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Achilles Tendon

cropped view of man touching leg while suffering from pain in Achilles tendon

The Achilles is the largest tendon in your body, which, if damaged, can cause a considerable amount of pain. This tendon commonly overtightens, which limits the range of motion in your ankle. This is called Equinus. 

Equinus can lead to over 20 issues in the foot and ankle including bone spurs, arthritis in the big toe and midfoot, pinched nerves, flat feet, heel spurs, plantar fasciitis, heel pain. A tight tendon can lead to tearing and degeneration overtime. Eventually, a heel spur can form due to the tight tendon pulling on the bone. 

Standard treatment can include: x-rays to check for spurs, an ultrasound to evaluate the tendon, immobilization in a boot, pain creams, a heel lift, physical therapy, a daily stretching brace, taping, and orthotics. Alternative services include non-steroidal injections, amniotic stem cell injections, laser therapy to help promote healing, minimally invasive debridement, minimally invasive resection of the spur. 

Ankle Instability

If you are someone who’s ankle tends to suddenly “roll” or give out on you, then you should be evaluated. There are many conditions that can lead to unstable ankles. Over time, your ankle ligaments can become stretched out and no longer protect your ankle from giving way. This could eventually lead to serious injuries such as ankle arthritis or ankle fractures. 

Standard treatment includes: x-rays and/or ultrasound, ankle bracing, taping, and physical therapy. If damage is minimal, we can give you daily strengthening exercises to help with re-tightening of the ligament and improve stability to the ankle joint itself. If damage is extensive, surgery can be performed to re-tighten the ligament itself.

Ankle Arthritis

Male runner is suffering from ankle pain on jogging

Typically x-rays are done to evaluate the joint to determine how severe the arthritis is. Sometimes there can be large spur or “potholes” in the cartilage. 

Standard treatment consists of x-rays, ankle bracing, ankle exercises to keep the joint from stiffening up, ankle taping, and physical therapy. Alternative treatments include non-steroid injections, prolotherapy, and laser therapy. Surgery can be indicated as well. 

Arthritis

Arthritis (aka osteoarthritis) is a degenerative condition that causes pain and stiffness when bones rub against one another from the cartilage in the joints breaking down. There are nerve pain endings in the bones which causes pain. 

Typically we perform x-rays to assess the extent of the arthritis. If mild, it can be treated with pain creams, orthotics, stretching and mobility exercises, and injections. Alternative treatment options we offer include nonsteroidal injections, amniotic stem cell injections, prolotherapy, and laser therapy.

If the condition is moderate to severe, treatment can include the above along with surgery. If surgery is required, it is ideal to keep it minimal and resect the bone spur. Sometimes with severe arthritis, the joint must be fused. 

Symptom foot pain and numbness in feet of adult women or ache from bunion disease or plantar

Big Toe Joint Pain

Arthritis and Gout are often leading causes of joint pain in the big toe. When there is arthritis in the big toe joint the cartilage wears down and the bones rub against each other causing pain. With time, the bones can start to form bone spurs and you may see lumps and bumps around the joint. Typically, we get x-rays to assess the extent of arthritis.  If mild, it can be treated with a variety of things including pain creams, orthotics, stretching and mobility, and injections. Alternative services we offer include non-steroidal injections, amniotic stem cell injections, prolotherapy, and laser therapy. If the condition is moderate to severe, treatment can include the above along with surgery. If surgery is required it is ideal to keep it minimal and resect the bone spur. Sometimes with severe arthritis, the joint must be fused.

Signs of gout include sudden redness, swelling, and severe pain in the big toe joint. Normally uric acid is present in the blood and eliminated in the urine; however, during gouty attacks the uric acid crystallizes and accumulates in the joint.  Some people do not get rid of enough uric acid through their kidneys, while others ingest too much from their diet or produce too much in their body.

If gout attacks run in your family, you could be at risk. Patients may have a gout flair up after over-indulging in high fatty foods or drinking larger quantities of alcohol. Sometimes, changes in your medication (especially diuretics or water pills) can trigger a gouty flare up. Typical treatment includes xrays, medication, injections, and waiting for the flare up to subside. Diet modification is often important to prevent another flare up. 

Bunions

Bunions are a foot deformity caused by shifting of the bones along the great toe joint. The 1st metatarsal( the 1st long bone) shifts outwards causing a boney bump at the base of the big toe. The great toe then starts to deviate towards the 2nd toe.

