Helping you through your busy life
We provide you a treatment solution for your foot and ankle pain that fits and is time tested. Our 25 years of experience is put to work every day to help our patients to return to thier normal function.
Heel Pain
Plantar fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot. Our practice can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain. Plantar fasciitis is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Also called "heel spur syndrome," the condition can usually be successfully treated with conservative measures such as use of anti-inflammatory medications and ice packs, stretching exercises, orthotic devices, and physical therapy.
Bunions
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. Podiatric medical attention should be sought at the first indication of pain or discomfort because, left untreated, bunions tend to get larger and more painful, making non-surgical treatment less of an option. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. The doctors will recommend treatments based on your specific condition, including, but not limited to padding and taping, medication, physical therapy, orthotics, or surgical options.
Ingrown Nails
Dr. Fox will resect the ingrown portion of the nail and may prescribe a topical or oral medication to treat the infection. If ingrown nails are a chronic problem, We can perform a procedure to permanently prevent ingrown nails. The corner of the nail that ingrows, along with the matrix or root of that piece of nail, are removed by use of a chemical, a laser, or by other methods.
Warts
Dr. Fox will prescribe the latest treatment in warts. Most of the time you do not have to have pain procedures to burn off the wart. His treatment is painless and works well even for young children. Lasers have become a common and effective treatment. But should be your last resort. A procedure known as CO2 laser cautery is performed under local anesthesia either in your podiatrist’s office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.
Children
Millions of American children participate in team and individual sports, many of them outside the school system, where advice on conditioning and equipment is not always available. Parents should be concerned about children's involvement in sports that require a substantial amount of running and turning, or involve contact. Protective taping of the ankles is often necessary to prevent sprains or fractures. Parents should consider discussing these matters with their family podiatrist if they have children participating in active sports. Sports-related foot and ankle injuries are on the rise as more children actively participate in sports.
Pinched Nerve
A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth toes that brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot. The principle symptom associated with a neuroma is pain between the toes while walking. Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe. The vast majority of people who develop neuromas are women.
Podiatry for your family
Home visits, Foot and Ankle Care is available for selected patients. We service Yorkville, Naperville, Oswego and Chicagoland area.
What is Arthritis?
Arthritis, in general terms, is inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis has multiple causes; just as a sore throat may have its origin in a variety of diseases, so joint inflammation and arthritis are associated with many different illnesses.
Arthritis is a frequent component of complex diseases that may involve more than 100 identifiable disorders. 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.
Arthritis is a disabling and occasionally crippling disease; it afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are most prone to arthritis.
Arthritic feet can result in loss of mobility and independence, but early diagnosis and proper medical care can help significantly.
Causes
Besides heredity, arthritic symptoms may arise in a number of ways:
- Through injuries, notably in athletes and industrial workers, especially if the injuries have been ignored (which injuries of the feet tend to be).
- Through bacterial and viral infections that strike the joints. The same organisms that are present in pneumonia, gonorrhea, staph infections, and Lyme disease cause the inflammations.
- In conjunction with bowel disorders such as colitis and ileitis, frequently resulting in arthritic conditions in the joints of the ankles and toes. Such inflammatory bowel diseases seem distant from arthritis, but treating them can relieve arthritic pain.
- Using drugs, both prescription drugs and illegal street drugs, can induce arthritis.
- As part of a congenital autoimmune disease syndrome of undetermined origin. Recent research has suggested, for instance, that a defective gene may play a role in osteoarthritis.
Types and Symptoms
Osteoarthritis: Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or “wear and tear” arthritis. Although it can be brought on suddenly by an injury, its onset is generally gradual; aging brings on a breakdown in cartilage, and pain gets progressively more severe, although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be accompanied by muscle weakness or deterioration. Walking may become erratic. It is a particular problem for the feet when people are overweight, simply because there are so many joints in each foot. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.
Rheumatoid arthritis (RA): RA is a major crippling disorder and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory system of diseases, often affecting more than a dozen smaller joints during the course of the disease, frequently in a symmetrical pattern—both ankles, or the index fingers of both hands, for example. It is often accompanied by signs and symptoms—lengthy morning stiffness, fatigue, and weight loss—and it may affect various systems of the body, such as the eyes, lungs, heart, and nervous system. Women are three or four times more likely than men to suffer RA.
RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of remission, during which symptoms disappear, and exacerbation, marked by the return of inflammation, stiffness, and pain. Serious joint deformity and loss of motion frequently result from acute RA. However, the disease system has been known to be active for months, or years, then abate, sometimes permanently.
Gout (gouty arthritis): Gout is a condition caused by a buildup of uric acid—a normal byproduct of the diet—in the joints. A single big toe joint is commonly the affected area, since it is farthest from the heart, and therefore the coldest; attacks of gouty arthritis are extremely painful, perhaps more so than any other form of arthritis. Men are much more likely to be afflicted than women, an indication that heredity may play a role in the disease. While a rich diet that contains lots of red meat, rich sauces, shellfish, red wine, and brandy is popularly associated with gout, there are other protein compounds in foods such as lentils and beans that may play a role.
Psoriatic arthritis: Psoriasis is often thought of as a skin disorder, but it can affect the joints as well. On the skin, psoriasis appears as dry, scaly patches. Not all people with psoriasis of the skin will develop joint symptoms—about one in twenty people with psoriasis will develop associated arthritis. The arthritis may be mild and involve only a few joints, particularly those at the ends of the fingers or toes. People who also have arthritis usually have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.
Traumatic arthritis: Traumatic arthritis is a form of arthritis that is caused by blunt, penetrating, or repeated trauma or from forced inappropriate motion of a joint or ligament. Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. This damage to the cartilage eventually leads to arthritic changes in the joint.
When to Visit a Podiatrist
Because arthritis can affect the structure and function of the feet, it is important to see a doctor of podiatric medicine if any of the following symptoms occur in the feet:
- Swelling in one or more joints
- Recurring pain or tenderness in any joint
- Redness or heat in a joint
- Limitation in motion of joint
- Early morning stiffness
- Skin changes, including rashes and growths
Diagnosis and Treatment
Different forms of arthritis affect the body in different ways; many have distinct systemic effects that are not common to other forms. Early diagnosis is important to effective treatment of any form. Destruction of cartilage is not reversible, and if the inflammation of arthritic disease isn’t treated, both cartilage and bone can be damaged, which makes the joints increasingly difficult to move. Most forms of arthritis cannot be cured but can be controlled or brought into remission; perhaps only five percent of the most serious cases, usually of rheumatoid arthritis, result in such severe disability that walking aids or wheelchairs are required.
The objectives in the treatment of arthritis are controlling inflammation, preserving joint function (or restoring it if it has been lost), and curing the disease if possible. Because the foot is such a frequent target, the doctor of podiatric medicine is often the first physician to encounter some of the complaints—inflammation, pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations of arthritis.
Arthritis may be treated in many ways. Patient education is important. Physical therapy and exercise may be indicated, accompanied by medication. In such a complex disease system, it is no wonder that a wide variety of drugs have been used effectively to treat it; likewise, a given treatment may be very effective in one patient and almost no help at all to another. Aspirin is still the first-line drug of choice for most forms of arthritis and the benchmark against which other therapies are measured.
The control of foot functions with shoe inserts called orthotics, or with braces or specially prescribed shoes, may be recommended. Surgical intervention is a last resort in arthritis, as it is with most disease conditions. Damaged joints can be replaced surgically with artificial joints.
Prevention
Not all types of arthritis are preventable. Osteoarthritis may be helped by correcting any faulty mechanics that lead to the joint not moving properly. Custom orthotics from your podiatrist will make sure that the foot and ankle joints are properly aligned. Controlling the uric acid level in people prone to gout helps to prevent gouty attacks and thereby reduces the chance of the associated arthritis.
More information is available from the Arthritis Foundation.
What Is a Bunion?
A bunion is commonly referred to as a “bump” on the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion—from the Latin “bunio,” meaning enlargement—can also occur on the outside of the foot along the little toe, where it is called a “bunionette” or “tailor’s bunion.”
Causes
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.
Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.
Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.
Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.
