"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.
Diseases of the Foot
Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. Although the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.
If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence. However, early diagnosis and proper medical care can limit or slow the damage.
Symptoms of arthritis in the foot and ankle include:
- Early morning stiffness.
- Limitation in motion of joint.
- Recurring pain or tenderness in any joint.
- Redness or heat in a joint.
- Skin changes, including rashes and growths.
- Swelling in one or more joints.
Forms of Arthritis
Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or wear and tear arthritis. Aging usually brings on a breakdown in cartilage, and pain gets progressively more severe. Dull, throbbing nighttime pain is characteristic, and may be accompanied by muscle weakness or deterioration. Many of these symptoms can be relieved with rest. Overweight people are particularly susceptible to osteoarthritis. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.
Rheumatoid arthritis is a major crippling disorder and the most serious form of arthritis. It is a complex, chronic inflammatory group of diseases, often affecting more than a dozen smaller joints during its course. In the foot, it frequently affects both ankles and toes.
Arthritis of the foot and ankle can be treated in many ways, including:
- Physical therapy and exercise.
- Anti-inflammatory medication and/or steroid injections into the affected joint. Note: Please consult your physician before taking any medications.
- Orthotics or specially prescribed shoes.
There are many kinds of cancers of the foot. Some take the form of cysts and lesions, while others are more widespread.
Malignant melanoma is a skin cancer that is curable if caught early. Although it makes up only one percent of skin cancers, malignant melanoma accounts for over 60 percent of skin cancer deaths. It is estimated that approximately 30 percent of melanomas occur in the lower extremities, and that 3 percent occur in the feet.
Neoplastic disorders, usually called tumors, are the result of abnormal growth of tissue. Both benign or malignant tumors occur in the foot.
Osteochondromas are benign bone tumors under the toenail. Osteochondromas account for about half of all benign bone tumors in the foot, occurring mostly in children and young adults. Unless they cause irritation to the surrounding tissue, they are generally not very painful. Sometimes, they can deform the toenail and cause an ingrown toenail. In rare cases, they are removed surgically.
A plantar fibroma is a benign tissue tumor or growth on the plantar, or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. There are a number of nonsurgical measures for treating plantar fibromas, such as orthotics. When these conservative measures fail to provide adequate relief of symptoms, surgical removal is a reasonable option.
Giant cell tumors are benign tumors of the tendon sheath. These masses are generally found on the toes, top of the foot, or sides of the foot. They can also occur deep inside the foot. They are firm irregular masses that are typically painful.
Charcot Foot is a form of arthritis that often develops suddenly and without pain. Without any warning, the bones in the foot and/or ankle spontaneously fracture and fragment, often causing a severe deformity. The arch of the foot often collapses, and pressure areas develop on the bottom of the foot, leading to open sores or ulcers.
The average age of patients developing a Charcot Foot is 40 years. About one-third of patients develop a Charcot Foot in both feet and/or ankles.
Although nonsurgical treatments, such as elevation, icing, casts, and braces, can help alleviate pain and resolve open sores or ulcers, many of these deformities may require surgery to correct the fracture or remove bone fragments. This usually occurs in cases characterized by:
- Chronic deformity with increased plantar pressures and risk of ulcers.
- Chronic deformity with significant instability that cannot be corrected by braces.
- Significant deformity that may include ulcers that do not heal or respond to therapy.
Freiberg’s Disease usually begins as a pain in the ball of a child’s foot. Its onset is often linked to an injury to the growth plate of one of the long bones behind the toes, called metatarsals. The loss of blood flow to the growth plate causes pain. Freiberg’s Disease is most frequently seen in adolescents between the ages of 13 and 15. It is three times as likely to occur in females than in males.
Treatment for Freiberg’s Disease consists of reducing pressure under the affected bone. This may require the use of crutches and/or prescription of a custom orthotic.
Gout (also known as gouty arthritis) is a condition caused by a buildup of the salts of uric acid (a normal byproduct of the diet) in the joints. A single big toe joint is the most commonly affected area, possibly because it is subject to so much pressure in walking. Attacks of gouty arthritis are extremely painful. Men are more likely to be afflicted than women. Diets heavy in red meat, rich sauces, shellfish, and brandy have been linked to gout. However, other protein compounds in foods, such as lentils and beans, may play a role.
The main symptom of gout is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen. The pain lasts for around three or four hours and then subsides. However, pain in the same toe usually returns within a few months.
Gout can be controlled by with prescription medications and diet. Note: Please consult with your physician before taking any medications. The application of ice or cooling lotions helps alleviate pain and swelling during an acute phase. In some cases, specially-made shoes are prescribed to relieve the pain associated with gout.
Kaposi’s Sarcoma is a cancerous lesion that can occur on the soles of the feet. The disease is usually associated with HIV infection and/or AIDS. The lesion is irregular in shape and has a purplish, reddish, or bluish-black appearance. Kaposi’s Sarcoma lesions tend to spread and form large plaques or become nodular. The nodular lesions have a firm, rubbery appearance.
Maffucci’s Syndrome is a very rare form of enchondromatosis that combines multiple enchondromas in bones anywhere in the body with benign soft tissue tumors (known as hemangiomas), which are associated with blood vessels. This condition tends to appear in the hands and feet and has a greater tendency toward malignant transformation than Ollier’s Disease.
Some form of injury or trauma to the toe results in the formation of this bony irregularity or prominence.
Maffucci’s Syndrome only requires treatment in cases where the tumors are aggressive and begin destroying bone tissue. In these cases, surgical removal is recommended.
Raynaud’s Disease is a disorder that affects the hands and feet. It is caused by contraction of the smooth muscles controlling the small arteries supplying circulation into the hands and feet. This contraction, called a vasospasm, makes the arteries so small that they restrict blood flow. Exposure to cold temperature can often bring on a vasospasm.
Raynaud’s Disease has no known cause and is most common in young women. Staying warm and exercising regularly to maintain healthy blood circulation throughout the body can help offset the disease.
Pain in the heel of a child’s foot, typically brought on by some form of injury or trauma, is sometimes Sever’s Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel.
A tight Achilles tendon may contribute to Sever’s Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger children and is frequently seen in the active soccer, football or baseball player.
Sports shoes with cleats are also known to aggravate the condition.
Treatment includes calf muscle stretching exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.