 

Over time the 2nd toe can start to lift up or turn into a hammer toe. While poorly fitting shoes can speed up the formation of a bunion, the primary cause is typically hereditary. Signs and symptoms include a bulging bump on the outside of the base of your big toe, swelling, redness, or soreness around the big toe joint, a callus along the big toe, pain along the big toe, restricted movement of the big toe. 

Conservative treatment includes padding, orthotics, taping, injections, and foot mobilization exercises. Conservative treatment can help alleviate pain but it can not fix the deformity. Often times surgery may be indicated. If the bunion is mild to moderate, minimally invasive bunion surgery can be performed. This involves very small incisions (<3mm in length), smoothening down the bump, cutting the bone and shifting it over, and placing 2 screws to fixate it. You can walk in a surgical shoe immediately after surgery. It will take about 6-8 weeks for the bone to heal.

For severe bunions, surgery can be more involved. In older populations, surgery can include fusing the toe joint which corrects the bunion.

Or in the younger more active population it involves the Lapiplasty procedure (Bunion Surgery has changed: Lapiplasty® 3D Bunion Correction™ | Treace Medical Concepts, Inc.) Dr. Stouder is trained and certified to perform the Lapiplasty as well.

Bunions do not go away on their own. If you suspect a bunion, we encourage you to schedule an appointment and have it evaluated. Over time, your symptoms may become much worse and could involve more complex surgery. Proactive treatment can help slow down the progression.

Children’s Foot Care

Did you know that it is normal for children to have flat feet up until the age of 5? At one year old, they can be the most severe and as each year passes the arch should slowly improve. By the age of 6, if your child still has significant flat feet it should be addressed immediately with x-rays, foot assessment, gait evaluation, and most likely orthotics.  Dr. Stouder is trained in biomechanics and can effectively evaluate your child’s foot. 

Toe-walking and in-toeing are other conditions that should be evaluated. If your child is growing quickly and/or has tight calf muscles, they could be developing Sever’s disease which is when the achilles tendon is pulling on the growth plate in the heel bone. Your child may have shin splints due to a combination of increased activity and stress on the muscles. 

If your child has flat feet they should be evaluated. It’s possible they were born with a coalition which is when two bones in the feet are fused together that shouldn’t be. We will take x-rays to rule this out. If your child does have a coalition it should be surgically removed and we can do this as well. Do  not let anyone tell you your child is just having “growing pains” or “they will out grow it”. There is a reason they are having pain. It can be evaluated and effectively treated before it becomes a serious issue.  

child walk feet close up

Orthotics can be very effective for children as well. If they have flat feet it is important to support the arches as they grow. It helps to maintain the integrity of their tendons and ligaments and also helps to support their knees, hips, and back. For example, did you know that flat feet in children can result in scoliosis? If one foot is flatter than the other it creates an imbalance in the legs, pelvis, and vertebrae resulting in scoliosis. Having a foot assessment at an earlier age is a proactive approach you can take for your child.  

Conservative treatment includes orthotics and sometimes bracing. If your child has a coalition, surgery would be indicated and would include excision of the bones that are fused together. If a coalition is not present and the child has a flexible flat foot, minimally invasive surgery can be performed which includes placement of a small bullet shaped implant (an arthroereisis), which helps prevent the arch from collapsing. If the flat foot is severe, surgery can sometimes include cutting of the heel bone to help re-create the arch. These are all surgeries that Dr. Stouder can perform.

Corns/Calluses

Closeup of woman feet sole with dry cracked skin. Foot and toes care concept

Calluses are thickened, hardened layers of skin typically caused by excessive pressure or friction. Corns are dense areas of dead skin protein (keratin) that form a knot-like bump. These can make it feel like you are walking on a stone. They can be caused by an injury, pressure, or unknown cause. Wearing soft shoes with padding can help alleviate the pain but typically corns need to be removed to provide effective pain relief. There are many different forms of treatments for corns. If you just excise it, it is very common for them to return weeks or months later. At On the Move Podiatry, we offer many different types of treatments to help prevent them from returning.

The most basic treatment includes excising out the core of the corn (which is usually painless and doesn’t require anesthetic), followed by application of Cantharone which is a solution derived from the blister beetle Cantharis Vesicatoria. The goal of this solution is basically to “shock” the skin cells into forgetting that they were producing excessive keratin in the first place.

Another simple option is to apply nitrous oxide to the base of the lesion after excision. We then place offloading padding in your shoe to take the pressure off.

