Big Toe Joint Aches and Pains - What you need to know:

Often times patients will present with what they consider to be a "Bunion" in their big toe joint, and they attribute this to their pain. Many times, this is false. A bunion is an actual deviation or dislocation of the big toe joint, whereas the painful prominence which are often gradually increasing in size after many years removed from an injury can be related or directly attributed to progressive "bump" production which has the general buzzword "Arthritis".

Arthritis is actually a misnomer, because many times the inflammation of the joint is only noted initially in the disease process and over time the cartilage wears away forming spurs and bone prominence which leads to the pain and inability to move the joint fluidly. This is actually an "arthrosis" which is the end result of the condition. Arthritis is not usually visualized directly on a radiograph but arthrosis is easily visualized.

A clinician will find effusions whenever arthritis is active. This is the "Swelling" that patients often note is painful and warrants medical attention. This is often including joint space widening in the case of inflammatory arthritis but narrowing over time with osteoarthritis, and reduction of ability to move the joint without pain and with eventual grinding.

Patients will often times not recall the traumatic event which sparks the progressive wear down of this area on their foot, but many times this is not necessary. Patients will also note that the "bunion" is growing and is usually located on top and side of the joint. This is not a bunion, as these tend to only be located on the side of the joint and not at all on top.

What do you need to know to determine what to do next??

1) If the pain is at the end of the day you should see a foot and ankle specialist.

2) If the motion of the joint is limited or not similar to your other foot, you need to see the specialist.

3) If you have been given 2 or more cortisone injections in the same joint, you need to see a specialist.


There is a common theme here. A foot and ankle specialist is paramount to help a patient achieve a good result in treating first toe joint arthrosis. Often times, this is progressive and may limit treatment options depending on the stage of the pathology. There is no actual cure for any form of arthritis, but there are means to treat and accommodate the condition in order to reduce pain and limitation with walking.  We are adept in treating all forms of arthritis, from the initial swelling stage, to the end stage limited motion in the toe joint.  There are many times several good options depending on the stage of the disease process, and we will be able to give you a definitive solution in many cases.

Dr TIMM.

Baby and Toddler Shoes

Before babies starts walking, they don't need shoes. In fact, supportive shoes like hard-soled Mary Janes may actually get in the way of your child's developing mobility. Socks, booties, and soft-soled baby shoes are useful for warmth, but bare feet are fine, too. In actuality their feet are very adaptable to the ground, whether it is carpeted or wood and tile. And early on it allows their proprioceptive feedback to allow them to balance easier and develop more readily in the very early stages without shoes.  

Once your child takes those first steps, it's time for a pair of real shoes. Unlike "baby shoes," which are more like slippers, first shoes will have a flexible, nonskid sole (probably rubber) and a more substantial upper. Shoes protect kids' feet outdoors and anywhere else that could be hazardous – a splintery surface, for example.

Note: Your child's foot is still developing, so it won't look (or act) like an adult foot. If your child still has a padding of baby fat under the arches, for example, she might appear a bit flat-footed. Or she may have a tendency to turn her toes in when she walks, called in-toeing or toeing in.Indoors (and outdoors on safe surfaces, such as sand), it's still a good idea to let new walkers wear soft baby shoes or socks. Your child can even go barefoot, if it's warm enough. Toddling around with feet bare or lightly covered actually helps little ones build strength and coordination in their legs and feet.

Mention any concerns to your child's doctor. It's easier to correct foot problems when your child is younger.

What to look for when buying

• Choose a breathable, lightweight material. Soft leather or cloth is best. Avoid stiff leather shoes, which can hinder foot development, and synthetics, which don't breathe.
• Bend the soles. They should be flexible and gripping, not smooth and stiff. A nonskid rubber sole with ridges will offer good traction.
• Check the fit. Have your child try on the shoes and stand up. There should be just enough room to squeeze your pinky between your child's heel and the heel of the shoe, and a full thumb-width between the end of your child's longest toe and the front of the shoe. The shoe should provide just enough wiggle room without being too big. Because baby feet grow quickly, it's a good idea to check every month to make sure the shoes still fit.
• Give it a squeeze. If the shoe is made of soft fabric, try to grab some of the material on the top of the foot when your child is wearing them. If you can't, the shoes might be too tight.
• Shop later in the day. Babies' feet swell and are often bigger at the end of the day. Shoes purchased in the morning might feel tight in the evening so usually try shoes on before dinner before you buy.
• Look for problem spots. Your baby's shoes shouldn't need any breaking in. Let your child toddle around indoors wearing the shoes, then take them off and look for any irritated areas on your child's foot which could be red areas or blisters, and in more rare cases even a callus formation can occur but this is not common.
• Make the choice: laces versus Velcro. Velcro fasteners make it easier to get shoes on and off, and you won't have to worry about retying laces all day. But a child may figure out how to remove his shoes and take them off when you wish he wouldn't! If you choose shoes with laces, make sure they're long enough to tie into double knots, so they won't come undone as often.

