Warts

What are warts?

A wart in an infection caused by a virus, which can invade your skin through small cuts or breaks. Over time, the wart develops into a hard, rough growth on the surface of the skin. A wart is most commonly seen on the bottom of the foot (plantar wart), but can also appear on the top. Children, teens, and people with allergies or weakened immune systems are more vulnerable to the wart virus.

Symptoms
Warts may appear spongy, with tiny red, brown, or black spots. They can grow up to an inch or more across, occurring alone (solitary) or with smaller warts clustered nearby (mosaic). Warts are sometimes mistaken for corns or calluses. They can persist for years and recur in the same spot. If left untreated, warts can spread to other parts of the foot or even to the hands or other areas of the body.

Evaluation
Your podiatrist examines your wart carefully to determine that it is not a corn or a callus. A wart will usually feel painful when your podiatrist squeezes it from side to side. To examine the wart further, the hard skin layer around it may need to be trimmed. A wart will have certain spots that bleed when trimmed; a callus will not.

How does my podiatrist treat warts?

There are many ways to treat warts, depending on their size and location. Medication or surgical removal, or both, may be effective treatments. A few of the possible treatment methods are described below; freezing or burning may also be used to treat warts. Even after warts are removed, they may recur.

Medication
The wart is broken down by applying an acidic medication. Blister-forming medication may also be used. Treatment may need to be repeated over several weeks.

Curettage
The wart is removed with a small, spoon-shaped instrument (curette). To lessen pain, a local anesthetic is often used with this procedure.

Laser
The wart is vaporized, using focused light energy produced by a laser. To lessen pain, a local anesthetic is often used with this procedure.

What can I do about warts?

After your podiatrist treats your warts, protect your feet from future infection by keeping them clean and dry. If you’re thinking of using over-the-counter medications for warts, ask your podiatrist first. Some of these treatments can damage skin—and may be dangerous if you have diabetes or poor circulation. Avoid going barefoot in public places like showers, gyms, and locker rooms. The wart virus may spread easily in moist settings like these. Wears thongs or sandals on your feet.

Tendonitis

What is tendonitis?

When you use a set of muscles too much, you’re likely to strain the tendons (soft tissues) that connect those muscles to your bones. At first, pain or swelling may come and go quickly. But if you do too much too soon, your muscles may over-tire again. The strain may cause a tendon’s outer covering to swell or small fibers in a tendon to pull apart. If you keep pushing your muscles, damage to the tendons adds up and tendonitis develops. Over time, pain and swelling may limit your activities. But with your doctor’s help, tendonitis can be controlled. Both your symptoms and your risk of future problems can be reduced.

Where does your foot hurt?

Depending on what causes the stress or overuse, tendons in the back, sides, or front of your foot may hurt. At first you may feel pain only during or after a workout, such as running or an aerobics class. As tendon damage adds up, however, your foot may hurt when you walk or even when you stand still.

The Back of Your Foot
The Achilles tendon connects the calf muscle to the heel bone. If tendonitis occurs here, you may feel pain when your foot touches down or when your heel lifts off the ground.

The Front of Your Foot
The anterior tibial tendon helps control the front of your foot when it meets the ground. If this tendon is strained, you may feel pain when you go down stairs or walk or run on hills.

The Inside of Your Foot
The posterior tibial tendon runs along the inside of the ankle and foot. If this tendon is strained, your foot may hurt when it moves forward to push off the ground. Or you may feel pain when your heel shifts from side to side.

The Outside of Your Foot
The peroneal tendon wraps across the bottom of your foot, from the outside to the inside. Tendonitis here may cause pain when you stand or push off the ground.

Your Physical Exam
During the exam, you’ll probably be asked to describe your symptoms, your overall health, and your usual activities. The doctor will check your foot and ankle for areas of redness, swelling, and warmth. The range of motion in your foot and ankle may also be tested.

Testing
X-rays may be taken to rule out a broken bone. To identify damage to a tendon, your doctor may order an MRI (magnetic resonance image).

Treating tendonitis

Your doctor’s first concern is to reduce your symptoms. Using ice and heat, taking medications, and limiting activity help control pain and swelling. Follow all of your doctor’s instructions. Returning to activity too soon may cause your symptoms to come back.

Ice and Heat
Ice helps prevent swelling and reduce pain. Place ice on the painful area for 10 minutes. Repeat the icing several times a day. If you already have swelling, using heat may help. Apply a heating pad or hot towels to the tendon for 30 minutes two or three times a day. 

Medications
Your doctor may tell you to take aspirin or other anti-inflammatory medications. These reduce pain and swelling. Take them as directed. Don’t wait until you feel pain. In more severe cases, cortisone may be injected to relieve pain.

Limiting Activities
Rest allows the tissues in your foot to heal. Stay off your feet for a few days, then slowly work back into activity. If you do high-impact activities, such as running or aerobics, try other activities that place less strain on your foot. Cycling and swimming are good choices.

Staying pain-free

Avoiding overuse is the best way to protect your feet and stay pain-free. If your doctor prescribes an ankle brace or custom-made shoe inserts (orthoses), wear them as directed. Also stretch your feet and ankles before and after exercise.

Protect Your Feet
Limit the amount of stress created when your foot hits the ground. The tips below can help.

  • Wear the right shoe for the activity, so the shoe’s support and cushioning meet your needs. Also, choose shoes with good arch and heel support. Ankle support is helpful, too.
  • Vary or reverse your exercise route or routine. That way, one set of muscles is not always under extra stress.

Turf Toe

What is Turf Toe?

The injury occurs with hyperextension of the great toe at the metatarsophalangeal (MTP) joint. Most often occurring with football athletes, although with the more common installation of artificial turf for field sports, this injury is happening with greater frequency and is often misdiagnosed by athletic staff.

There are three grades of severity according to the mechanism of injury. Depending on the force and direction of impact, a variety of injuries can occur ranging from strain or sprain of the plantar capsule to outright dislocation of the toe. Based on a proper diagnosis by one of our foot and ankle specialist, an appropriate treatment plan may be implemented.

When a Grade I or II has been determined, physical therapy has a high success rate for a full recovery and return to sport. According to McCormick and Anderson, whose study reports, “In all cases, acute and chronic, diligent rehabilitation with the assistance of a therapist or trainer is critical to the full recovery of the patient.”

If one is diagnosed with a Grade III, physical therapy is still the primary route prescribed for regaining push-off strength, but if conservative treatment fails, one must consider the possibility of surgical intervention, even though the cases are rare in which surgical repair is a necessity. McCormick and Anderson state in their research, “Because of the infrequency with which these injuries are surgically repaired, they should always be referred to a foot and ankle specialist.”

*Turf Toe Injuries are Commonly Misdiagnosed and Mistreated.