Our team of specialists and staff believe that informed patients are better equipped to make decisions regarding their health and well being. For your personal use, we have created an extensive patient library covering an array of educational topics. Browse through these diagnoses and treatments to learn more about topics of interest to you. Or, for a more comprehensive search of our entire Web site, enter your term(s) in the search bar provided.

As always, you can contact our office to answer any questions or concerns.

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New York Podiatrist
… If you are considering surgery this is our specialty…

Precision Foot Care
… As Assistant Clinical Professor at the Hospital I enjoy Medical and Surgical treatment of the patients as well as training the residents Education NY College Of Podiatric Medicine- Post Doctoral Preceptorship in Podiatric Medicine and Surgery                                                                                                                                                                                                                                                                                                                                                                              1984 – 1988 NY College of Podiatric Medicine 55 East 124th Street NY, NY   1988 – 1989 1989 – Present Private Practice 133 East 58th Street, Suite 506 NY, NY 10022 Board Certification American Board of Podiatric SurgeryFoot Surgery Diplomate of the American Board of Podiatric SurgeryFoot Surgery  2000- Present Recertified August 2009- August 2020 Fellow American College of Foot and Ankle Surgeons 2009- Present Staff Privileges Assistant Clinical Professor at Woodhull Medical and Mental Health Center Grammercy Park Surgical Center 1988- Present Woodhull Medical & Mental Health Center Affiliated with NYU Langone Medical Center 2006 – Present Treasurer of NYSPMA – New York Division 2009-Present   Fellow American College of Foot and Ankle Surgeons 2013  Assistant Clinical Professor At Woodhull Medical and Mental Health Center About the Doctor Married – Doris Giraldo, DDS Children – Alician & Isabella Jurcisin Active member New York Road Runners Club Active member New York Triathlon Club Active member Asphalt Green Triathlon Club Active member St…

Our Services
From routine checkups to treatments for surgery, Precision Foot Care is equipped to handle all your podiatric needs…

New Patients
…Jurcisin, a Diplomat of the American Board of Podiatric Surgery and board certified in foot surgery, practices in Manhattan office equipped with state-of-the-art X-ray equipment that enables him to swiftly diagnose many conditions…

Video Testimonials
Back in high heels after Hammertoes SurgeryPain Free!!   Back in heels after many years! Bunion surgery    Record time healing after Hammertoe Surgery with the best therapy!   No longer shy about wearing sandals after Hammertoe and Bunion Surgery   Bye bye years of painful feet- Hammertoe and Bunion Surgery   Best Surgical experience!- Correction of Bunion and Tailors bunion      Bunion Surgery Patient   Bone Spur Surgery Patient   Bunion and Hammertoe Surgery Bunion Correction Surgery and Physical Therapy Heel Pain- Plantar Fasciitis treated with Injection Therapy and Orthotics Hammertoe Surgery and Emergency treatment Foot Pain- Plantar Fasciitis treated with Physical Therapy Patient for over 20 years- Best Podiatrist in NY!!! Longtime Patient- Heel Pain, Bunion and Nail care Tendon Tear Hammertoes, Bone Spurs and Bunions  Happy after Successful Bunionectomy- Bunion Surgery  Bunion Surgery Heel Pain- Heel Spurs Surgery Walk and feel better after Corns and Calluses treatment Able to play Basketball after Buinion Surgery Written Testimonials Amazing doctor and staff! I visited Dr…

Bunions
…In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe…

Hammertoes
…Left untreated, hammertoes can become inflexible and require surgery

Bunionectomy Before and After Photos
New York City Podiatrist before and after photos of Bunion and Hammertoe Surgery at Precision FootCare with Dr…

Video Testimonials in Spanish
Patient – Bunion Surgery (Spanish)   Heel Pain- Heel Spurs Surgery (Spanish) Longtime Patient- Heel Pain, Bunion and Nail care (Spanish)

Losing weight after Thanksgiving
… Orthotic device Injection therapy Removable walking cast Night Splint Physical Although most patients respond to non- surgical teatment, a small percentage of patients may require surgery

Pressure Relief
…  Surgery to remove deformities including bunions, hammertoes and bony bumps in ball of the foot   are one of the ways that your podiatrist may remove an area of increased pressure that is likely to develop or has previously developed an ulcer…

