Limb salvage is a procedure that involves saving a lower extremity from amputation. In podiatry, limb amputation often occurs as a result of diabetes, peripheral vascular disease, neuropathy, cancer, and severe crush injury. The fundamental goal of limb salvage is to restore and maintain stability and movement of the affected lower extremity.

The procedure typically involves removing the diseased tissue and a small portion of the surrounding healthy tissue, as well as the removal of any affected bone if necessary. If the bone is removed, it is then replaced with prostheses, synthetic metal rods or plates, or grafts from either the patient’s body or a donor. Limb salvage is typically the preferred choice of procedure over amputation, as the procedure preserves both the patient’s appearance and allows for the greatest possible degree of function in the affected limb.

Upon diagnosis and determining that limb salvage is the appropriate treatment, the podiatrist may enlist the help of a physical and/or occupational therapist to prepare the patient for surgery by introducing various muscle-strengthening, walking, and range of motion exercises. Such exercises may be continued as rehabilitation post-procedure.

Flatfoot is a foot disorder that is not as straightforward as many people believe.  Various types of flatfoot exist, each with their own varying deformities and symptoms.  The partial or total collapse of the arch, however, is a characteristic common to all types of flatfoot.  Other signs of flatfoot include:

• “Toe drift,” or the pointing outward of the toes and the front part of the foot
• The tilting outward of the heel and the tilting inward of the ankle
• The lifting of the heel off the ground earlier when walking due to a tight Achilles tendon
• Hammertoes
• Bunions

One of the most common types of flatfoot is flexible flatfoot.  This variation usually starts in childhood and progresses as one ages into adulthood.  Flexible flatfoot presents as a foot that is flat when standing, or weight-bearing.  When not standing, the arch returns.  Symptoms of flexible flatfoot include:

• Pain located in the heel, arch, ankle, or along the outside of the foot
• Overpronation, or an ankle that rolls in
• Shin splint, or pain along the shin bone
• General foot aches or fatigue
• Pain located in the lower back, hip, or knee

Your podiatrist will most likely diagnose flatfoot by examining your feet when you stand and sit.  X-rays may be taken to define the severity and help determine the treatment option best for your condition.  Nonsurgical treatments can include activity modification, weight loss, orthotics, immobilization, medications, physical therapy, shoe modifications, and ankle foot orthoses (AFO) devices.  If nonsurgical methods prove ineffective, surgery may be considered.  Multiple surgical procedures can correct flatfoot; and depending on your specific condition, one may be selected alone or combined with other techniques to ensure optimal results.

A congenital foot problem is a problem affecting the feet, toes, and/or ankle that a child is born with. Several issues with a child’s feet can occur congenitally. Such problems include clubfoot, vertical talus, tarsal coalition, polydactyly, macrodactyly, and cleft foot. Some of these problems have a genetic basis, with someone in their family history having a gene causing the condition, and some are simply an anomaly.

The following are specifics about a few of these conditions:

-    Clubfoot, also called congenital talipes equinovarus or talipes equinovarus, is When the tendons of the foot shorten, the bones are of an unusual shape, and the Achilles tendon is tight, causing an inward and downward pointing of the foot. The soles of the feet might also face each other. In most cases of clubfoot, both feet are affected. If not treated, the affected child will walk on the sides of their feet or ankles.

-    Polydactyly is a condition where the child has more than five fingers or toes on either or both feet. Presentation usually consists of a nubbin or small lump of tissue without a bone, a toe that is partially formed but has no joints, or an extra toe.

-    Vertical talus is where the talus bone forms in the wrong position, other bones in the foot do not line up properly, the front of the foot points up, and the bottom of the foot is stiff, has no arch, and usually curves out. This can occur in one or both feet and if left untreated, can lead to serious disability or discomfort as the child grows.

-    Tarsal coalition is when there is an abnormal connection of two or more bones in the foot leading to severe, rigid flatfoot. The tarsal bones, located toward the back of the foot and in the heel, are the ones affected. This condition is often present at birth, but signs of the disorder usually come on in early adolescence.