For more severe recurring cases, the corn can be surgically excised in the office using a punch biopsy. If you have a very prominent bone in the ball of the foot or toe that is causing the corn than the deformity can be addressed with minimally invasive surgery in the office. The bone can be shaved down through a tiny 3 mm incision. You can walk on the foot immediately after surgery, wearing a surgical shoe. If you have developed a corn due to fat pad atrophy in the ball of the foot then another treatment option includes fat pad injections.

Regardless of the cause, we can perform a thorough foot evaluation and come up with a unique treatment just for you. Who says your corn has to be trimmed every 3 months by a podiatrist? The goal is to have permanent removal so that it does not return ever again.

Deformed Toenails

There are many different reasons why toenails can be deformed and they can have many different appearances. They can be thickened, crumbly, discolored, cracking, curvy, have ridges, etc. The most common cause for deformed nails is fungus. Fungus creeps up under the toenail and gets between the skin and nail. It then begins to replicate, which over time deforms the nail. It can make the nail appear thicker, change colors, and cause crumbling underneath. Common treatments include topical medication and oral medication. We offer an effective alternative treatment which includes micro drilling of the toenail, application of topical medicine, followed by class IV MLS Laser therapy. (See Micro Drilling Services)

Trauma is another cause of toenail changes. If trauma only occurred to the nail plate, the nail may return to normal as it grows back in. If trauma occurred to the actual nail matrix (which is located back by the cuticle), the damage may be permanent. For example, if you have a deep cut in your skin, you may develop a scar that never goes away. This is a similar scenario – if the cells that grow the toenail (the nail matrix) are damaged enough, then they are forever altered and the nail will not grow in the way it used to. Treatment can include: routine trimming and smoothening of the nail, permanent removal of the nail, or cosmetic nail reconstruction (See Cosmetic Nail Reconstruction Services).

Foot with ingrown toenail painful infection ready to be treated

Another common cause of toenail changes may be related to certain diseases or environmental factors. If you have psoriasis you may notice pitting changes to the toenails or white discoloration. Toenail appearances can also change due to chemotherapy. Although these types of toenails do not have to be treated, the cosmetic appearance of the nail may bother you. If that is the case, treatments include routine trimming or smoothening of the nail, permanent removal of the nail, or cosmetic toenail reconstruction (See Cosmetic Nail Reconstruction Services).

Diabetes

Ulcer recovering diabetic foot syndrome

Dr. Stouder is highly trained in diabetic foot care and wound healing. Patients with diabetes must pay close attention to their feet because they can be more susceptible to severe complications. If your blood sugar is elevated it can limit blood flow, decrease your nerve function, dry out the skin, cause muscle weakness, delay healing to wounds or blisters, and even deform the toenails.

By seeing a podiatrist for foot care, your foot can routinely be evaluated to ensure you are not developing a new condition. At your foot care appointment, we make sure to check the pulses/blood flow in your feet, inspect the skin for any changes, and also assess for neuropathy. We will also perform any additional care needed, such as nail and callus trimming. We can measure your feet and recommend certain types of diabetic shoes (which can be purchased at the office). Dr. Stouder has helped save many feet and toes by early identification of foot conditions. Proactive and early treatment is crucial when you are diabetic.

Unfortunately, there are times when patients receive treatment after it is too late. If that is the case urgent surgery in the office is sometimes necessary. Drainage of abscesses and certain amputations can be performed in the office. If the infection is life threatening or requires extensive surgery, you will be advised to go immediately to the hospital.

Dr. Stouder can perform minimally invasive surgery in the office to help accelerate healing of diabetic ulcers, in as little as 2 weeks. If you address the underlying biomechanical issue, this can be the fastest way to heal a wound.  

Flat Feet

Flat feet can often be seen in today’s population. The arch is typically collapsed which can cause the toes to point outwards and/or cause the heel to cave in. There are two kinds of flat feet:

 1) Flexible flat feet: Can retain motion and the arch returns to normal when standing on supportive orthotics. Typically, arthritis is not involved in this scenario.

 2) Rigid flat feet: When the arch is stuck in a specific position and can not be lifted back up with an orthotic. This often times involves arthritis.

Symptoms of either type can include: pain in the ankle, heel, arch, and forefoot. The tendon that holds up the arch can be over worked resulting in pain and tendonitis. Muscle cramping can be a common symptom. Flat feet can make your whole foot unstable and can contribute to ankle sprains, bunions, and hammertoes.

