Foot and ankle emergencies happen every day. Broken bones, dislocations, sprains, contusions, infections, and other serious injuries can occur at any time. Early attention is vitally important. Whenever you sustain a foot or ankle injury, you should seek immediate treatment from a podiatric physician.

This advice is universal, even though there are lots of myths about foot and ankle injuries. Some of them follow:

Myths

Before Seeing the Podiatrist

If an injury or accident does occur, the steps you can take to help yourself until you can reach your podiatric physician are easy to remember if you can recall the word “rice.”

Prevention

• Wear the correct shoes for your particular activity.
• Wear hiking shoes or boots in rough terrain.
• Don't continue to wear any sports shoe if it is worn unevenly.
• The toe box in “steel-toe” shoes should be deep enough to accommodate your toes comfortably.
• Always wear hard-top shoes when operating a lawn mower or other grass-cutting equipment.
• Don’t walk barefoot on paved streets or sidewalks.
• Watch out for slippery floors at home and at work. Clean up obviously dangerous spills immediately.
• If you get up during the night, turn on a light. Many fractured toes and other foot injuries occur while attempting to find one’s way in the dark.

Pain around your back heel area, also known as posterior heel pain, can be a very debilitating condition. The first step in treatment is a proper diagnosis because different causes of this type of heel pain can require very different treatments.

Three common causes of posterior heel pain are insertional Achilles tendonitis, pump bump (Haglund's disease), or an Achilles tendon rupture. Insertional Achilles tendonitis, also called Achilles tendinopathy, is a chronic inflammatory or degenerative disorder which affects the place where the Achilles tendon inserts onto the heel bone. A pump bump, Haglund's disease, is a bump on your heel bone that rubs on the back of shoes causing pain and inflammation. An Achilles tendon rupture is a total or partial tearing of the Achilles tendon. This condition usually requires immediate surgery and you should be evaluated by a podiatric foot and ankle specialist soon after the injury. Insertional Achilles tendinopathy and pump bump can often be relieved by conservative treatments although in some cases surgery is required. Only your foot and ankle specialist can determine what treatment is right for you. Today's topic will center around insertional Achilles tendinopathy.

Symptoms:
- Chronic posterior heel pain
- Tenderness at the Achilles insertion
- Insidious (gradual) onset
- Symptoms aggravated by shoes
- Symptoms relieved by backless shoes

Treatment:
- Rest
- Ice
- Heel lifts or custom molded shoe inserts (orthotics)
- Stretching
- Physical therapy
- Modifications in training or daily activities
- Immobilization or casting
- Surgery

Only a physician can decide which treatment is right for you. Here at Foot and Ankle Associates, Dr. Ades and Dr. Shapiro will design a custom plan of treatment to relieve your pain quickly and help return you to your activities faster. If you have any further questions about insertional Achilles tendinopathy, posterior heel pain, or any other foot or ankle problems please contact our office online at www.footandankleassociates.com or by phone at (704) 662-3660.

Foot & Ankle Associates surgeon, Dr. Joe Ades, recently lectured at the North Carolina Foot & Ankle Society yearly meeting.

Over 200 of the state's foot and ankle surgeons were present for a four day series of lectures on various foot and ankle topics.

Dr. Joe Ades lectured on two topics consisting of "Correction of Brachymetatarsalgia (short toe)" and "Treatment of Posterior Heel Pain and Insertional Achilles Tendonitis".

For more information regarding Brachymetatarsalgia, refer to our blog posted in December. Our November blog covers information regarding Heel Pain and more to come in March regarding Insertional Achilles Tendonitis.

What Is an Ingrown Toenail?
When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This "digging in" of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.
If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe isn't painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.
Causes
Causes of ingrown toenails include but are not limited to:
- Trauma. Sometimes an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as kicking or running.
- Improperly sized footwear. Ingrown toenails can result from wearing socks and shoes that are tight or short.
- Nail Conditions. Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.
Treatment
Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if an infection is suspected, or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot, or poor circulation.
Physician care:
After examining the toe, the foot and ankle surgeon will select the treatment best suited for you. If an infection is present, an oral antibiotic may be prescribed.
Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail. After applying a local anesthetic, the doctor removes part of the nail's side border. Some nails may become ingrown again, requiring removal of the nail root.
Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.

Ever wonder if you were the only one with a short toe on one or both of your feet? Well, you are not alone. Short toes can be caused by many things: prior surgery, injury, a congenitally short toe bone or a short bone behind the toe (called a metatarsal). Regardless of the cause there are treatment options available and you should find a surgeon well versed in the correction of these sometimes complex deformities.
In this blog, I will briefly discuss brachymetatarsia, a common cause of short toes. The word brachymetatarsia loosely means short bone behind the toe. This condition can be caused by many things including trauma, infection, or congenital anomalies. The congenital form of brachymetatarsia occurs much more commonly in females with a rate of about 1/1800 in females compared to a rate of 1/4500 in males and becomes visually obvious at four to 15 years of age.
What are your treatment options? Non-surgically your options include accommodative shoes, pads, or orthotics. Surgically, there are essentially two options.
The first is called an acute correction. This involves obtaining a bone graft from somewhere in your body, usually your hip or heel bone, and placing the graft in your short metatarsal. This is usually held in place by a plate and screws and is usually used for smaller corrections. You are typically nonweightbearing for six to ten weeks while the bone graft incorporates.
A newer technique, usually used for larger corrections, involves a small bone stretching device called an external fixator which is placed percutaneously into your short metatarsal. No bone graft is required and only a small incision is needed to make a bone cut. Over the next several weeks your short metatarsal is lengthened by turning a bolt on the external fixator. This is usually a painless process and you are able to bear weight on your foot with crutches to balance during this process. The external fixator is usually removed six to ten weeks after the procedure depending on the amount of lengthening needed and you may return to shoes shortly after that.
If you have any further questions about brachymetatarsia (short toes) or any other foot or ankle problems please contact our office online at www.footandankleassociates.com or by phone at (704) 662-3660.