-    Cleft foot is a rare condition where the foot has missing toes, a V-shaped cleft, and other anatomical differences. Surgery can often help improve the foot’s function since the heel remains normal and is what is most needed for walking. The main issues with this affliction are whether the affected foot can fit into a shoe and the shape and appearance of the foot.

-    Macrodactyly is when the toes are abnormally large due to overgrowth of the underlying bone or soft tissue. Having this condition makes it harder for the child to use the affected foot for certain activities.

Diabetics must be wary of all wounds, regardless of depth or size. Diabetes, a chronic disease in which the body cannot properly use glucose the way it normally would, causes various complications that make wounds difficult to heal. Nerve damage or neuropathy will cause diabetics to have trouble feeling the pain of a blister or cut until the condition has significantly worsened or become infected. A diabetic’s weakened immune system can make even the most minor of wounds easily susceptible to infection. Diabetics are also more prone to developing narrow, clogged arteries, and are therefore more likely to develop wounds.

Wounds should be taken care of immediately after discovery, as even the smallest of wounds can become infected if enough bacteria build up within the wound.  To remove dirt, wounds should be first rinsed under running water only. Soap, hydrogen peroxide, or iodine can irritate the injury and should be avoided. To prevent infection, apply antibiotic ointment to the wound and cover it with a bandage. The bandage should be changed daily. The skin around the wound may be cleaned with soap.

To prevent further exacerbation, see a doctor—especially if you have diabetes. Minor skin conditions can become larger problems if not properly inspected. As the wound heals, make sure to avoid applying pressure to the affected area.

The human foot has 26 different bones, and the foot is divided into three parts: the hindfoot, the midfoot, and the forefoot. Each section of the foot is composed of a different amount of bones. For instance, the forefoot is made up of 19 bones. The midfoot is composed of five smaller bones called the navicular, cuboid, and three cuneiform bones. Lastly, the hindfoot is made up of only the talus and the calcaneus. The feet tend to be vulnerable to slipping and twisting; consequently, fractured bones within the foot are common. When a bone gets crushed, bent, twisted, or stretched it may become broken.

Many foot fractures occur through an accident or trauma. More specifically, common causes for broken feet are car accidents, falls, missteps, or overuse. If you have a broken ankle or foot, you may have one or more of the following symptoms: throbbing pain, swelling, bruising, tenderness, deformities, and difficulty walking.

There are some factors that may put you at a higher risk of developing a broken foot. People who participate in high-impact sports are more likely to develop foot fractures because of the stresses, direct blows, and twisting injuries involved in gameplay. Additionally, those who suddenly increase their activity level are more likely to suffer a stress fracture.

Unfortunately, there are different complications that may arise because of a foot fracture. For instance, arthritis may be caused by fractures that extend into the joints. Bone infections are also possible in open fractures due to the bone being exposed to bacteria. However, there are ways you can help prevent yourself from breaking your foot. One way to avoid fractures is to wear proper footwear. If you plan on going on a run, you should wear running shoes. You should also replace your shoes if you notice that they are becoming worn out. For runners, it is best to replace shoes every 300 to 400 miles.

Treatment for foot fractures usually consists of rest, ice, elevation, and compression (RICE). If you plan on wrapping your foot, try not to wrap it too tightly because doing so may cut off blood supply in the foot. You should also avoid walking on the fractured foot.

If you suspect you have a broken foot, you should see your podiatrist right away. It is important that you have someone bring you to your doctor, since driving with a broken foot can be dangerous. You should especially seek urgent care if you are experiencing numbness, pain, or deformities in your foot.

Hammertoe is a foot deformity that occurs due to an imbalance in the tendons, muscles, or ligaments that are responsible for holding the toes in their normal position. This condition may be caused by poor footwear, foot structure, trauma, and disease. The most common solution for hammertoe is to relieve the pain by changing your footwear and wearing orthotics. In severe cases, surgery may be required.

