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.

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 a sack that is created over any bony prominence when excessive pressure or friction to the areas occurs. Bursae can be filled with a thick watery like fluid.

Treatment

Treatment consists of removing the pressure and avoiding shoes that 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 causes of pain in the ball of the foot. The type of pain and its location help the doctor in determining the cause of the pain and helps to direct them in the best treatment for the patient.

Calluses on the bottom of the foot can be painful. These calluses are caused by an abnormal alignment of the bones behind the toes called metatarsal bones. When there is an abnormal alignment of one or more of these bones, they will experience excessive weight and pressure. The skin thickens in response to this pressure forming the callus. Treatment consists of periodic trimming or shaving the callus, padding the shoes to remove the pressure, functional shoe orthotics, or surgery. Surgery should not be contemplated until the use of orthotics has been determined to have failed. The surgery consists of fracturing the involved metatarsal bone to realign it (See metatarsal surgery). Following the surgery, the patient should wear an orthotic to prevent the occurrence of new areas of callus. People with diabetes should not trim or shave these areas or use over the counter corn removers.

Pain in the ball of the foot not associated with calluses can be a result of inflammation of a tendon into the toe, inflammation of the joint, or due to a pinched nerve called a Neuroma. A neuroma will also often cause a burning pain into one or more toes. Another cause of pain in the ball of the foot is arthritis. Arthritis will usually affect multiple joints in the ball of the foot. Common types of arthritis are rheumatoid arthritis, osteoarthritis and degenerative arthritis. Degenerative arthritis most commonly affects the big toe joint. The big toe joint is often stiff causing jamming (Hallux Limitus). Over time the jamming of the joint will cause an enlargement on the top of the joint.

The most common cause of pain in the ball of the foot, in the area of the big toe joint, is sesamoiditis. Sesamoiditisis an inflammation of two small bones under the big toe joint. On occasion, a stress fracture can occur in one of these bones. Severe pain with sudden onset about the big toe joint may be gout.

There are several causes of pain in the arch of the foot and heel region. The type of pain and its location help the doctor in determining the cause of the pain and helps to direct them in the best treatment for the patient.

The most common pain in the bottom of the foot is heel pain. This pain tends to be worse first thing in the morning or after rest. It is associated with a tight ligament in the bottom of the foot called the plantar fascia. X-rays will often reveal a spur on the bottom of the heel. (See plantar fasciitis and heel spurs) Pain in the back of the heel can be due to bony enlargements (Hagland's deformity), spurring in the Achilles tendon or Achilles tendonitis. Burning pain in the bottom of the foot may be caused by a condition called tarsal tunnel syndrome or it may be due to peripheral neuropathy. People with diabetes frequently experience burning in the bottom of the feet. Pain in the middle of the arch of the foot that is also associated with small, hard knots may be due to plantar fibromatosis.