Feet test

Conservative treatment includes: x-rays, wearing better-fitting shoes that provide adequate support, taping or bracing, and foot mobilization and physical therapy. Alternative services we offer include nonsteroidal injection, amniotic stem cell injections, and laser therapy.

If the tendon that holds the arch up is inflamed, we can perform all natural injections to relieve the inflammation. This is an area where it is not recommended to inject a steroid because it could further damage the tendon. Sometimes surgery is indicated when you have failed conservative treatment. For flexible flat feet, minimally invasive surgery can be an option depending on what your x-rays look like. For the rigid flat foot surgery can be more complex, involving hardware placement and fusion of the affected joints.

Foot Deformity

Top view of bare feet of older woman suffering from hallux valgus

From flat feet to bunions, we can check you for any possible foot issues to keep you moving. Sometimes the deformity is mild and not serious, but other times it can be related to a serious condition. 

Severely high arches can be associated with a neurological condition (known as Charcot Marie Tooth disease). Flat feet in children may be caused by a birth defect where the two bones are fused together that shouldn’t be (known as a coalition). If your foot deformity has been concerning you or weighing on your mind, call us today so that we can alleviate some of your concerns!

Fractures

If you had an injury (especially with signs of bruising and swelling), call us right away for x-rays and assessment of possible fracture. It is important to have a foot specialist evaluate you for foot injury. Sometimes fractures or serious injuries can be missed in larger health care settings, such as the emergency room. Maybe you have had ongoing foot pain and swelling for the last several months and keep thinking it will get better but it’s not. You may have a stress fracture which can be just as serious. If not treated promptly the bones could shift necessitating the need for surgery. If treated right away the bones could heal appropriately, negating the need for surgical fixation. Don’t hesitate to have your foot evaluated today!

X-ray of a foot fracture close-up on a consultation with a doctor.

Fungus

toenail problems fungus. nail disease.

Fungus is very common and can occur in the skin or in the toenail. (See Deformed Toenails Section). Fungus in the skin of the feet is called athlete’s foot. If affects the upper layer of skin and can occur from the heel to the toes, in between the toes, and even up the sides of the foot. It can make the skin pink in color, cause peeling of the skin, itching, or sometimes even small white pus filled bubbles. It is contagious and can spread in places like swimming pools, locker rooms, showers, etc. Fungus loves dark environments where there is a lot of moisture (so a sweaty foot inside of a boot for 12 hour work shifts is a great home for these little guys!)  

People who have a weak immune system are more susceptible to developing the fungal infection and should receive treatment immediately. It may start out as mild fungus between the toes, but if the skin breaks down and you develop an ulcer it can lead to a bacterial infection. 

Treatment includes topical creams, foot soaks, and sprays. Sometimes oral medication is indicated if the infection is severe and uncontrollable. It is also important that feet are washed and dried thoroughly, even between the toes. Keep socks and shoes clean and dry. Use powder to keep the feet dry, especially if you have sweaty feet. Wearing shoes and socks that are made of breathable materials can help air circulate around the feet. Never share socks or shoes. Wear flip-flops or water shoes in public areas such as showers, pools, and lockers.

Hammertoes

Hammertoes are when the toes become deformed and contracted. They may be crooked at the knuckle joint causing pain in this area or a “lump”. If the toes are curled enough, it can cause the tip of the toe to get excessive pressure when walking. Sometimes the toes may deviate to the side, rubbing against the other toe. Any area where the toe is receiving too much pressure could lead to skin breakdown, ulcer formation, pain, or even the formation of a corn.

Some hammertoes are flexible which means you can manually straighten out the toe, but when you let go the toe curls up again. These are far simpler to treat and can be surgically corrected in the office with a 1mm incision.

Rigid hammertoes are a little more complicated. These are stuck in the curved position which means the bone has to be broken and straightened out in order to fix the toe. This can also be done in the office with minimally invasive surgery but it does take longer to heal. Both types of surgeries can be performed with local anesthesia, with the patient experiencing very little pain after the anesthetic has worn off. You are awake during the procedure but the toe is completely numb. You can walk out of the office in a surgical shoe. The beauty of minimally invasive surgery is that there is no need for an expensive implant or wires sticking out of the toes. We splint the toe in place as it heals.

