. One doctor told me I had hallux varus and needed surgery while another said it was metatarsus adductus and gave me custom orthotics saying that they would bring my big toe toward my second toe.

Metatarsus adductus is all of the metatarsal bones of the foot (essentially the middle of the foot to the base of the toes) pointing inward (toward the other foot). Hallux varus is the big toe pointing inward at its main joint. They can exist together but are very different things and require different treatments. However, orthotics are unlikely to help either of these problems.


Q : 7

05/08/2012
I have pain in the balls of my feet when I walk and stand, such as burning and pins and needles. When I rest, they seem to ache. Are burning and pins and needles symptoms of sesamoiditis?

Sesamoiditis is isolated to the area under the big toe joint. So if the pain is over all the ball of the foot, then it is a different problem. This can be nerve related problems from the back, nerve problems from diabetes or other diseases, or overload of the ball of the foot from a tight Achilles tendon.


Q : 8

03/16/2012
Do you treat toe fungus? Are you using laser treatment?

I do not treat toe fungus, but we do have a podiatrist who does. We do not currently have laser treatment available.


Q : 9

02/01/2012
I have an ingrown toe nail that is very painful. What can I do to treat it?

Warm soaks and using a Q-tip to loosen the tissue under the nail can help. Never cut your nails too short as the skin comes up over the edge and then can get irritated and infected. If it becomes infected, then it's best to see a podiatrist for treatment which often involves draining any abscess and removing part of the nail.


Q : 10

01/28/2012
How can you get rid of corns on yours toes?

Corns usually come from pressure points. Using pads or cushions help to alleviate the pressure and using a pumice stone or over the counter medications can help to shrink the corn itself. But the key is reducing pressure and rubbing over that spot.


Q : 11

12/03/2011
After an ankle sprain, when should you consider seeing an orthopedic doctor? Approximately how many days until you should be able to bear weight?

Most ankle sprains don't need an orthopaedic doctor. If you don't have a fracture, then you can bear weight as soon as it is tolerable. This could take a day or up to two or more weeks. It is often helpful to use a stirrup or lace-up ankle brace for initial stability. After RICE (rest, ice, compression, elevation) for 7 days, start an exercise program focusing on range of motion of the ankle and gentle strengthening. Ankle sprains can take anywhere from 3 weeks to 3 months for recovery. For the most part, if you haven't seen substantial improvement by 3-4 weeks, then an evaluation by an orthopaedic doctor is appropriate. You primary care doctor should be able to help you for the initial phase with a brace, anti-inflammatories, etc.


Q : 12

11/14/2011
At the age of two, I had my club feet fixed. Now I am 45 and they swell and hurt really bad when walking. Is there something I can do for this? My doctor did x-rays and said it's arthritis and best to find a job where I can stay off of my feet. Will I have to live with this forever?

It is common for patients with clubfeet to develop early arthritis in the foot and ankle. Conservative treatments include activity changes, anti-inflammatories (Motrin, etc) and bracing. If that's not adequate, there are often surgeries that can help but that is different for each individual. So you don't have to live with it forever, but the first steps are to manage it and when it is no longer manageable, consider surgery.


Q : 13

10/02/2011
I am a keen trekker doing a minimum of 50 kilometers a week. For the past year I have experienced discomfort (it cannot be described as pain) on the underside of the base of the two middle toes on the right foot where the toes join the foot. This condition occured suddenly and has not changed in intensity. The feeling is like there is a roll of sock screwed up under the toes. Should I do anything about this?

You may have a neuroma or some scar tissue there near the nerve. If it's just an annoyance but tolerable, you don't need to do anything. One simple help is using a metatarsal or neuroma pad (See Hapad.com)to offload that area and it may quiet down over time.


Q : 14

07/17/2011
I suffer from a chronic pain condition in my right peroneal nerve. Several years ago I had a traumatic accident that crushed my nerve at the knee and left me with drop foot. Has there been any medical changes in treating drop foot, other than AFO braces?

Drop foot can be treated with tendon transfers (using another muscle to help pull the foot up) if there is a strong enough muscle available. I often use the posterior tibial muscle which normally pulls your foot down and in. Alternatively, a fusion of the ankle joint can hold the foot up without having to use a brace. However, the chronic pain that you describe can be much more difficult to treat than the mechanical issues. Often a neurologist or pain management specialist is needed.


Q : 15

06/08/2011
I'm embarrassed to even visit a podiatrists' office because I have a terrible bunion. Is there anything I can do?

The reason we fix a bunions is primarily to alleviate pain or skin or shoe-wear problems. We discourage seeking surgery for cosmetic issues as there are risks involved in any surgery. I wouldn't feel embarrassed to see a DPM or an orthopaedic surgeon with foot and ankle expertise as this is what we see all the time. To find an orthopaedic surgeon in your area, visit AOFAS.org.


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