Revive your Running from Achilles Tendonitis
…   Luckily, in most cases, if diagnosed before extensive calcifications have developed, Achilles tendonitis can be successfully treated without surgery

Pau’s Palntar Fascia Pushes Him to the bench
Plantar fasciitis or inflammation of the plantar fascia is one of the most common causes of foot pain that leads people around Columbus to consult their podiatrist at Columbus Podiatry and Surgery

Diabetes and Your Feet
…Surgery is considered if your deformity is too severe for a brace or shoe…

Ms Sex & The City herself hits her limit with heels!
…  Surgery may be required to resect the excess bone for heel pain that is not resolved or has recurred with conservative treatment…

Ankle pain doesn’t stop this Nets player
…  After receiving several corticosteroid injections he has luckily been able to return to game play this week! Surgery may become necessary if conservative treatments do not relieve ankle pain following an injury in three to six months…

Posterior Tibial Tendon Dysfunction (PTTD)
…If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested…

What is Brachymetatarsia?
… In some cases, surgery is performed to lengthen the short toe…

Best Bunion and Hammertoe Surgery in NYC
…Everything from your preoperative appointment to physical therapy after surgery is offer right in his office…

Smoking side effects to your lower extremity
…This is of great concern in those with a foot wound or incision after surgery, in which blood flow and oxygen are vital to skin healing…

TENDON PROBLEMS FOR ONE OF THE SAN FRANCISCO GIANTS
…  Unfortunately for highly active individuals like Pablo, depending on exactly what structures are damaged around his tendons, surgery may eventually be necessary to achieve optimal function…

Smoking and Bone Healing – 5 Surgical Risks Smokers Take
…But, what many don’t know is that it can also cause serious complications and affect patients’ healing time aftersurgery

Prevent Charcot Foot
…  Depending on the severity, surgery is another option…

Stop the Pain of Bunion
…   When to Consider Surgery If conservative treatments fail to resolve your pain, and your ability to walk or enjoy normal activities is limited, it’s time to discuss a surgical solution for your bunion…

Is my Achilies Tendonitis affecting my running
…   Luckily, in most cases, if diagnosed before extensive calcifications have developed, Achilles tendonitis can be successfully treated without surgery

Ankle Sprain
…Serious ankle sprains, particularly among competitive athletes, may require surgery to repair and tighten the damaged ligaments…

Osteochondritis
…In more severe cases, however, surgery may be prescribed…

Ankle Sprain Injuries
…Serious ankle sprains, particularly among competitive athletes, may require surgery to repair and tighten the damaged ligaments…

Broken Ankle
…If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint,surgery may be required to secure the bones in place so they will heal properly…

Fractures
…This injury may take longer to heal or require surgery

Osteochondritis (stiff ankle)
…In more severe cases, however, surgery may be prescribed…

Bunions
…In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe…

Flat Feet
…In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function…

Hallux Varus
…It is a possible complication from bunion surgery

Hammertoes
…Left untreated, hammertoes can become inflexible and require surgery

Overlapping or Underlapping Toes
…If the deformity is rigid, surgery may be needed to remove a small portion of the bone in the toe…

Pain Management for Conditions
…Treatment consists of periodic trimming or shaving the callus, padding the shoes to remove the pressure, using shoe orthotics, or, in severe cases, surgery

Calluses
…In most cases, plantar calluses can be treated without surgery

Smelly Feet and Foot Odor
…Recent advances in technology have made this surgery much safer, but may increase sweating in other areas of the body…

Bunions
…In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe…

Hallux Varus
…It is a possible complication from bunion surgery

Hammertoes
…Left untreated, hammertoes can become inflexible and require surgery

Overlapping, Underlapping Toes
…If the deformity is rigid, surgery may be needed to remove a small portion of the bone in the toe…

Treating Foot Odor
…Recent advances in technology have made this surgery much safer, but you may notice sweating in other areas of the body after the procedure…

General Information
…Limited weight bearing, elevating and icing the foot, and keeping the area dry are commonly required for the first two weeks following surgery until sutures are removed…

Ankle Surgery
…Patients need to arrange for another person to take them home afterwards and stay with them for the first 24 hours following the surgery

Bunion Surgery
…Bunion surgery can reduce or eliminate the bone deformity, improve foot alignment and function, and prevent damage to other toes, but it does have its limitations…

Cyst Removal
…The recovery period depends on the location of the ganglion and the amount of dissection required duringsurgery