Ingrown Toenails

Ingrown toenails are pretty common and there are a variety of treatment options. Ingrown toenails happen when the edges of the nail curve and grow into the skin. This can cause irritation leading to pain, redness, swelling, warmth, drainage, odor, and infection. Causes of ingrown toenails include trauma, improper foot wear, genetics, and fungal infection. If it is your first time having an ingrown toenail, and it is mild, a simple treatment can include trimming the curved portion out. This is typically painless and does not require injections or surgery. 

If the ingrown portion of the nail is severe and infected, then we recommend surgical excision. The toenail is first numbed up and then only the curved portion of the toenail is removed all the way back to the base of the nail. A solution is applied to kill the nail cells that grow along the border so that the ingrown nail does not return. This is a permanent solution and we only remove the sliver of the nail along the side that is incurvated. It is important to note that antibiotics do not effectively treat an ingrown toenail! They only calm down the infection, but the nail that is curved into the skin must be dealt with!

If you are trying to avoid a surgical procedure, On the Move Podiatry does offer an alternative treatment that is not offered anywhere else in this area. We use a nail correction system which is a nonsurgical treatment option for involuted and ingrown toenails. A composite is applied to the toenail that hardens and provides a “brace-like structure” for the toenail. This brace maintains the normal curvature of the nail and helps hold it straight as the nail grows out without any tension or pain. This is a good option for those where a surgical procedure may be contraindicated (such as a diabetic or someone with poor blood flow lacking healing capabilities).  

Injuries

If you have had an injury, we will do our best to see you as soon as possible. We understand that injuries can be serious and should not be overlooked.  Whether it’s just a simple skin tear that needs stitches or a swollen bruised foot that is fractured. We can assess and determine the appropriate course of treatment.

A common injury we see is a smashed toenail caused by dropping something on the foot. Schedule an appointment if you have blood trapped under the nail. With an injury like this, the skin under your toenail maybe be lacerated or torn, and it is crucial to have it repaired so that the bone underneath does not become infected. Maybe you have a simple fracture that requires a cast or walking boot. Or maybe you have a serious fracture that needs surgery. We see all types of injuries on a day-to-day basis. Call us for an appointment today!

Injury man in doctor

Midfoot Pain

Sport injury

There are many different types of midfoot pain. If you stand on your feet all day and just started noticing recently that your foot aches after long periods of standing or walking, this is an early sign of too much stress on your midfoot joints. We can evaluate your arch and gait to determine what is causing it. Often times it may be your tight calf muscles altering the way you walk, putting excessive stress on those joints.

Another type of midfoot pain is from arthritis. The cartilage may be worn causing the bones to rub or even causing joint spurs.

Maybe in the past you had an injury to the midfoot and you continue to have ongoing pain in this area. It is possible that you could have had an injury to the Lisfranc ligament which is a very important ligament that supports the bones in your arch. If this went undiagnosed it can lead to severe pain and even arthritis down the road.

We can treat all types of midfoot pain, whether you need x-rays, orhotics, injections, taping, bracing, laser therapy, physical therapy, or even surgery – we offer all of the above.

Neuromas

A neuroma is a thickened, inflamed, and irritated nerve that can develop in the foot but is most common in the forefoot. It may feel like you are walking on a pebble, or you may feel pain in the ball of the foot, numbness, tingling, and burning in the toes. If left untreated it’s possible the nerve can become damaged and permanent. Common causes include wearing narrow shoes with a tapered toe box, or high heeled shoes. If you have tight calf muscles it can cause excessive pressure on the ball of the foot when walking. Also people who have bunions, hammertoes, and flat feet are at a higher risk of developing a neuroma.  Conservative treatment can include special padding, orthotics, stretching, and shoe modifications. An alternative treatment includes a series of an injection containing a nerve-blocking medicine. This can be successful in resolving pain and doesn’t involve steroids. Steroids can relieve pain and inflammation but they do not heal the tissue and can actually put the tissues at risk for injury, including tearing of the nearby toe ligaments. If the neuromas have been present for quite some time an ultrasound can be performed to assess the size of the neuroma. Sometimes extremely large neuromas have to be surgically excised.

Neuropathy or Nerve Pain

young man touching foot while sitting on bed and suffering from pain

There are many different reasons why people can develop neuropathy or nerve pain. The most common ones including diabetes, sciatica, back conditions (such as herniated discs or stenosis), Lyme’s disease, chemotherapy, trauma, surgery, and nutritional deficiencies. Some neuropathy is considered idiopathic, meaning we don’t know the underlying cause. It is important to address the underlying cause because treatments to address the pain are limited.

