Venous Ulcers..

Veins are thin vessels that transport blood from the body back to the heart. Veins contain valves that act like gates providing a continuous forward flow of blood. When valves become weakened and incompetent they allow blood to flow backwards and pool in the lower extremity. This pooling of blood stretches the skin and can lead to the development of venous ulcers.

Clinically, venous ulcers present as shallow irregular ulcers located over bony prominences. Varicosities, edema and skin discolorations are common findings associated with venous ulcers. Risk factors for developing venous ulcers are older age, obesity, previous leg blood clots, and history of leg swelling.

Treatment options include:

Debridement – can be sharp (with a blade or curette), enzymatic (topical ointments that are applied and eat away at the dead skin), mechanical debridement (wound scrub). Debridement aids in removal of dead and unhealthy tissue that hinders the healing process.

Dressings – promotes faster healing. Some dressings may contain antibiotic properties to prevent infection

Compression – there are two types of compression, inelastic and elastic. Unna boot is an example of inelastic compression. Unna boots provide static compression and aids in removing excess fluid from the lower extremities. It contains zinc an anti-bacterial and anti-inflammatory agents and calamine lotion to sooth skin irritation. Compression stockings are an example of elastic compression. Compressions stockings should provide at least 30mmHg of compression to aid in moving blood up the legs and reduce edema.

Skin grafting – to help close non-healing wounds, improve function and appearance of the leg

Surgery – to remove insufficient veins to prevent recurrence of venous ulcers

For treatment of venous ulcers please visit us at Foot & Ankle Doctors, Inc

Dr. Nejad

Shooting Foot Pain – Tarsal Tunnel Syndrome

Tarsal tunnel is similar to carpal tunnel where a nerve is compressed producing sharp shooting pain. Tarsal Tunnel refers to a canal on the inside of the ankles. This canal allows tendons, nerves, arteries and veins to course along the ankle and into the foot. A sheath covers this canal to hold the structures in place. When this canal becomes compressed it pinches the tibial nerve in the canal causing a shooting pain.

Tarsal tunnel can be caused by:

  • Flat feet or “fallen arches” can compress the tibial nerve

  • Trauma or previous ankle injury causing swelling placing pressure on the nerve

  • Abnormal structures such as ganglion cyst, varicose veins, inflamed tendon, bone spur

  • Systemic diseases: arthritis, diabetes

Symptoms include tingling, numbness or shooting pain in the feet. Our doctors at Foot& Ankle Doctors, Inc will tap along the course of the tibial nerve, if symptoms are reproduced while performing this test it is an indication for tarsal tunnel. It is important to exclude the possibility of a pinched nerve in the lower back that can produce similar symptoms.

Treatment for tarsal tunnel syndrome starts with conservative options to reduce inflammation, pressure and or limit motion to the tarsal tunnel:

  • Rest

  • Ice

  • Oral medication

  • Immobilization/bracing

  • Steroid injection

  • Physical therapy

  • Orthotics

In cases where conservative treatments fail, surgery may be required in which case a tarsal tunnel release will be performed.

Come see us at Foot& Ankle Doctors, Inc for more information

Dr. Dardashti

Stiff Painful Big Toe – Hallux Limitus

A stiff big toe that is painful to move is a sign of degenerative arthritis and is known as hallux limitus. It can be a disabling condition preventing patients from walking normally and performing their daily activities. Hallux limitus is a progressive condition that gets worse overtime and can eventually lead to a “rigid” toe that patients describe as a “frozen big toe.”

Hallux limitus can be caused by:

 Abnormal foot structure or biomechanics

 Overuse or wear and tear of the joint

 Trauma

 Inflammatory diseases – ex. Rheumatoid arthritis, Gout

Symptoms and treatment of hallux limitus vary depending on the stage of the condition. Early stage symptoms include pain and stiffness when walking, standing for extended periods of time or squatting. Later stages present with swelling of the big toe, difficulty wearing shoes, formation of a bump on top of the toe as well as stiffness.

Treatment options include the use of nonsteroidal anti-inflammatory medications, custom orthotics, shoe modifications and corticosteroid injections. In some cases surgery may be an option to reduce pain. Surgical options include:

 Cleaning the joint and removing pieces of bone that limit motion

 Fusing the big toe to prevent further degeneration of the joint

 Replacing the joint of the big toe with an implant

If you are experiencing pain or stiffness in your big toe come see our physicians at the Foot & Ankle Doctors, Inc.

Dr. Nejad

Getting Rid of Ingrown Toenails

Ingrown toenails are a painful nail condition where the nail curves downwards and grows into the soft tissue surrounding the border of the toenail. The big toe is commonly affected with an ingrown nail and can be a result of:

 Trauma

 Ill-fitting shoes

 Improper trimming of the nail

 Thick fungal nail

Patients complain of a red swollen nail edge(s) that are painful upon touch. If the skin surrounding the nail becomes pierced bacteria can grow in the area leading to an infection, and antibiotics may be needed. If you are suffering from an ingrown toenail come see us at Foot & Ankle Doctors, Inc.

At Foot & Ankle Doctors, Inc. we offer various treatment options patients can choose from:

 Partial removal of the offending nail

 Complete removal of the offending nail

 Permanent removal of the offending nail

Dr. Farshid Nejad

Ganglion Cysts- Foot Lumps

If you are noticing a fluid like lump on your foot, you probably have a ganglion cyst. Ganglion cysts are not cancerous and do not spread to other areas, however cysts may appear at multiple locations. They commonly appear on the hands and wrists and feet. Ganglion cysts form lumps beside joints or tendons and is filled with a viscous fluid. Irritation at a joint or tendon is believed to cause the formation of a ganglion cyst. They may grow in size or disappear spontaneously.

At Foot& Ankle Doctors, Inc we offer a variety of treatment options, which include:

  • Monitoring – if the cyst is painless intervention may not be needed since it may disappear completely on its own

  • Aspiration – placing a needle into the cyst to remove fluid and allow the cyst to decompress

  • Shoe modifications – padding may be used to reduce irritation and pressure of the cyst

  • Surgery – involves removing the cyst and a portion of the joint capsule or tendon sheath

It is important to note that regardless of the treatment option ganglion cysts may return, even with surgery.

Dr. Dardashti