Tarsal Coalition In Children

If your child is complaining of foot or ankle pain that is unexplained by an injury come see us at Foot & Ankle Doctors, Inc where our physicians will examine for a tarsal coalition. Tarsal bones are bones located in the middle of the foot, the heel and the ankle. A tarsal coaltion occurs when there is an abnormal connection between two or more of these bones. This condition is usually present at birth, but your child may not show symptoms until later in life, usually around ages 9 to 16. Children with a tarsal coalition display the following symptoms

 

 Limp when walking

 

 Experience stiffness around the ankle and has decreased range of motion

 

 Tired legs

 

 Muscle spasms in the legs

 

 Flatfoot can be present in one or both feet

 

An x-ray and advanced imaging studies may be required to fully evaluate the condition before treatment is made. The goal of treatment is to reduce pain in your child’s foot. Our physicians at Foot & Ankle Doctors, Inc will take a conservative approach first by offering

 

 Physical therapy to increase range of motion

 

Custom orthotic devices to stabilize the foot and relieve pain

 

 Immobilization to remove stress from the foot and allow painful areas to rest

 

 Oral medication to reduce pain and inflammation

 

 Steroid injections to reduce pain and inflammation

 

If pain persists with conservative treatment, surgical intervention may be needed.

 

Dr. Dardashti

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

What is a neuroma?

What is a neuroma? “-Neur” is root for nerve and “-oma” is root for swelling or tumor.

Neuroma is a benign over growth of nerve tissue. Neuromas commonly occur in the interspace between the 3rd and 4th toe and are referred to as a Morton’s Neuroma.

Overgrowth of the nerve in the small interspace leads to compression in that area creating pain and irritation. Symptoms include a tingling, burning or numbing sensation, and pain in the ball of the foot.

Shoes are the culprits when it comes to neuromas, especially high heeled shoes or shoes that cause the toes to be squished together. With repeated irritation the nerves become swollen and inflamed leading to the development of a neuroma.

Treatment options for neuromas include: cortisone injections, sclerosing injections, custom orthotics, shoe modifications, padding, and in severe cases surgical removal.

If you think you have a neuroma come visit one of our doctors at Foot & Ankle Doctors.

Dr. Dardashti

My Child Has Heel Pain

Severe’s disease AKA calcaneal apophysitis is a growing pain at the back of the heel in young adolescents between the ages of 8 to 14. The heel bone contains a growth plate where the Achilles tendon attaches. Sever’s disease can occur for various reasons such as:

 The heel bones growth quicker than the ligaments that attach to it causing inflammation and pain

 A tight heel cord

 The undeveloped heel bone becomes stressed from repeated forces such as running and pounding on hard surfaces

 Obesity

 Biomechanical problems

Regardless of the etiology, children will often complain of pain at the back of their heel during sports, when they stand for too long or from shoes that rub at the back of their heels.

Diagnosis can be made based on the child’s symptoms and by performing a squeeze test. A positive squeeze test is defined as elicited pain when the child’s heel is squeezed from side to side.

Treatment for Severe’s disease is simple and mainly involves resting. It is advised that children take time off from sports and physical activity, stretch the leg muscles, ice the heel and take anti-inflammatory medications if needed to help reduce the swelling and alleviate pain. Gel inserts and orthotics may be recommended to support the heel. In severe cases a short leg cast may be applied to immobilize the foot and ankle and allow healing to occur.

If your child experiences symptoms of Sever’s disease come see our staff at Foot & Ankle Doctors, Inc.

 

Dr. Nejad

Podiatrists Preventing Falls

Fall related injuries are a serious burden on the public health system. More than a third of older adults fall each year and injuries can result in fractures, head traumas, decreased function and loss of independence in the elderly. Podiatrists can help reduce fall related injuries by evaluating your gait (the way you walk), your strength and your balance.

 

Dr. Dardashti stresses the importance of finding the right shoes. When selecting shoes he evaluates the heel height, sole slip resistance, sole flexion point (does the shoe bend in the correct area), sole hardness and sole thickness. Finding the right shoe increases support when walking thus boosting confidence and decreasing the fear of falling. Custom orthotics can also improve balance and support by evenly distributing pressure and forces, realigning the body in a more anatomically correct position that improves stability and reduces the likelihood of falling.