What it's going to cost you

Simple baby shoes can cost as little as $15 to $20. Fancier shoes, of course, can cost a lot more. And remember any foot concerns can be addressed at any age here at FFLC. 

DR TIMM

Flatfoot May Lead to Knee Arthritis.

DID YOU KNOW?

Having flat feet is associated with an increased prevalence of knee pain and cartilage damage in older adults according to research funded by the Arthritis Foundation. Using the Framingham Foot and OA Studies, a research team from Boston University School of Medicine and the Institute on Aging Research in Boston gathered data on 1,884  older adults whose mean age was 65 years. Twenty-two percent of knees were reported as painful on most days. Magnetic resonance images of the painful knees were acquired to determine the health of the cartilage within the joint. The Staheli Arch Index was used to determine the participants’ foot arch shape. The scientists analyzed the data and adjusted for age, sex and body mass index. 

They found that people with the lowest foot arches – commonly called “flat feet” – had 1.39 times the odds of having pain in the knee on the same leg as the low arch. Likewise, those with flat feet had 1.76 times the odds of having cartilage damage in the inner aspect of the knee joint (the medial tibiofemoral compartment). Because of the nature of the study, cause and effect cannot be determined. 

People with low or flat arches may be able to ensure proper knee alignment by wearing supportive shoes and/or orthotic inserts. 

Gross KD, et al. Planus foot morphology is associated with knee pain and cartilage damage in older adults. Abstract presented at American College of Rheumatology Annual Scientific.

Are my running shoes the right ones?

Minimalist shoes, a controversial topic in foot and ankle biomechanics and running safety.

So what is it that lets me know that a shoe like the one I wore today is the right one? I’ve tried to think about this scientifically, but sometimes subjective impressions are good enough, or even better when it comes to individual impressions. 

Here are 5 subjective things that let me know a shoe is a good match:

1. It causes no pain. 

No abrasion, no hot spots, no unusual aches in my legs or feet. No pain is good. Note: sometimes pain may be present as your body adapts to a given shoe, and it starts to feel better after a few runs, so this may not always be a perfect indicator on your first run in a shoe.

2. It disappears on my feet. 

If I weren't concentrating on how it feels, the shoe would go completely unnoticed. It doesn't make me think about my form, it doesn't force my feet to move in ways that they don’t want to, and it doesn't get in the way while I run. When I run in a shoe that’s a good match, I feel strong and as if my body is in complete control. A good shoe works with my body, not against it.

3. Ground contact simply feels “right.” 

This is something that is extremely difficult to verbalize but very easy to feel the moment I start running in a shoe that’s a good match for me - a good shoe simply feels right when it hits the ground. Unfortunately, it may require running in a lot of shoes before you get a sense of what the “right” shoe feels like for you. After you get a sense of the variation among several shoes, you begin to notice that some shoes feel dead on contact, and they feel like they rob your legs of energy. A good one feels responsive and like it’s helping you progress forward on your run.

4. It makes you want to run fast. 

Sometimes a shoe feels so good that you simply want to cut loose and run wild. It’s an incredible feeling to have everything clicking and hit that moment when you start cruising down the road or trail with reckless abandon – it’s like I imagine sitting behind the wheel of a sports car might feel (I drive a Prius…). A good shoe makes you want to move, and move fast!

5. A good shoe makes you long to run in it again. 

This, for me, is the number one sign that a shoe is a good match. When I finish a run in a good shoe, I simply can’t wait to run in it again. In fact, it may motivate me to get out the door simply so I can put it back on my feet. As I sit here writing this, I have the shoes I wore on the trails this afternoon on the floor next to me, and I have half a mind to go out for an evening run in them just to put more miles on them. On the other hand, it takes willpower to run in a shoe that just doesn't feel right to me – it’s like a wasted opportunity to get maximum enjoyment from the time I spend on the run. When you want to run in a particular shoe even though you have 50 to choose from, you know it must be a good one.