Hammertoe Surgery
…Left untreated, hammertoes can become inflexible and painful, requiring surgery

Heel Surgery
…There are many causes of heel pain and most cases can be effectively treated without surgery

Metatarsal Surgery
…Patients with rheumatoid arthritis may also need metatarsal surgery

Nerve Surgery (Neuroma)
…In cases of chronic nerve pain from neuromas, surgery may be recommended…

Children’s Shoes
…Casting, bracing, or surgery may be needed if a serious deformity is present…

Corrective and Prescription Shoes
…Immediately following surgery or ulcer treatment, special shoes may be necessary before a regular shoe can be worn…

Flat Feet (over pronation)
…In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function…

Bunions
…Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain

Ankle pain doesn’t stop this Nets player
…  Ankle synovitis is one of the causes of such chronic pain

Bunions
…Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain

Flat Feet
…Left untreated, it may lead to severe disability and chronic pain

Pain Management for Conditions
…You can help prevent chronic pain from developing by following these simple steps: Follow your doctor’s instructions carefully and complete the prescribed physical rehabilitation program…

Bunions
…Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain

Flat Feet (over pronation)
…Left untreated, it may lead to severe disability and chronic pain

Cavus Foot (High-Arched Foot)

What is Cavus Foot?
Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet.

Causes
Cavus foot is often caused by a neurologic disorder or other medical condition such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy, or stroke. In other cases of cavus foot, the high arch may represent an inherited structural abnormality.

An accurate diagnosis is important because the underlying cause of cavus foot largely determines its future course. If the high arch is due to a neurologic disorder or other medical condition, it is likely to progressively worsen. On the other hand, cases of cavus foot that do not result from neurologic disorders usually do not change in appearance.

Symptoms
The arch of a cavus foot will appear high even when standing. In addition, one or more of the following symptoms may be present:

  • Hammertoes (bent toes) or claw toes (toes clenched like a fist)
  • Calluses on the ball, side, or heel of the foot
  • Pain when standing or walking
  • An unstable foot due to the heel tilting inward, which can lead to ankle sprains

Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.

Diagnosis
Diagnosis of cavus foot includes a review of the patient’s family history. The foot and ankle surgeon examines the foot, looking for a high arch and possible calluses, hammertoes, and claw toes. The foot is tested for muscle strength, and the patient’s walking pattern and coordination are observed. If a neurologic condition appears to be present, the entire limb may be examined. The surgeon may also study the pattern of wear on the patient’s shoes.

X-rays are sometimes ordered to further assess the condition. In addition, the surgeon may refer the patient to a neurologist for a complete neurologic evaluation.

Non-Surgical Treatment
Non-surgical treatment of cavus foot may include one or more of the following options:

  • Orthotic devices. Custom orthotic devices that fit into the shoe can be beneficial because they provide stability and cushioning to the foot.
  • Shoe modifications. High-topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability.
  • Bracing. The surgeon may recommend a brace to help keep the foot and ankle stable. Bracing is also useful in managing foot drop.

When is Surgery Needed?
If non-surgical treatment fails to adequately relieve pain and improve stability, surgery may be needed to decrease pain, increase stability, and compensate for weakness in the foot.

The surgeon will choose the best surgical procedure or combination of procedures based on the patient’s individual case. In some cases where an underlying neurologic problem exists, surgery may be needed again in the future due to the progression of the disorder.


Diabetic Peripheral Neuropathy

What is Diabetic Peripheral Neuropathy?
Diabetic neuropathy is nerve damage caused by diabetes. When it affects the arms, hands, legs and feet it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves.

Three different groups of nerves can be affected by diabetic neuropathy:

  • Sensory nerves, which enable people to feel pain, temperature, and other sensations
  • Motor nerves, which control the muscles and give them their strength and tone
  • Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.

Diabetic peripheral neuropathy doesn’t emerge overnight. Instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy.

The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg, or even a life.

Causes
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes. However, even diabetic patients who have excellent blood sugar (glucose) control can develop diabetic neuropathy. There are several theories as to why this occurs, including the possibilities that high blood glucose or constricted blood vessels produce damage to the nerves.

