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.

A fibroma is a benign fibrous tissue tumor or growth, that can occur anywhere in the body, for example in the uterus they're called fibroids. On the plantar, or bottom surface of the foot, they are called plantar fibromas. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. When non-surgical measures for treating plantar fibromas, such as orthotics have failed to provide adequate relief of symptoms, surgical removal is a reasonable option. Attempts may be made to surgically remove solitary nodules (a single lump or bump) with wide excision, however there is reported to be a high incidence of recurrence. Multiple plantar fibromas generally require more extensive excision of the entire fibrous band of plantar fascia (known as a Steindler plantar fascial stripping), in order to insure complete removal and prevent recurrence.

Description of the Surgery

The surgical procedure involves a long, often curvilinear, incision on the bottom of the foot. The incision extends from the heel to the ball of the foot. The surgeon will dissect through the fatty tissue layer on the bottom of the foot to expose the thick fibrous plantar fascia. The plantar fascia, which includes the multiple benign fibromas, extends from the bottom of the heel, through the arch, all the way to the ball of the foot. The fascia removal requires careful separation from deeper soft tissue structures, and small nerves. Once the fascia has been removed, the bottom of the foot is stitched closed. Often a drain is placed into the surgical site to help prevent blood and other fluids from collecting there. The surgical wound is bandaged and the patient must remain non-weight bearing on the foot (with crutches) for a minimum of three weeks. Normal post-operative care including rest, ice, elevation, and maintaining a clean surgical site would be followed. The drain is usually removed 3 to 5 days after the surgery. The stitches are removed between 2 and 3 weeks after the surgery.

The common cause of a painful bump on the back of the heel is called Hagland's deformity. This is due to an enlarged bony prominence on the back of the heel. It can involve the entire back of the heel or just a portion of the back of the heel, usually on the outside portion of the heel. Also called the Pump Bump, it is most common in women and is frequently a result of pressure from the back of the shoe. As the shoe rubs on the back of the heel bone it begins to swell and enlarge. Quite often a bursa will form. A bursa is sack that is created over any bony promance when excessive pressure or friction to the areas occurs. Bursa can be filled with a thick watery like fluid.

Treatment of Hagland's Deformity and Pump Bumps

Treatment consists of removing the pressure and avoiding shoes, which rub on the back of the heel. Orthotics, custom molded shoe inserts, can be useful because they reduce the rocking motion side-to-side of the heel while walking which aggravates the painful area. Cortisone injections can temporarily reduce the pain or eliminate the pain. Surgery can be the treatment of choice if other means to reduce the pressure are unsuccessful.

There are several different causes of lumps and bumps on the top of the toes and foot. Working from the toes back these are:

1. Muco-Cutaneious Cyst

Small nodular single mass that can form on the top of the toe is called the Muco-Cutaneious Cyst. These occur most frequently at the joint just behind the toenail. These are caused by a weakening of the joint capsule, which allows a swelling to occur. They are firm and rubbery to the touch. Sometimes as the skin thins due to the stretching pressure of the mass it will appear translucent. When the mass is broken or punctured, a thick clear fluid will leak out. If the mass does break open, the area should be kept clean and free of infection. Once the skin heals the mass will reappear.

There are many different causes of lumps and bumps on the inside of the foot. Starting from the big toe and working back to the heel:

A swelling along the margin of the big toenail is likely to be due to the formation of an ingrown toenail. At times this swelling can produce open, weeping flesh. Treatment consists of removing the ingrown toenail (See treatment for ingrown toenails).

A swelling often associated with a hard, callused area may form on the side of the big toe. This is due to an enlargement of the bone in this area. It is usually associated with a deviation at the joint in the big toe. Treatment consists of using a functional foot orthotic to redirect the pressure from the area. Surgical removal of the underlying bony prominence or surgical straightening of the toe may be recommended. People who have diabetes must watch this area because over time the excessive pressure to the area from walking can cause the skin beneath the callused area to break down forming an ulceration that can become infected. Left untreated, the bone can become infected and in severe cases amputation of the toe may be necessary.

There are a number of different causes of lumps and bumps on the bottom of the foot. Working from the toes to the heel:

1. Lumps and Bumps on the Bottom of the Big Toe

A painful lump may be found on the bottom of the big toe. This condition often presents itself as a hard callused area. Sometimes a hard lump may be felt beneath the callused area. The most common cause of this condition is a limitation of movement of the big toe joint while walking. If there is limitation of movement at this joint, then the big toe cannot bend upward as the heel comes off the ground while walking. As a consequence, there is excessive force placed on the bottom of the big toe and an enlargement of the bone in this area will occur secondary to the pressure. Another cause is the presence of an extra bone or piece of cartilage in the area. However, it is the limitation of movement in the big toe joint that causes the area to become enlarged and painful.

People who have diabetes must watch these areas closely. Over time, the excessive pressure can cause this area to break down and ulcerate. One way to check to see if there is a limitation of movement of the big toe joint is to perform the following test. While standing on a flat surface, have another person try to bend the big toe upward. The joint that must move is the joint where the toe attaches to the foot. There is a joint in the middle of the big toe and this is not the one you are checking. If the big toe joint cannot be bent upward then a limitation of motion exists. Testing the movement at the joint without putting weight on the foot will give a false impression as to the available movement at the joint while you are walking. This limitation of movement of the big toe while walking can, over, time create an arthritic condition in the joint. A bony mass may then form on the top of this joint as a result of jamming in the joint. This condition is called hallux limitus or hallux rigidus. Treatment for the painful lesion in the bottom of the big toe joint consists of using functional foot orthosis to correct the functional limitation of the big toe joint motion or may consist of surgical correction of the hallux limitus. Rarely is surgery to remove only the lesion on the bottom of the toe alone, successful, because the cause of the initial problem still exists.

There are a few causes of lumps, bumps or prominence on the outside of the foot. Some of these are just normal anatomy; others are due to abnormal processes. Starting from the fifth toe and working back to the heel:

A common prominence on the fifth toe is due to the formation of a hammertoe. A hammertoe is a structural deformity of the fifth toe causing the joint in the toe to become propionate. Pressure from shoes will cause athickening of the skin. On occasion, this can become very painful making it difficult to wear a closed shoe. Treatment consists of trimming the thick skin or padding the area to reduce the pressure from the shoe. At times surgical strengthening of the toe is necessary (See hammertoe surgery).

Just behind the fifth toe, at the joint where the toe connects to the foot, a prominence can develop. This is called aTailors bunion. It is caused by the abnormal function of the foot and can be slowly progressive. Some people naturally have an enlargement in this area. Shoe pressure can make the area painful and at times cause a bursa to form. A bursa is a sack of inflamed tissue that occurs over a bony prominence in response to excessive pressure or friction. The bursa is spongy to the touch and can be very painful. The bursa can be treated with cortisone injections to reduce the swelling and inflammation. Padding the area is also useful to reduce the pressure from the shoes. Selecting the correct shoe can also be helpful See selecting the appropriate shoe). Surgical correction of the tailor's bunion is a common procedure to reduce the prominence and the pain associated with it (See Tailors bunion surgery). A rare occurrence of  can also occur in this area. This condition usually presents with a sudden onset of pain and swelling in the area.