Take the 'fire' out of ant bites

The time has come for many of our patients to wear sandals and even more patients to walk around outside without shoes. Most people in Florida already do this, but with all of our seasonal residents returning, the number of people doing this will triple. This may often lead to exposure of your exposed foot and ankle to fire ant bites. These can be relatively nasty and may sting and burn for extended periods of time. Sometimes they may become infected and lead to abscess formation in patients with diabetes or vascular disease. It is important to have this looked at by a physician if the area becomes more red and swollen than the above picture shows, or if a fever or chills begin to occur. Even drainage and bleeding after 3 days time should be reported to the physician immediately. FFLC physicians are always ready and able to treat any foot and ankle emergency, and will often have immediate appointments available at one of the three locations.

• General Treatment Guidelines
• Local stings: Cool compresses and oral antihistamines are recommended for mild reactions as first line treatment at home. Sometimes the physician will administer corticosteroids which may be used topically or intralesionally injected for anti-inflammatory effect.
• Multiple stings: Systemic corticosteroid use is controversial in patients with extensive lesions who do not have systemic allergic reactions or generalized skin reactions.

  • Large doses of corticosteroids and intravenous fluids may complicate the treatment of patients with preexisting cardiovascular disease.
  • Sometimes, the immunosuppressive effect of corticosteroids may predispose patients to secondary infection.
  • Oral antihistamines and topical corticosteroids are recommended in most cases; nevertheless, some practitioners still use prednisone or other systemic steroids to treat patients with numerous lesions.
• Anaphylaxis: Acute management of fire ant anaphylaxis is identical to treatment of anaphylaxis from other causes. Subcutaneous epinephrine is used and repeated every 10-15 minutes as needed to reverse the symptoms. This may occur rapidly, and requires 911 and EMS for life saving efforts in some cases. 

Always remember that any red swollen area or lesion of any kind which is not improving after 5-7 days should be evaluated by a physician. 

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Many Roads Lead to Foot Pain

Reflexology Chart, used for demonstrative purposes only. This is not a Pro-Reflexology article.

If you browsed through medical textbooks that explain different diseases, you'd find that many conditions can lead to harmful changes in the feet, including foot pain.

For example, if your thyroid — a gland in your throat that makes crucial hormones — is not working properly, associated problems with your nerves can affect the sensation in your feet. Or if you have degenerative changes in your lower back, the nerves coming off your spinal cord may become irritated, which could also affect the health of your feet, he says.

Here's a look at three common conditions that may result in foot pain and unhealthy feet.

Peripheral Arterial Disease

About 8 million Americans have peripheral arterial disease (PAD), according to the American Heart Association. In PAD, a fatty substance called plaque that builds up in the arteries in your legs, reducing the flow of blood to your lower legs and feet.

PAD can cause the muscles in your calves and other parts of your legs to cramp while you're moving around. The condition can also lead to foot pain and poorly healed foot wounds. While the foot and leg-related symptoms of PAD are usually quite obvious, the disease is also associated with hidden damage to the heart and brain — which places those with PAD at much higher risk of heart attack and stroke.

Not surprisingly, other risk factors for heart disease and stroke, such as smoking, diabetes, high cholesterol, and high blood pressure, also increase your risk of PAD.

Medications can be used to manage PAD, but changes in diet and lifestyle (like quitting smoking) are very important as well.

Rheumatoid Arthritis and Gout

According to the Arthritis Foundation, 46 million Americans have arthritis or other chronic problems affecting their joints. For patients with rheumatoid arthritis — which affects 1.3 million Americans — about 90 percent will develop symptoms in the foot and ankle.

Rheumatoid arthritis (RA) develops when the body's natural defense system against disease, the immune system, mistakenly attacks your joints, causing them to become painful and swollen. The symptoms of RA may include severe foot pain. When the condition affects your feet, pain usually begins in your toes and later spreads to the rest of your feet and ankles. The joint damage caused by RA can eventually change the shape of your toes and feet. In some people, foot symptoms are the first hint that they even have RA. Once diagnosed, RA can often be treated effectively with medications, exercise and, in some cases, surgery.

Another type of arthritis that is known for causing foot pain is gout. This condition occurs when a substance called uric acid accumulates in your body. Deposits of uric acid collect in the joints — particularly in your big toes — and can cause intense, episodic pain. Uric acid can also lead to kidney stones if too much of it builds up in the kidneys.