Symptoms
The symptoms of a bunion include the following:
- Development of a swelling, callus or firm bump on the outside edge of the foot, at the base of the big toe
- Redness, swelling, or pain at or near the MTP joint
- Development of hammertoes or calluses under the ball of the foot
- Corns or other irritations caused by the overlap of the first and second toes
- Restricted or painful motion of the big toe
Home Treatment
What can you do for relief?
- Apply a commercial, non-medicated bunion pad around the bony prominence
- Apply a spacer between the big toe and second digit
- Wear shoes with a wide and deep toe box
- If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling
- Avoid high-heeled shoes over two inches tall
When to Visit a Podiatrist
If pain persists, podiatric medical attention should be sought. Bunions tend to get larger and more painful if left untreated, making non-surgical treatment less of an option.
Diagnosis and Treatment
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity.
A podiatrist may recommend these treatments:
Padding and Taping: Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.
Medication: Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammation caused by joint deformities.
Physical Therapy: Often used to provide relief of the inflammation and bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
Orthotics: Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
Surgical Options: When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available to the podiatrist. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.
A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint. Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatrist. Your podiatrist wants you to have a satisfactory and speedy recovery, and this can be achieved by carefully following the postoperative instructions that you have discussed prior to and immediately after surgey.
Prevention
There are some steps that may help prevent, or at least slow, the progression of bunions:
- Avoid shoes with a narrow toe box
- If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, get custom orthotics from your podiatrist
- See your podiatrist at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression
What is a Hammer Toe?
A hammer toe is a contracture, or bending, of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammer toes are more common in females than males.
There are two different types:
Flexible Hammer Toes: These hammer toes are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammer toes because they are still moveable at the joint.
Rigid Hammer Toes: This variety is more developed and more serious than the flexible condition. Rigid hammer toes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammer toe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.
Causes
A hammer toe develops because of an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammer toe. Arthritis is another factor, because the balance around the toe in people with arthritis is disrupted. Wearing shoes that are too tight and cause the toes to squeeze can also cause a hammer toe to form.
Symptoms
The symptoms of a hammer toe include the following:
- Pain at the top of the bent toe upon pressure from footwear
- Formation of corns on the top of the joint
- Redness and swelling at the joint contracture
- Restricted or painful motion of the toe joint
- Pain in the ball of the foot at the base of the affected toe
Home Treatment
What can you do for relief?
- Apply a commercial, non-medicated hammer toe pad around the bony prominence of the hammer toe to decrease pressure on the area.
- Wear a shoe with a deep toe box.
- If the hammer toe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
- Avoid heels more than two inches tall.
- A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. While this treatment will make the hammer toe feel better, it is important to remember that it does not cure the condition. A trip to the podiatrist’s office will be necessary to repair the toe to allow for normal foot function.
- Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.
When to Visit a Podiatrist
If pain persists, see a podiatrist. If left untreated, hammer toes tend to become rigid, making non-surgical treatment less of an option.
Diagnosis and Treatment
The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.
Padding and Taping: Often padding and taping are the first steps in a treatment plan. Padding the hammer toe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain.
Medication: Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity.
Orthotic Devices: Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammer toe deformity.
Surgical Options: Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammer toes, which are not fully reducible, may require more complex surgical procedures.
Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatrist.
Prevention
There are several things you can do to help prevent hammer toes from forming or progressing:
- Wear supportive shoes to help prevent deformities. Hammer toes are often related to faulty foot mechanics, especially foot flattening.
- Wear custom orthotics prescribed by your podiatrist. Orthotics may slow the progression or prevent the development of hammer toes.
- Avoid shoes with narrow or pointed toe boxes that can compress the toes.
When is Foot Surgery Necessary?
Many foot problems do not respond to “conservative” management. Your podiatrist can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to alleviate discomfort or to restore the function of your foot.
Types of Foot Surgery
Bunion Surgery: There are many different types of bunion surgery depending on the severity of the bunion and the joint involvement. Your podiatrist can explain the bunion procedure that is most appropriate for your bunion. Depending on the surgical procedure, the recovery time can be very different—particularly if you need to be on crutches after the surgery or in a cast.