The most common treatment is nerve pain medication such as Gabapentin or Lyrica. These medications do not heal the nerves, they help alleviate the pain but can often cause other serious side effects. Other treatments can include pain creams and electrical stimulators to apply along the painful area (pain relief is limited).

At On the Move Podiatry, we offer unique alternative treatments that may help with your nerve pain. One of these treatments includes a series of nerve pain blocking injectables. We use Sarapin which is an injectable analgesic indicated for the management of neuropathic pain. Sarapin has been used safely and effectively for pain management for over 70 years. Unlike steroids (which are known to cause many side effects). Sarapin is a biological medicine derived from the pitcher plant which has virtually no known side effects. A side effect could include an allergic reaction. If you are someone who is known to have many allergic reactions to plants then this may not be an option for you. It works by stopping pain signals coming from the nerve. It only affects sensory nerves which means it will not interfere with your motor functions. The injection regimen is modified for each patient, but typically includes an injection every 2 weeks until the pain subsides.

We also offer MLS laser therapy for nerve pain. The MLS laser is FDA approved and is a noninvasive, safe, effective, and convenient treatment for those suffering from nerve pain. Light energy enters damaged nerve cells and stimulates intercellular activity. This reduces pain in the area and speeds recovery of damaged cells. The light energy does the following: stimulates cells to remove toxins, allows oxygen and food loads into the cell, blocks pain signals in the brain and releases endorphins and encephalin (a natural pain killer), increases the production and cell growth bringing blood flow into the area, and jump starts healing by stimulating the mitochondria in the cells. A single treatment takes less than 15 minutes and is completely painless and comfortable.

Plantar Fasciitis/Heel Pain

Plantar fasciitis is very common in the general population, and if treated early on, there is a high success rate of recovery. The plantar fascia is a ligament that extends from your heel bone towards your toes and helps provide support to your arch. If you do not provide adequate support to this ligament or the ligament tightens up, it can lead to inflammation. When you sit down to rest or sleep at night, the ligament tightens up like a rubber band. When you go to stand up, the ligament suddenly elongates, pulling on the heel and causing significant pain. As you walk around a little bit, the pain may ease up as the ligament slowly stretches. Treatment includes x-rays, orthotics, taping, and stretching. Sometimes a stretching brace is indicated if you have already failed straight forward stretches at home. If your pain is severe and you need urgent relief, we can perform an injection as well. Our injections are all natural and do not contain steroids. Steroid injections can cause tearing of the ligament or cause thinning of the fat pad in the heel. Our alternative injections do not cause either of these. They can help lower pain and inflammation. By following the above treatment protocol, it is not common to need surgery for this condition.

Woman massage with tennis ball to her foot in bedroom,Feet soles massage for plantar fasciitis

Skin Conditions Such as Psoriasis, Dermatitis

rough cracked skin on heel of male foot

Because fungus is so common in the feet, diagnoses such as psoriasis and dermatitis can be misdiagnosed. Therefore, if you are prescribed an antifungal lotion it will not treat your condition. It is important to correctly identify your skin condition so that an accurate topical can be prescribed. If necessary, a biopsy can be performed. 

At On the Move Podiatry, we try to avoid steroids when possible, so we will recommend alternative topical lotions and oils that do not cause skin thinning or skin damage.

Skin Lesions/Moles

If you have a spot, lesion, or mole on your lower leg or foot that you are concerned about, we can evaluate the area and perform a biopsy in the office. The specimen will then be sent out to a lab to be tested. We will call you with the results as soon as possible. If the skin lesion is suspicious for malignancy then we will refer you out to a specialist such as a dermatologist or plastic surgeon.

Tendonitis

Physiotherapist during an Achilles tendon treatment

Tendonitis means inflammation of a tendon. Common tendons that become inflamed include the achilles, posterior tibialis tendon, peroneal tendons, flexor tendons, and occasionally the anterior tibialis tendon. It is crucial to determine if your tendon is inflamed due to a structural foot deformity. For example, if your foot is flat, the posterior tibialis tendon which holds the arch up is being overworked. By determining the cause of the inflamed tendon, we can then formulate a  treatment. Often time orthotics are important in order to support the area of the foot where the tendon is hurting. 