The shoes that are most likely to cause hammertoe are high heeled shoes or shoes that are too tight in the toe box. Tight shoes will force your toes to crowd together in a curled position. This position will likely continue when you take your shoes off. Another cause is trauma. When you stub your toe, you are increasing the chance that you will develop hammertoe.

There are risk factors that may make you more likely to develop this condition. Women are more likely to have the condition compared to men, and it is also more likely to appear in those who are older in age.

Many different foot problems can be avoided by wearing shoes that have adjustability, adequate toe room, and low heels. Furthermore, if you want to buy new shoes, you should look to purchase them at the end of the day and make sure you know your correct size. The importance of buying shoes at the end of the day is that your feet swell as the day progresses. You should also ensure that you are wearing your correct size because your shoe size may change as you grow older.

To diagnose someone with hammertoe, your podiatrist will need to conduct a thorough examination of your foot. Your doctor may even order an x-ray to evaluate the bones and joints of your feet and toes.

If you have hammertoe, your podiatrist may recommend that you wear shoes that fit you better along with inserts to place inside them. Additionally, he or she may suggest special exercises for you to perform to stretch your toes. One helpful exercise it to pick up marbles with your feet or crumple a towel with your toes.

Prior to meeting with your podiatrist, it will be helpful to make a list of all the symptoms you are experiencing. You should also make a note of medications you are taking and important personal information about your medical history.

Blisters are a common ailment of people who wear shoes that are either too tight or rub against the feet in an uncomfortable way. Knowing the basics of blisters is important for understanding how they are formed and what treatments should be used for them.

A blister on the foot, or any other part of the body, is a small pocket that is filled with fluid. It usually forms on the upper layer of the skin because these layers are loose enough to allow a blister to form. The most common fluid in a blister is just a clear, watery-like fluid that usually isn’t cause for concern. However, blisters can fill up with blood if they are deep enough and pus if they have become infected with bacteria.

Blisters almost always form on the feet due to shoes rubbing up against the foot, where the friction causes blisters. These can occur after you have walked for a long period of time or when your shoes do not fit you properly. Your feet are also more prone to blisters if they are moist, so keeping them dry and clean is one preventative step you can take.

Preventing infection should be the number one concern when treating blisters, as well as relieving the pain they can cause. Using a bandage to cover up the blister will help it heal and prevent bacteria from entering it. New skin will form under the blister and eventually cause it to pop. You can also take a sterilized pin and try to pop it yourself.

If the blister is filled with pus or blood, seeking treatment from a doctor is ideal. Antibiotics may need to be taken in order to completely eliminate the bacteria inside the blister. See a doctor to have an antibiotic prescribed.

The best way to treat blisters is to prevent them all together. Keeping your feet dry and making sure that your shoes fit properly are just two of the steps you can take to prevent blisters. Shoes that are too tight or shoes that are too loose and allow your feet to slide in them will cause blisters. Applying a bandage to an area where you think a blister is about to form is another way you can prevent them.

High heels are uncomfortable, but many women sacrifice comfort to be stylish. There are many problems that stem from wearing high heels, however these issues can be avoided by wearing proper shoes.

Heels are bad because they push your weight forward toward the fall of the foot. The higher the heel is, the more weight and pressure get shifted. This process causes the back to hyperextend backwards to counterbalance which may cause pain in the leg, hip, and back. Consequently, major posture problems may occur, and these issues may eventually become permanent.

Wearing high heels is one of the leading cause of ingrown toenails. Heels create a great deal of pressure on the big toenails which disrupts proper toenail growth. This may eventually lead to the big toenail growing into the skin.  Another common problem that stems from high heels is bunions. If bunions go untreated, they can cause serious scar tissue to form along with severe pain.

However, there are ways to minimize the harmful risks associated with wearing heels. You should try to massage and stretch your legs and feet after wearing heels for an extended time. Stretching helps prevent the Achilles tendons and calf muscles from becoming too tight. A good substitute for heels are platforms which provide a better surface area to evenly distribute the body’s weight.

If you are experiencing any painful foot conditions from wearing high heels, you should consult with your podiatrist right away.