Fusions: Fusions are usually performed to treat arthritic or painful conditions of the foot and ankle. A fusion involves removing all cartilage from a joint and then joining two or more bones together so that they do not move. Fusions can be done with screws, plates, or pins, or a combination of these.
Hammer Toe Surgery: Hammer toe surgery may involve removing a portion of one of the bones in the toe to realign the toe or could involve fusing the joints in the toe (see Fusions, above). In some cases, it may involve placing a temporary wire to hold the toes straight or a permanent implant in the toe to maintain realignment.
Heel Spur Surgery: Based on the condition and the nature of the disease, heel surgery can provide relief of pain and restore mobility in many cases. The type of procedure is based on examination and usually consists of plantar fascia release, with or without heel spur excision. There have been various modifications and surgical enhancements regarding surgery of the heel. Your podiatrist will determine which method is best suited for you.
Metatarsal Surgery: Surgery on the long bones of the feet behind the second, third, fourth, and fifth toes is performed for a variety of reasons but is commonly performed to redistribute the weight bearing on the ball of the foot. In some severe cases, such as rheumatoid arthritis, surgery may involve removing the metatarsal heads (the bones in the ball of the foot area).
Nail Surgery: Toenails can become deformed, damaged, or infected. It may be determined that the best treatment may involve surgery. Surgery is typically performed in the office under local anesthetic, and many patients can walk out and return to activities. Surgery involves either partial or total removal of the nail. An avulsion is a non-permanent type of surgery that allows relief, but the nail will grow back. A matrixectomy is a permanent type of surgery, which involves destroying and/or removing the nail root so that no new nail grows.
Neuroma Surgery: Neuroma surgery involves removing a benign enlargement of a nerve, which may be causing tingling/burning/numbness to certain toes, usually between the metatarsal heads in the ball of the foot. This soft tissue surgery tends to have a shorter recovery time than bone procedures, but it leaves some residual numbness related to the removal of the piece of nerve tissue.
Reconstructive Surgery: Reconstructive surgery of the foot and ankle consists of complex surgical repair(s) that may be necessary to regain function or stability, reduce pain, and/or prevent further deformity or disease. Unfortunately, there are many conditions or diseases that range from trauma to congenital defects that necessitate surgery of the foot and/or ankle. Reconstructive surgery in many of these cases may require any of the following: tendon repair/transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, tumor excision, amputation, and/or the osteotomy of bone (cutting of bones in a precise fashion). Bone screws, pins, wires, staples, and other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone in reconstructive procedures.
Skin Surgery: Lipomas, fibromas, warts, moles, and rashes can occur on any part of the foot skin surface. Some of these conditions can be painful and impact function. In other cases, they can be questionable because they are new in appearance and a biopsy may be recommended. These skin conditions may or may not be painful. Depending on the size and depth of the condition, surgery may be performed in the office under local anesthesia or take place in the operating room.
Tendon Surgery: Surgery on the tendons can be performed for acute injuries such as ruptures and can also be performed for chronic conditions to lengthen or shorten the tendon, depending on the problem. In some cases, tendons may be re-routed to improve foot and ankle function.
Preoperative Testing and Care
As with any type of surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to improve a successful surgical outcome. Prior to surgery, the podiatrist will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status may be ordered by your podiatrist, such as blood studies, urinalysis, EKG, X-rays, a blood flow study (to better evaluate the circulation of the foot and legs), and an examination of the structures of your feet while walking. A consultation with another medical specialist may be advised by a podiatrist, depending on your test results or a specific medical condition.
Postoperative Care
The type of foot surgery performed determines the length and kind of after-care required to assure that your recovery from surgery is uneventful. The basics of all postoperative care involve to some degree each of the following: rest, ice, compression, and elevation. Bandages, splints, surgical shoes, casts, crutches, or canes may be necessary to improve and ensure a safe recovery after foot surgery. Your podiatric surgeon will also determine if and when you can bear weight on your foot after the operation. Your podiatrist wants you to have a satisfactory and speedy recovery, and this outcome can be achieved by carefully following the postoperative instructions that you have discussed prior to and immediately after surgery.