 

Muscle weakness can reduce flexibility and balance contributing the falls. For these patients Dr. Dardashti recommends braces and AFO’s (ankle foot orthotics). It’s crucial to stretch the muscles of the leg, foot and toes to improve strength, balance and proprioception. The specialists at the Foot & Ankle Doctors, Inc can provide you with simple stretches you can perform at home to improve your strength and balance.

 

Certain foot problems are risk factors for falls that can be addressed by podiatrists such as lower extremity muscle weakness, limited ankle motion, foot deformities like bunions, toe deformities such as hammertoes and calluses. It’s important to see your podiatrist regularly to address any of these risk factors.

Dr. David Dardashti

 

Got a pump bump?

A Haglund’s deformity also known as “pump bump” is a bony enlargement at the back of the heel that becomes irritated when rubbed against the stiff heel counter of shoes. It commonly presents in women who wear high-heeled shoes (pumps) for long periods of time. The bump appears near the attachment of the Achilles tendon and becomes red and swollen. There is a fluid filled sac called a bursa that sits between the heel bone and the Achilles tendon, which becomes inflamed and very painful with constant aggravation.

Dr. Nejad first recommends taking your shoes off and resting while icing the back of your heel for 20 minutes. He also recommends placing heel pads in the back of your shoes to relieve the pressure from the area of discomfort. In most cases the shoes you are wearing is the culprit so try switching from closed back shoe to an open back shoes or shoes with a softer heel counter. If the pain persists come see Dr. Nejad at Foot & Ankle Doctors, Inc.

 

Other treatment options include shoe modifications, topical anti-inflammatory medications that can directly be applied to the heel, ultrasound treatments and steroid shots to reduce the inflammation. In some patients the Achilles tendon or heel cord is tight and can compress the bursa causing pain. Stretching exercises can reduce the tightness of the Achilles tendon and relief pressure off the bursa. Heel lifts added to the shoe can also reduce the tension from the Achilles tendon. Custom orthotics can aid in controlling abnormal motion of the foot contributing to symptoms. In more extreme cases a walking cast may be used immobilize the foot reducing pressure and allowing the inflammation to subside. If these treatment options don’t provide adequate relief, surgery may be required to remove the bony bump from the heel.

Dr. Farshid Nejad

Budding Bunions

Bunions are every shoe lover’s worse nightmare. A bunion is a painful bump that forms on the joint at the base of the first or fifth toe making it difficult to wear shoes. These deformities progress over time and can be debilitating especially in runners. Overpronators are more prone to bunions because they place excessive stress on the big toe when running. This repetitive stress causes changes to the joint resulting in deviation of the toe inwards towards the other toes.

Padding and taping your foot before running can help position the foot in a more “normal” alignment and prevent abnormal stresses. Toe exercises can help strengthen the foot muscles and reduce the progression of the deformity. Physical therapy and anti-inflammatory medications can reduce the inflammation at the joint. Orthotics and proper fitted shoes with a deep and wide toe box are also recommended. If these treatment options fail or in severe cases surgical intervention is required to realign the joint and remove the bony bump on the side of the foot.

If you are concerned about your bunion come and see Dr. Nejad for a consult.

What are custom orthotics?

Custom orthotics are devices that are custom molded to your feet. They fit comfortably inside your shoes and are designed to reduce stress and strain on the feet, knees legs hips and back. Orthotics will help improve your gait making walking and running more comfortable. Orthotics will help to correct your body’s misalignments also known as “biomechanical or structural deformities.” Most people that have biomechanical deformities will develop symptoms that usually present as pain in the joints, muscles or tendons.

Think of wearing orthotics as similar to wearing eyeglasses. When you wear your glasses they help correct your sight by placing corrective lenses in front of the eyes. This helps your eyes function as close to 20/20 vision. Orthotics help the body function in a similar way by helping to restore normal biomechanical function in your feet and legs.

There are a variety of types of custom orthotics, the two main types are: functional orthotics and accommodative orthotics. Functional orthotics help re-align the feet and legs. They reduce, or control abnormal motion that may be causing pain in the foot, leg and back. Accommodative orthotics are made out of softer material and they are designed to absorb shock and reduce pressure. They are less effective in controlling abnormal motion, they simply cushion and pad ulcers, painful calluses, bony prominences and other pathologies of the foot.

If you have pain or discomfort and think you can benefit from orthotics come see Dr. Nejad or Dr. Dardashti at Foot & Ankle Doctors, Inc.