idiopathic (no defined explanation). There are a variety of treatments to include shoe modifications, foot orthos with metatarsal pad to relieve pressure from the area, physical therapy, nerve block with corticosteroid, and finally surgery for either decompression or excision. There are other less investigated procedures to include ablations of nerve with chemical or
thermal probe and shock wave treatment.
Initial management includes shoe modification, metatarsal pad with or without supportive insole, activity modification and judicious use of anti inflammatory such as ibuprofen if permitted. If this does not produce improvement, I would recommend x-rays to rule out differential causes of pain to include stress fracture, joint disorder. Other imaging techniques for neuroma include ultrasound and MRI. If definitively neuroma then consider nerve block with cortisone and physical medicine. If this all fails, you may need to investigate more invasive treatment such as surgery and if this does not appeal to you some of the other less investigated approaches mentioned.
be reduced and biopsied.
I have pain in my ankle and it may need surgery. Will my diabetes make it difficult to heal my ankle?
secondary infection risk, and bone healing. Elevated blood sugars impact healing at the cellular level and influence compromised immune response. Blood sugars can be monitored acutely with finger sticks and getting a snapshot understanding of current control, but more frequently, we utilized a test known as the hemoglobin A1c to get a better understanding of her overall glycemic control over an extended period of time. Although there is no consensus, we do appreciate that a hemoglobin A1c representing normal glycemic control is ideal. In my own practice, I typically utilize an A1c of 7.5 mg/dL as a cutoff point for elective surgery. As a side other factors that are looked at particularly when it comes to bone and joint
surgery include the health of the bone from the standpoint of vitamin D as well as social factors such as smoking, which can also impact wound healing and bone healing.
specialist such as a primary physician, dermatologist, or podiatrist.
feet require special attention by medical practitioners who have a keen appreciation for subtle changes that may portend future complications. Reduced ability to palpate pulses in the feet, diminished or absent hair growth, sluggish capillary return, altered skin temperature can suggest reduced blood flow. Reduced appreciation for tactile sensation to light touch, sharp stimulus, vibratory appreciation can suggest reduced feeling. Inability to mount an appropriate immune response to local microbial contamination can result in severe infection. For these reasons, diabetics are encouraged to have a periodic evaluation by a foot specialist. Depending on the identified risk presentation, the frequency of visits will be determined by the specialist.
attachment points resulting in acute micro bleeding with secondary calcification and ossification of the soft tissue. Over time these prominences enlarge and can be appreciated on plain film radiographs and clinically with visible and palpable presentation when discussing those of the back of the heel. Commonly these spurs are can be managed conservatively without surgical intervention. Particularly bone spurs associated with the plantar fascia. In both cases, it is believed the pain generator is not the bone spur, but the acutely or chronically inflamed or degenerated connective tissue. Most cases of plantar fascia/heel spur pain resolve with good conservative care of appropriate footwear, arch support or heel cushion, program of stretching and judicious use of anti-inflammatory medication. When surgery is indicated, the bone spur is frequently not addressed and it is simply the plantar fascia that may be partially released or selectively debrided with ultrasound guidance. Posterior heel spurs are a little more challenging and may require removal if they become large enough to interfere with footwear and the counter of the shoe rubbing on the back of the heel. In both cases, anesthesia is frequently afforded with plantar fascia procedure requiring at a minimum local anesthetic to the area and potentially IV sedation. The posterior heel spur being more invasive frequently requires sedation with a regional block or general anesthetic.
different types of arthritis may be a contributing factor to its presentation to include osteoarthritis and rheumatoid arthritis. If you are suffering from other joint discomfort beyond the great toe or have other systemic complaints it would be prudent to be medically evaluated. Bunion deformities typically become more painful if there is developing arthritis within the joint as bump pain alone can be relieved with appropriate foot wear that minimizes compression to the area.`
from organ issues related to kidney, heart, liver; or local vascular issues frequently seen with venous insufficiency or lymphedema. If this swelling does not remit as anticipated with current medical management, I do believe it is important that further investigation occurs to determine why the swelling in your feet persists.
suggest proprioceptive dysfunction. Nerve endings around our joints that allow us to appreciate spatial relationships of our anatomy and appropriately adjust if placed in awkward positions. Structural dysfunction results from true ligament disturbance by tear or attenuation or bony deformity that drives our ankle to rotate inappropriately. There are situations that ankle instability arises from both functional and structural deficits.