Common Ailments Podiatrists Treat

By Brad Christiansen, DPM

According to research by the American Podiatric Medical Association, 77% of adult Americans experience foot problems. Trinity Health Podiatrist Brad Christiansen, DPM, discusses several common foot and ankle ailments along with treatment options. 

Plantar fasciitis is a mechanical problem with the plantar fascia ligament located on the bottom of the foot and extends from the heel to the toes. Pain comes from inflammation of this ligament that is often tight, and it can occur in patients who have flat feet, high arches, or any foot type. 

It is important for patients to understand that podiatrists try to exhaust conservative treatment options prior to considering surgery because surgery may not be the proper treatment. If we can avoid surgery, we do. In my practice, the incidence of surgery for plantar fasciitis is low. 

For this condition, we start with conservative measures. Oral or injected anti-inflammatories may address the pain of plantar fasciitis but do not address the underlying mechanical problem. At-home rehabilitation (stretching exercises) or physical therapy, along with appropriate shoes and shoe inserts, can address the mechanical problem. The good news is that 90% of my patients can be treated with over-the-counter inserts based on their unique foot type. 

Some patients have bone spurs along with plantar fasciitis. Bone spurs do not cause pain in the heel. We no longer remove the spur surgically because studies have shown that the pain does not come from the spur. Instead, if conservative measures fall short, we surgically release the ligament for treatment.

Achilles tendonitis has similar mechanical causes to plantar fasciitis. Patients can often present with both conditions. The Achilles tendon starts with the calf muscle on the back of the leg and connects to the back of the heel bone. The pain is similar to plantar fasciitis and stems from a mechanical problem with this tight tendon.

With acute (severe or sudden onset) Achilles tendonitis, stretching or physical therapy is not recommended. Instead, we calm down the tendon with an anti-inflammatory for four to six weeks to allow the tendon to heal — this also offers some pain relief and helps patients remain ambulatory (able to walk).

Once the tendon has recuperated and healed, I can teach my patients comprehensive stretching exercises that they can do at home to address the underlying mechanical problem. In some cases, I order physical therapy.

Osteoarthritis in the foot or ankle is more common than rheumatoid and psoriatic arthritis. Typically, the most common complaint is in the big toe joint, followed by the ankle joint and the top of the midfoot joint. 

Arthritis is a progressive and often painful disease with no cure. It occurs most often when the smooth surfaces of bones are worn down and no longer smoothly glide past each other during movement. Instead, the patient experiences bone-on-bone, which causes pain and inflammation.

Steroid injections can manage symptoms but do not treat the “disease.” Eventually, the injections no longer work. When pain interferes with everyday living, we explore surgical options.
The gold standard for surgical treatment is bone fusion, where the surgeon removes the cartilage between the bones and fuses the bones together. In the case of the big toe, my patients have remained active — run marathons and play pickleball — after bone fusion surgery.

A common reason for arthritis of the ankle is due to a mild sprain or fracture: known as post-traumatic arthritis. In fact, this arthritis could appear years or decades following the injury. Because your ankle must move with every step you take, it is important to treat the pain and inflammation. 

To address the symptoms, we immobilize the joint with an ankle brace and address the pain with ankle joint injections. Other less common surgical treatments include ankle joint fusion or ankle joint replacement.

Not all foot or ankle fractures require surgery. If the ankle is unstable/displaced, then surgical treatment may be necessary, where the surgeon stabilizes the ankle using plates and screws. However, with a minimally/non-displaced ankle fracture, protected weight bearing in a cast boot may be all that is necessary to allow the bones to heal. 

Foot fractures often occur in people who are physically active. Protected weight bearing in a cast shoe or boot may be necessary to allow the bones to heal with occasional surgical intervention, depending on fracture type and location.  

If there is a toe fracture with the toe pointing in the wrong direction, then surgery is indicated. Again, pins or plates may be used to stabilize and redirect the toe.

Bunions are genetic. Shoes can worsen the problem, but they do not cause the problem. A bunion is not a bone growth. An unstable bone joint in the middle of the foot causes the bunion. It is a mechanical problem. We treat bunions conservatively by managing symptoms, such as selecting a shoe with a wider toe box or a shoe insert. This deformity cannot be reversed without surgery. There are numerous surgeries for this condition. 

Claw toes and hammertoes are also genetic. Again, this is a mechanical problem. They are often seen with bunions. In the absence of performing surgery to correct the problem, conservative therapy is shoe modification to reduce pressure points.

Flat feet (pronation) and high arches (supination) are common. Few people have a “neutral” foot. Musculoskeletal deficiencies may be causing these conditions. There may be no pain from these conditions, but they are predictors of other foot conditions in the future. When there is no musculoskeletal deficiency, we use external foot supports in shoes to bring the foot into a more neutral position.

Ingrown toenails can be caused by tight shoes or an infection. If they chronically bother you, we perform an in-office procedure in which we remove the corner of the nail. If there is no pain, then nothing needs to be done.

Diabetic feet: Patients with a loss of protective sensation on the bottom of their foot or poor blood flow on the bottom are at high risk for developing a foot ulcer. Patients with diabetes often have one or both of these conditions, although patients without diabetes may also have these conditions. Patients may be unaware of the foot ulcer due to a lack of sensation (they don’t feel the ulcer), so they continue walking on it. Such ulcers can cause serious infections resulting in hospitalization. The key is to catch the ulcer quickly.

Charcot foot is a rare condition in which a foot fracture occurs in patients with complete neuropathy and causes an arched foot to invert so the bottom of the foot is like a rocker. This severe deformity can cause an ulcer, which could lead to bone infection. If an ulcer chronically reoccurs, then surgical reconstruction is required. Otherwise, we manage the ulcer with more conservative treatments.

If your foot or ankle problems are limiting your quality of life, it is time to schedule a consultation with a Trinity Health podiatrist.