Other treatments include taping, stretching, therapy, and pain creams. We also offer alternative injection therapies that do not contain any steroids so they can not further damage the tendons. If the tendon has been inflamed for a long time, an ultrasound can be performed or an MRI can be ordered to assess the integrity of the tendon. If the tendon itself has damage then it can be surgically repaired. Minimally invasive tendon debridement may be performed if damage is mild to moderate. If damage is severe you may need open surgery.

Tarsal Tunnel

Tarsal tunnel is when the tibial nerve along the inside of your ankle is somehow being compressed or squeezed which causes burning, tingling, numbness, or shooting pain down into the bottom of your foot and towards your toes. It is very important to determine what is causing the tarsal tunnel and treat the etiology. Covering up your nerve symptoms with pain medication is not a solution. The etiology can be biomechanical in nature, especially if you have a flat foot. Wearing custom orthotics can lift up your arches, taking stress off the nerve. 

Sometimes there may be a mass near the nerve, pushing on it and causing pain. If that is the case, we can perform an ultrasound or order an MRI. Other times it may seem like tarsal tunnel but the nerve pain could be emanating from your back. As you can see, your treatment will depend on what is causing the tarsal tunnel. If you suspect tarsal tunnel please call us today for an appointment. If ignored over time you can develop permanent nerve damage.

Woman with a sprained ankle

Ulcers/Wounds

Unrecognizable doctor bandaging foot of patient

Whether your wound is caused by trauma, diabetes, neuropathy, veins, etc., Dr. Stouder has extensive training in wound care. She has been treating ulcerations and wounds for over 7 years and has treated many patients in the hospital and wound care setting. She takes pride in helping patients heal who may have had issues healing in the past. There is always an underlying reason why someone has a wound and it is important to address the underlying cause. Etiologies can include high blood sugar, poor blood flow, ill fitting shoes, prominent bones or foot deformities, improper nutrition and vitamin deficiencies, and infection. It is crucial to evaluate the wound thoroughly and determine a unique treatment plan for the patient. Every patient is different and not everyone will have the same treatment plan.

For example, if you have a hammertoe that is causing an ulcer on the tip of the toe this can be surgically corrected in the office and the wound could resolve within a week or two. If a bone is severely prominent and causing the wound, then minimally invasive surgery can be performed to take the pressure off of that area. Sometimes tendon and ligament releases are necessary. If you have poor blood flow this can be assessed during your appointment. If your shoes are ill fitting we can measure your feet and make new recommendations. We can apply offloading padding in your shoes or provide a special type of shoe. Sometimes it is necessary to apply a walking cast in order to take pressure of the ulcer site. If you have an infection, the wound should be tested for bacteria and you can be placed on the appropriate antibiotic. 

Dr. Stouder routinely performs surgeries in the office for wound infections, including abscess drainage and toe amputation. You may not even have a wound but have an area of skin that always appears pink or blistered. This should be evaluated as well. MLS laser therapy is done in the office to speed up healing. There have been patients with wounds over a year old that healed within 6 weeks after having MLS laser therapy. Don’t hesitate to have your wound evaluated today. Proactive treatment drastically reduces the need for serious surgeries, including amputations.

Warts

Warts are caused by a viral strain (HPV) that gets into the superficial layer of skin. It causes solitary lesions or warts that come in clusters. They can look like thickened skin or look like small black dots. They are typically painful when pressure is applied. The concern with no treatment is that the warts can spread to other areas of the feet and hands, as well as to other people. It is common to want to treat them right away. There are many forms of treatment for warts. If the wart fails to respond to one form of treatment, then you can switch to a different type of treatment.

First, the dead skin on top of the wart is trimmed off (this is usually not painful, but if so we can apply topical lidocaine first). Next, cryotherapy can be performed (freezing the wart) or a solution called Cantharone can be applied. Cantharone is made from the blister beetle called Cantharis Vesicatoria. It is typically very effective in most patients. Commonly the wart reduces in size after just the 1st application and the pain may entirely resolve or diminish greatly. Stubborn warts can sometimes require several applications.

If you have many warts (or mosaic warts) we recommend wart needling. This procedure is done in the office. The “mother wart” or the largest wart is numbed with lidocaine. Then needling is performed into the wart. This technique is performed once and helps initiate an immune response for the body to attack the wart. The patient waits 6 weeks for the immune response. There is a 68-86% chance that the mother wart and the surrounding warts disappear. The more warts you have and increased duration can lower the success rate. In severe case the wart can be surgically excised but this can cause pain and scarring.