Common Disorders
Click on the categories below to read articles on foot disorders and conditions. You may also use the search button below.
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 neuroma is the swelling of nerve that is a result of a compression or trauma. They are often described as nerve tumors. However, they are not in the purest sense a tumor. They are a swelling within the nerve that may result in permanent nerve damage. The most common site for a neuroma is on the ball of the foot. The most common cause of neuroma in ball of the foot is the abnormal movement of the long bones behind the toes called metatarsal bones. A small nerve passes between the spaces of the metatarsals. At the base of the toes, the nerves split forming a "Y" and enter the toes. It is in this area the nerve gets pinched and swells, forming the neuroma. Burning pain, tingling, and numbness in one or two of the toes is a common symptom. Sometimes this pain can become so severe, it can bring tears to a patient's eyes. Removing the shoe and rubbing the ball of the foot helps to ease the pain. As the nerve swells, it can be felt as a popping sensation when walking. Pain is intermittent and is aggravated by anything that results in further pinching of the nerve. When the neuroma is present in the space between the third and fourth toes, it is called a Morton's Neuroma. This is the most common area for a neuroma to form. Another common area is between the second and third toes. Neuromas can occur in one or both of these areas and in one or both feet at the same time. Neuromas are very rare in the spaces between the big toe and second toe, and between the fourth and fifth toes. Neuromas have been identified in the heel area, resulting in heel pain.

A puncture wound or laceration that injures a nerve can cause a neuroma. These are called traumatic Neuromas. Neuromas can also result following a surgery that may result in the cutting of a nerve.

The chemical destruction of the nerve, called neurolysis, is an older form of treatment that has recently come back into vogue. This treatment requires a series of injections of ethanol mixed with a local anesthetic. The injections are given into the area of the neuroma. Nerve tissue has a natural affinity for ethanol, and it is readily absorbed into the nerve. Ethanol, however, is toxic to nerve tissue and with repeated exposure, will destroy the nerve. The rate of success is variable, but has been reported to be over 60%. Many insurance plans will not pay for weekly injections and require the doctor to wait a minimum of ten days between injections before they will reimburse for the procedure. This likely reduces the rate of success for this treatment, because during the time between the injections, the nerve will attempt to repair itself. One way to solve this delay is for the patient to pay for those injections not paid for by the insurance plan. The disadvantages for this form of treatment are the need for repeated visits to the doctor’s office, and the occasional pain in the area of the injection the following day or two after it has been administered. The advantages to this form of treatment is that it requires a minimal amount of time off of work and the overall cost as compared to the surgical removal of the nerve. If this form of treatment fails, then surgical removal is the only option that remains.

Peripheral Neuropathy is a nerve condition that affects the arms, hands, legs, and feet. The most common form of peripheral neuropathy is due to diabetes.

Diabetic Peripheral Neuropathy

People with diabetes have an abnormal elevation of their blood sugar, and lack adequate insulin to metabolize the blood sugar. As a consequence, the blood glucose (sugar) abnormally enters certain nerve tissue and damages the nerve. This can occur in any type of diabetes. It does not matter if the patient is on insulin, is taking pills, or is diet controlled. The nerve damage that occurs is considered to be permanent.

As the nerve damage occurs, the protective sensations are affected. These include a person's ability to determine the difference between sharp and dull, hot and cold, pressure differences, and vibration. These senses become dulled and/or altered. The process begins as a burning sensation in the toes and progresses up the foot in a "stocking distribution". As the condition progresses, the feet become more and more numb. Some people will feel as though a pair of socks on their feet, when in fact they do not. Other patients will describe the feeling of walking on cotton, or a water-filled cushion. Some patients complain of their feet burn at night, making it difficult to sleep. The feet may also feel like they are cold, however, to the touch, they have normal skin temperature. Diabetic peripheral neuropathy is not reversible. The progression of the condition can be slowed or halted by maintaining normal blood glucose levels.

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 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.

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.

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.