"After my athletic injury, I had met with several doctors in the Northern Virginia area… many were quick to diagnose, quick to jump into surgery, and quick to misdiagnose. Dr. Pontell not only examined my foot via MRI, Xray, Ultrasound and in person – he explained EVERYTHING to me... After completely healing, at 38 years old I can run longer, and run faster than I ever had been able to run before – even before my injury. I’m in the best shape of my life. I tell everyone all the time that I am able to do what I do because of him - my foot he reconstructed is a million times stronger than my uninjured foot." -A.D.
"I went to Dr. Hallivis based on his reputation and his extensive experience. He definitely stood up to his reputation. He was professional, friendly, approachable and knew everything there was to know about my problem. He treated me and my pain resolved in 2 days. His office ran on time and his staff was warm and helpful. I would recommend him to anyone with a foot problem.” - M.H.
Diagnostic Procedures & Orthotics
Computed tomography (CT) examination (also known as a CAT scan) is used in podiatry to help diagnose and treat foot or ankle problems. A CT is a kind of X-ray device that takes cross-sectional images of a part of the body, giving the physician a three-dimensional image. CT scans are often superior to conventional X-rays because they can more accurately pinpoint a suspected problem. Common foot problems a CT exam can help diagnose include: arthritis, deformities, flat feet, foreign bodies, fractures, infection, and tumors.
Pregnant women, especially those in their first trimester, are advised against having a CT exam or any X-ray examination because the radiation may harm the unborn child.
X-rays help determine whether a bone has been fractured or damaged by conditions such as an infection, arthritis, or other disease.
Other reasons for conventional X-rays on your feet are to:
- Evaluate changes in the bones from infections, arthritis, or other bone disease.
- Assess whether a child’s bones are growing normally.
- Locate foreign objects (such as pieces of glass or metal) in a wound.
- Determine whether bones are properly set after treating a fracture.
Pregnant women, especially those in their first trimester, are advised against having X-rays because the radiation may harm the unborn child.
Magnetic resonance imaging (MRI) is sophisticated diagnostic equipment used to diagnose an array of health problems or conditions, including:
- Injuries of the tendons, ligaments, or cartilage.
MRIs use no radiation like conventional X-rays or CT scans. They employ large magnet and radio waves to produce three-dimensional images. MRIs are very good at portraying soft tissues and bones in your feet and ankles.
People with the following conditions may not be good candidates for a MRI:
- Conditions that requires a heart pacemaker.
- Artificial heart valves.
- Electronic inner ear implants.
- Electronic stimulators.
- Implanted pumps.
- Metal fragments in eyes.
- Surgical clips in the head (particularly aneurysm clips).
Individuals with dental fillings or bridges, a replacement hip or knee, or tubal ligation clips are generally safe to have a MRI.
In most cases, a full exam of the foot and ankle via MRI lasts between 60 and 90 minutes.
Ultrasound is a very effective tool for diagnosing a wide variety of foot and ankle problems, particularly soft tissue problems. Ultrasound uses sound waves on the body in a way much like radar uses sound waves. The waves hit a targeted area and are bounced back to a recording device, which produces an image. Ultrasound is a completely safe, noninvasive, and painless diagnostic procedure.
Common problems for which ultrasound may be prescribed include:
- Heel spurs or plantar fasciitis.
- Injuries of the ligaments, tendons, or cartilage.
- Morton’s neuroma.
- Presence of foreign bodies.
- Soft tissue masses.
- Tarsal tunnel syndrome.
- Tendonitis or tears in a tendon.
Most individuals will experience foot pain at some point in time during their lives. Foot pain is caused by a wide variety of injuries, health problems or disorders
According to an American Podiatric Medical Association survey, 76 percent of Americans said they spend more than four hours each day on their feet. The same percentage said they had foot problems in the last 12 months.
Recurring or persistent (chronic) pain on the outer side of the ankle often develops after an injury, such as a sprained ankle.
The American Orthopaedic Foot and Ankle Society identifies both conservative and surgical treatment methods to alleviate this pain. Conservative treatments include:
- Anti-inflammatory medications, such as aspirin or ibuprofen to reduce swelling.
- Physical therapy, including tilt-board exercises directed at strengthening the muscles, restoring range of motion, and increasing the perception of joint position.
- An ankle brace or other support.
- An injection of a steroid medication.
- In the case of a fracture, immobilization to allow the bone to heal.
Almost half of all people who sprain their ankle once will experience additional ankle sprains and/or chronic pain. You can help prevent chronic pain from developing by following these simple steps:
- Follow your doctor’s instructions carefully and complete the prescribed physical rehabilitation program.
- Do not return to activity until cleared by your physician.
- When you do return to sports, use an ankle brace rather than taping the ankle. Bracing is more effective than taping in preventing ankle sprains.
- If you wear hi-top shoes, be sure to lace them properly and completely.
Plantar fasciitis is an inflammation of a thick, fibrous ligament in the arch of the foot. The plantar fascia (arch of the foot) attaches into the heel bone and fans out toward the ball of the foot, attaching into the base of the toes. If this ligament is stretched excessively it will become inflamed and begin to cause pain.
The main emphasis for treatment of arch pain is to reduce the forces that are causing the plantar fascia to stretch excessively. This includes calf muscle stretching, over the counter arch supports, and orthotics. Oral anti-inflammatory medications may be useful in controlling the pain.
Additionally, cortisone injections may be recommended for the treatment of plantar fasciitis.
Ball of the foot pain
Calluses are the most common source of pain on the ball of the foot. Treatment consists of periodic trimming or shaving the callus, padding the shoes to remove the pressure, using shoe orthotics, or, in severe cases, surgery.
Pain in the ball of the foot not associated with calluses can be a result of inflammation of a tendon in the toe, arthritis, inflammation of the joint, or a neuroma. Stiffness in the big toe and big toe joint (Hallux Limitus and Hallux Rigidus) and sesamoiditis, an inflammation of two small bones under the big toe joint, are also conditions that lead to pain in the ball of the foot.
While treatments vary based on the condition and individual case, techniques for reducing pain in the ball of the foot include:
- Physical therapy and exercise.
- Over-the-counter or prescription pain and/or anti-inflammatory medications.
- Orthotics or specially prescribed corrective shoes.
- Cortisone injections.
- Proper shoe wear.
Plantar fasciitis is commonly traced to an inflammation of the ligament that stretches across the bottom of the foot. The condition can usually be treated effectively with conservative measures, such as use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy.
Top of the foot pain
There are several causes of pain on the top of the foot. The quality of the pain and its location helps podiatrists determine the cause.
Managing pain on the top of the foot can be aided by:
- A period of limiting activity.
- Below-the-knee walking casts.
- Functional orthotics.
- Oral anti-inflammatory medications.