Doctors can treat gout with nonsteroidal anti-inflammatory drugs (NSAIDs) and other medications including steroids. Getting regular exercise, drinking lots of water, avoiding certain medications, and staying at a healthy weight can help prevent gout attacks, too.

Foot Pain Health Problems: Diabetes

Roughly 24 million Americans have diabetes — and 6 million of them don't even know it yet. If you have this health problem, the glucose or blood sugar that your body normally uses as fuel can build up in your blood. This excess sugar can damage nerves and blood vessels in the feet — eventually leading to decreased sensation and compromised blood flow.

As a result, symptoms of high blood sugar include numbness or tingling in your feet as well as severe foot infections. Diabetes is a major cause of foot problems in the United States and can lead to the surgical removal of a toe or even more of your foot or lower leg.

Fortunately, diabetes and its associated foot complications can be managed with medication and regular foot exams by your doctor. It is also important for diabetics to quit smoking, wear supportive shoes, and avoid being barefoot to prevent unnecessary foot trauma.

After a long day of standing at work, it's common to experience some foot discomfort, but if you notice severe foot pain that seems out of proportion to your physical activity, tell your doctor. What starts as a minor foot problem could indicate a more serious medical condition.

After hurting my ankle, now what?

Ankle Rehab Exercises: Improving Your Strength

A good ankle rehabilitation program should focus on ankle rehab exercise to improve the strength of the muscles of the ankle.  This is the most common focus for ankle rehabilitation, and rightly so.  Without a good strengthening program, you cannot get back to your normal pain - free life and sports.

Whether you are going through rehab in a clinic with an athletic trainer or physical therapist, or you are doing your own rehab at home, your strengthening program needs to focus on several specific areas.

The following are examples of ankle rehab exercises to help improve your strength.

The Calf

The calf muscles, including the gastroc and soleus are important during ankle function. They are the muscles that are responsible for you being able to point your toes, lift your heels up, walk, run, and jump. They also help control a lot of the movements that you perform during sports.

Strengthening of the calf can be accomplished with lots of different exercises. My favorite is the simple heel raise against the wall with forward support. 

Initially, you will want to do the heel raises on both feet at the same time, but as your ankle heals, you will be able to do single leg heel raises. 

Another way to strengthen the calf is with theraband exercises. Lunges, step ups, and balancing activities will also help to strengthen the calf muscles.

The Peroneals

The peroneal muscles are the stabilizers of the ankle. Located on the outside of the leg, they help the ankle maintain a neutral position when you are putting weight on your leg.

Try balancing on one foot for a few seconds. Watch what your ankle does while you are balancing.

Notice how your foot rolls in and out and adjusts to keep you balanced? The peroneal muscles help to keep your foot neutral while you are balancing, as well as when you are walking, running, jumping, and landing. 

Strengthening of the peroneals can be done with theraband exercises. This type of ankle rehab exercise will isolate these muscles, and can be helpful in the early stages of your rehabilitation. 

Once you are stronger, more advanced exercises like lunges, step ups, and other balancing activities will help improve the peroneal's strength.

The Posterior Tibialis Tendon and Muscle

The posterior tibialis is the medial stabilizing muscle of the calf. It helps to do the same thing as the peroneals, only on the opposite side. It works to keep the ankle and foot in a neutral position when you are bearing weight, and works with the peroneals to do this.

The posterior tibialis can also be strengthened with theraband exercises, and then more advanced exercises like lunges, step ups, and balancing.

Other Muscles

There are several other muscles in and around the ankle that can be strengthened during ankle rehabilitation. The anterior tibialis, extensor digitorum, flexor digitorum, and other intrinsic muscles can all benefit from strengthening exercises.

It is important to remember though, that sports activities as well as daily life do not occur in isolation. So, ankle rehab exercises to improve your strength should also not occur in isolation.

In the early stages of rehab, some isolation is needed to retrain the muscles to be able to contract. This is very true if you have a lot of swelling. Theraband strengthening is a great way to work on isolated muscle activity.

After the first 1-2 weeks following initial rehabilitation, your program should progress to more multi-muscle exercises, like the lunges and step ups, and balancing activities discussed already. 

Ankle rehab exercises for improving strength should include the major muscle groups that produce the motions at the ankle as well as stabilize during activities. Your program should start out with simple exercises like theraband strengthening, and then progress to more advanced functional activities like lunges, step ups, and balancing.

Source http://www.sports-injury-info.com/ankle-rehab-exercises-strength.html