Foot and ankle injuries are common among athletes and those who exercise frequently. Most of these injuries are non-life-threatening and can heal in weeks with proper treatment and care. Serious injuries, however, require urgent medical treatment.

Common minor injuries include ankle sprains, ankle strains, Achilles tendonitis, plantar fasciitis, stress fractures, and turf toe. An ankle sprain is when the ligaments in the ankle have either become stretched or torn. When the muscle or tendon is stretched or torn, it is an ankle strain. When the big toe is sprained, it is known as turf toe. Achilles tendonitis is the overuse and inflammation of the Achilles tendon. Plantar fasciitis is the inflammation of the plantar fascia and generally occurs from overuse in athletics. Stress fractures are also caused from overuse and are small cracks in the bone.

Achilles tendon ruptures are common, but more serious. This injury occurs when the Achilles tendon, the largest tendon in the body, ruptures. In most cases, this causes severe pain and difficulty walking; some who have experienced this injury have reported, however, no signs or symptoms. A laceration is a deep cut that can occur anywhere on the body. Lacerations on the foot are rarer, but can occur from things like metal cleats landing on the foot.   

Treatment options cover a wide range of methods based upon the injury and its severity. Conditions like plantar fasciitis, stress fractures, Achilles tendonitis, turf toe and ankle sprains/ strains can heal on their own without immediate medical care, but seeing a podiatrist to monitor the injury is always recommended. Following the RICE (Rest, Icing, Compression, and Elevation) protocol is generally enough to treat minor injuries. This means resting the foot by either keeping pressure off the foot or not walking at all. Icing the injury will help reduce swelling and pain. Compressing the wound with a wrap will immobilize and help promote healing. Finally, keeping the wound elevated will also reduce swelling and also help the healing process.

It is important to note that even minor injuries can vary in severity, with grade one being a minor injury and grade three requiring urgent care by a podiatrist. Achilles tendon ruptures and lacerations on the foot generally require urgent medical care and treatment options that need a podiatrist. These could include imaging tests, stitches for cuts, rehabilitation, and casts or braces. Every case is different, however, so it is always recommended to see a podiatrist when pain in the foot does not disappear.

Toe pain can originate from corns, calluses, hammertoes, and bunions, as well as ingrown toenails, sprains, fractures, and dislocations. Corns develop as the toe rubs against the inside of a shoe which causes the skin to thicken as a form of protection. A corn is typically cone-shaped and has a small, hardened spot that points inward. When a corn is pressed into the skin, the toe becomes painful. Corns usually form on the top or side of the toe. A callus is also a thickened patch of skin that generally forms on the bottom of the foot. Calluses are the result of friction from the toe rubbing against the inside of a shoe. They may also occur by walking barefoot or having flat feet. A hammertoe is a bump on the knuckle of the second toe that is produced by wearing shoes that are too short for your feet. The bony protrusion rubs against the top of the shoe causing pain and irritation. A bunion is a malformation of the big toe. The base of the big toe pushes away from the smaller toes, forcing the top of the big toe to press toward the other toes. Bunions can be hereditary, or they can result from injury to the toe joint or from wearing high heels with a narrow toe box. The toe becomes inflamed, and a bump may develop at the end of the misplaced bone. Ingrown toenails typically affect the big toe and its surrounding skin. The nail will dig into the skin and become painful. Wearing tight or narrow shoes that compress the big toe causes the nail to grow into the fleshy part of the toe. Cutting toenails incorrectly can also add to the development of an ingrown toenail. A toe sprain originates from a torn or stretched ligament. Strapping the injured toe to the toe next to it for stabilization is common. A broken or fractured toe usually occurs from trauma like dropping a heavy object on it or bumping into something extremely hard and rigid. Osteoporosis, a thinning of the bones, can also bring about toe fractures. 

Any of the conditions mentioned can lead to pain and irritation. While some are more serious than others, seeking an examination and diagnosis from a podiatrist is a good idea. A podiatrist can treat each ailment and get you back on your feet again without pain.