Common Disorders
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Did you know the foot has 28 bones, 37 joints, 107 ligaments, 19 muscles, and numerous tendons? These parts all work together to allow the foot to move in a variety of ways while balancing your weight and propelling you forward or backward on even or uneven surfaces. It is no wonder that most Americans will experience a foot problem that will require the care of a specialist at one point or another in their lifetime.

Ingrown toenails are due to the penetration of the edges of the nail plate into the soft tissue of the toe. It begins with a painful irritation that often becomes infected. With bacterial invasion, the nail margin becomes red and swollen often demonstrating drainage or pus. In people who have diabetes or poor circulation, this relatively minor problem can be become quite severe. In this instance, a simple ingrown toenail can result in gangrene of the toe. Patients with joint replacements or pace makers are at risk of bacterial spread through the blood stream resulting in the spread of infection to these sites. These patients should seek medical attention at the earliest sign of an ingrown toenail. There are several causes of ingrown toenails: a hereditary tendency to form ingrown toenails, improperly cutting the toenails either too short or cutting into the side of the nail, and ill-fitting shoes can cause them. Children will often develop ingrown toenails as a result of pealing or tearing their toenails off instead of trimming them with a nail clipper. Once an ingrown toenail starts, they will often reoccur. Many people perform "bathroom" surgery to cut the nail margin out only to have it reoccur months later as the nail grows out.

Athletes will often encounter a problem with their toenails turning dark. This may be due to the toes hitting the end or the top of the shoe toe area. Quite often the toenail may become loose and fall off. This can also occur in people who have worn a tight shoe for a prolonged period of time. The dark color is a result of bruising under the toenail. Generally it is not painful. The damage caused to the toenail may allow the establishment of a fungal infection in the nail. In people who have diabetes, any change in the color of the toenail should be evaluated by a doctor. The pressure, which caused the bruising of the nail, can cause a small sore under the toenail, which can become infected.

Gout is caused by abnormal metabolism of substances called purines that result in the accumulation of uric acid in the blood stream. Purines are a by-product of cell break down. When the excretion of the uric acid is hampered the accumulated uric acid in the blood stream causes crystalline deposits to form in joints or in the soft tissues. When this happens, there is a sudden onset of extreme pain with associated swelling, redness, and increased warmth to the skin or joint. Classic gout occurs in the big toe joint. It also commonly occurs in the knee joint. Rarely is it seen in more than one joint at a time. Uric acid accumulation in other joints and areas of soft tissue is less common. When gout presents in these areas it, may not be recognized as gout by the treating doctor.

Gout can also mimic an infection. Your doctor will evaluate you for the possability of infection and may treat you for infection as well as gout.

The common wart is known as verruca vulgaris. They are caused by a viral infection of the skin. This occurs as a result of direct contact with the virus. They do not spread through the blood stream. They occur more commonly in children than adults. When they occur on the bottom of the foot, they are called plantar warts. This name is derived from the location of the foot on which they are found; the bottom of the foot is called the plantar aspect of the foot. A common misconception is that plantar warts have seeds or roots that grow through the skin and can attach to the bone. The wart may appear to have a root or seeds, but these are in fact small clusters of the wart just beneath the top layer of the skin. The wart cannot live in any tissue except the skin. Moist, sweaty feet can predispose to infection by the wart virus. They can be picked up in showers and around swimming pools. They are not highly contagious, but being exposed in just the right situation will lead to the development of the wart. Avoiding contact in the general environment is nearly impossible. If a member of the family has the infection, care should be taken to keep shower and tile floor clean. Children who have plantar warts should not share their shoes with other people. Young girls often share shoes with their friends and this should be discouraged.

Blisters

Blisters form as a result of heat, moisture and friction. Blisters can also form as a result of fungal infections of the skin, allergic reactions or burns. If a patient has diabetes, they should be evaluated by a doctor in a timely fashion. Generally, a person will recognize a burn by association with a specific painful event. People with diabetes may not be able recognize the painful event due to a condition called neuropathy. A doctor should attend to burns. Blisters are due to fungal infection of the skin or to allergic reactions, which will generally occur in clusters and be smaller than blisters caused by friction. They will also often occur in areas of the foot, which are free from friction forces.

Psoriasis is a common, chronic, and recurrent inflammatory disease of the skin. It is characterized by round, reddish, dry scaling patches covered by grayish white or silvery white scales. The lesions have a predilection for the nails, scalp, elbows, shins and feet. On the feet, it can be difficult to distinguish it from athlete's foot, and the nail appearance may be confused with fungal infections of the toenails. The nail appearance does have a unique characteristic; it may have a pitting appearance. A characteristic feature of the condition is pinpoint bleeding when the scaled areas are brushed off. A variant of psoriasis is called pustular psoriasis. This form of the disease is characterized by small pustules or blisters filled with clear or cloudy fluid. This can mimic acute athlete's foot. It characteristically does not itch or burn. It is distinguished from athlete's foot by negative fungal cultures. The picture can become confusing because a secondary fungal infection is possible. In this instance both conditions are present at the same time.

Corns and calluses are areas of thick skin that result form excessive pressure or friction over a boney prominence. When these areas develop on the bottom of the foot they are called calluses. When they occur on the top of the toes they are called corns. They can also occur between the toes, the back of the heels and the top of the foot. The thickening of the skin is a normal body response to pressure or friction. Often times they are associated with a projection of bone called a bone spur. Not all areas of thickened skin are corns or calluses. Planter warts, inclusion cysts and porokeratoses also cause a discreet thickening of the skin that resembles corns and calluses.

Calluses

The most common area for the formation of calluses on the bottom of the foot is in the area of the ball of the foot. This is a weight bearing area where the long bones behind the toes called metatarsals, bear the greatest amount of weight and pressure. If one or more of these long bones (metatarsals) is out of alignment then excessive pressure is generated in the area producing a callous. The callused area can be very discreet and have a "core" or they can be more dispersed covering a larger area. These areas can become quite painful as the skin thickens. People who have diabetes are at risk of these areas breaking down producing sores or ulcerations that can become infected.People with diabetes should not try home remedies and should see a doctor for the treatment.

Athlete's foot is caused by a fungal infection of the skin on the foot. The majority of these infections are caused by one of three fungal agents called dermatophytes. Athlete's foot is by far the most common fungal infection of the skin. The infection can be either acute or chronic. The recurrent form of the disease is often associated with fungal-infected toenails. The acute form of the infection most often presents with moist, scaling between the toes with occasional small blisters and/or fissures. As the blistering breaks, the infection spreads and can involve large areas of the skin on the foot. The burning and itching that accompany the blisters may cause great discomfort that can be relieved by opening and draining the blisters or applying cool water compresses. The infection can also occur as isolated circular lesions on the bottom or top of the foot. As the skin breaks down from the fungal infection, a secondary bacterial infection can ensue.