Pediatric Clubfoot

Every 1 in 1,000 births a child is born with a clubfoot, which can be devastating to parents. Pediatric clubfoot is curable and if the deformity is corrected early, children born with clubfoot are indistinguishable from other children with normal feet.

 

What is Clubfoot?

 

Clubfoot occurs when a child’s foot is turned inwards and the heel points downwards. In 50% of cases the deformity can occur in both feet. The calf muscles of the affected side are smaller than normal. Clubfoot is a congential deformity, meaning the child is born with the condition.

 

Causes

 

 Clubfoot is most often idiopathic (no apparent cause)

 

 Associated with genetic syndromes and birth defects

 

 Result from a neuromuscular disorder

 

Treatment

 

The “Ponseti” casting method is the preferred method for treating pediatric clubfoot. Treatment should begin within the first month of life for best results. The child’s foot is manipulated into the correct position through a serious of casting. 6-8 leg casts are applied every 5-7 days to slowly correct the deformity overtime. In some cases a small cut may be made to the heel cord to release contracture of the Achilles tendon. After the casting series is completed a special brace is required to be worn during naps and at night until the age of 4.

 

Clubfoot is visible at birth and can be detected by fetal ultrasound. If your child has been diagnosed with clubfoot come see us at Foot& Ankle Doctors, Inc for more information.

 

Dr. Dardashti

Avoid Overuse Injuries This Spring

Spring is around the corner and many of us are ready to get back into shape and hit the pavement with the first spring thaw.  Many of us haven’t hit the gym for months and it’s important to get back into the routine of working out slowly to prevent overuse injuries.


Overuse injuries occur over time with repetitive microtrauma to tendons, bones and joints. Common overuse injuries in the lower extremities include runner’s knee, jumper’s knee, Achilles tendinitis and shin splints.


Causes of overuse injuries include

  • Training errors – over training or increasing acceleration, intensity, duration or frequency too quickly instead of gradually over time

  • Form error – improper technique or shoe gear can lead to injury overtime

  • Returning to a sport or activity too soon after injury

  • Biomechanical and individual factors – body alignment and foot structure can predispose individuals to overuse injuries


Treatment of overuse injuries can be remembered by the mnemonic RICE-AR

  • Rest – complete rest from the activity may be necessary or cross training with a different sport/activity

  • Ice – apply ice to injured area for 15 minutes a day

  • Compression – apply an ACE bandage or elastic wrap after icing to prevent further swelling

  • Elevation – elevate the injured extremity above the level of the heart when resting

  • Anti-inflammatory medication – ibuprofen or Tylenol can be taken to reduce inflammation

  • Re-condition – stretching and strength training are important steps in rehabilitation and preventing future injury


If you suspect you have an overuse injury, consult one of our doctors at Foot& Ankle Doctors, Inc.


Dr. Nejad

Toe Injuries Are Not Just For High Athlete Performers

Athletes involved with high impact sports will often suffer from toe injuries. Sports fans will remember when Pierre Garcon and Taylor Martinez both suffered from a plantar plate tear. Although a lot of us are not professional athletes we too can suffer from plantar plate tears.

The plantar plate is a ligament located on the bottom of the toes. It is responsible for cushioning the ball of the foot when walking and running and prevents hyperextension of the toes. With repeated overuse the ligament can stretch and tear and lead to a predislocation syndrome also known as a crossover toe deformity or a floating toe syndrome. Plantar plate tears most commonly affect the second toe.

Symptoms of a plantar plate tear:

  • Persistent pain at the ball of the foot

  • A toe that is changing position – lifting up or crossing over

  • Swelling

Plantar plate tears can be difficult to diagnose. Common misdiagnoses include a neuroma, tuff toe or a stress fracture. If you were given one of these diagnoses and you are unresponsive to treatment, ask your doctor about the possibility of a plantar plate tear.

At Foot& Ankle Doctors, Inc we will first offer conservative treatment options:

  • Rest

  • Ice

  • Anti-inflammatory medication

  • Accommodative padding to alleviate pressure from the ball of the foot

  • Plantarflexion strapping of the digit to hold it in place

  • Orthotics and stiff soled shoe or rocker-bottom shoes may be recommended

If conservative treatments fail, surgery may be required to repair the ligament.

 

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

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

Turf Toe.. More Serious Than You Think

Turf toe sounds like a minor injury that only involves a single toe, however it can be a career ending injury like it was for Deion Sanders. It commonly occurs in athletes who play sports on artificial turf, hence the name “turf” toe. This injury occurs when athletes bend their big toe beyond its normal flexibility. Cleats often get stuck in divots in artificial turf leading to hyper extension of the toe. Hyper extension of the big toe can take place every time the athlete pushes off with their toes to start running. This motion occurs multiple times during every game and practice eventually over time the big toe becomes sprained.

The severity of the injury is graded from 1 to 3

Grade

Injury

Treatment

1

Mild sprain

  • RICE – rest, ice, compress, elevate

  • Taping the toe to restrict movement

  • Non-steroid anti-inflammatory medication

2

Partial tear of the capsule and ligaments

  • Same as Grade 1 + walking boot to immobilize the big toe joint

3

Complete tear of the capsule and ligaments

  • Same as Grade 1 + walking boot or cast for immobilization

 

Physical therapy should also be implemented to prevent stiffness in the joint and gain adequate range of motion. Surgery is often not needed, but is an option for some cases.

Foot& Ankle Doctors, Inc recommend athletes who return to sports should have their shoes modified with a steel shank or stiff insoles to restrict hyper extension of the toe.

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

Toenail Fungus

Our staff at Foot & Ankle Doctors, Inc. understand that toenail fungus is an embarrassing problem. It can lead to thickened brittle yellow discolored nails that may be painful. Fungal nails are also referred to as onychomycosis and are caused by microscopic fungi, yeasts and molds. A sample of the infected nail should be taken and sent to a lab to determine the causative agent. There are a variety of treatment options available, however fungal infections are difficult to treat and can return after treatment has finished.

The different treatment options include:

 Oral medications – required to be taken for 6-12 weeks

 Topical nail lacquer – can be used twice a day for up to 4 weeks, but is often ineffective in severe cases

Laser therapies – involve multiple sessions to achieve clearance

We will help you determine the best course of action to treat your toenail infection. It is advised during treatment to discard old shoes, which may house fungi and use antifungal spray or powder to prevent reinfection.

 

Dr. Dardashti