As diabetic peripheral neuropathy progresses, various nerves are affected. These damaged nerves can cause problems that encourage development of ulcers. For example:

  • Motor Neuropathy (Deformity)

    +

    Ill-fitting shoes

    +

    Sensory Neuropathy (numbness)

    =

    Ulcers (sores)

    Deformities (such as bunions or hammertoes) resulting from motor neuropathy may cause shoes to rub against toes, creating a sore. The numbness caused by sensory neuropathy can make the patient unaware that this is happening.

  • Because of numbness, a patient may not realize that he or she has stepped on a small object and cut the skin.
  • Cracked skin caused by autonomic neuropathy, combined with sensory neuropathy’s numbness and problems associated with motor neuropathy can lead to developing a sore.

Symptoms
Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.

For sensory neuropathy:

  • Numbness or tingling in the feet
  • Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet

For motor neuropathy:

  • Muscle weakness and loss of muscle tone in the feet and lower legs
  • Loss of balance
  • Changes in foot shape that can lead to areas of increased pressure

For autonomic neuropathy:

  • Dry feet
  • Cracked skin

Diagnosis
To diagnose diabetic peripheral neuropathy, the foot and ankle surgeon will obtain the patient’s history of symptoms and will perform simple in-office tests on the feet and legs. This evaluation may include assessment of the patient’s reflexes, ability to feel light touch, and ability to feel vibration. In some cases, additional neurologic tests may be ordered.

Treatment
First and foremost, treatment of diabetic peripheral neuropathy centers on control of the patient’s blood sugar level. In addition, various options are used to treat the painful symptoms.

Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used.

In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.

Prevention
The patient plays a vital role in minimizing the risk of developing diabetic peripheral neuropathy and in preventing its possible consequences. Some important preventive measures include:

  • Keep blood sugar levels under control.
  • Wear well-fitting shoes to avoid getting sores.
  • Inspect your feet every day. If you notice any cuts, redness, blisters, or swelling, see your foot and ankle surgeon right away. This can prevent problems from becoming worse.
  • Visit your foot and ankle surgeon on a regular basis for an examination to help prevent the foot complications of diabetes.
  • Have periodic visits with your primary care physician or endocrinologist. The foot and ankle surgeon works together with these and other providers to prevent and treat complications from diabetes.


Equinus

What is Equinus?
Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. When it involves both feet, the limitation of motion is sometimes worse in one foot than in the other.

People with equinus develop ways to “compensate” for their limited ankle motion, and this often leads to other foot, leg, or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by “toe walking,” while a smaller number take steps by bending abnormally at the hip or knee.

Causes
There are several possible causes for the limited range of ankle motion. Often it is due to tightness in the Achilles tendon or calf muscles (the soleus muscle and/or gastrocnemius muscle). In some patients, this tightness is congenital (present at birth) and sometimes it is an inherited trait. Other patients acquire the tightness from being in a cast, being on crutches, or frequently wearing high-heeled shoes. In addition, diabetes can affect the fibers of the Achilles tendon and cause tightness.

Sometimes equinus is related to a bone blocking the ankle motion. For example, a fragment of a broken bone following an ankle injury, or bone block, can get in the way and restrict motion.

Equinus may also result from one leg being shorter than the other.

Less often, equinus is caused by spasms in the calf muscle. These spasms may be signs of an underlying neurologic disorder.

Foot Problems Related to Equinus
Depending on how a patient compensates for the inability to bend properly at the ankle, a variety of foot conditions can develop, including:

  • Plantar fasciitis (arch/heel pain)
  • Calf cramping
  • Tendonitis (inflammation in the Achilles tendon)
  • Metatarsalgia (pain and/or callusing on the ball of the foot)
  • Flatfoot
  • Arthritis of the midfoot (middle area of the foot)
  • Pressure sores on the ball of the foot or the arch
  • Bunions and hammertoes
  • Ankle pain
  • Shin splints

Diagnosis
Most patients with equinus are unaware they have this condition when they first visit the doctor. Instead, they come to the doctor seeking relief for foot problems associated with equinus.

To diagnose equinus, the foot and ankle surgeon will evaluate the ankle’s range of motion when the knee is flexed (bent) as well as extended (straightened). This enables the surgeon to identify whether the tendon or muscle is tight and to assess whether bone is interfering with ankle motion. X-rays may also be ordered. In some cases, the foot and ankle surgeon may refer the patient for neurologic evaluation.

Non-Surgical Treatment
Treatment includes strategies aimed at relieving the symptoms and conditions associated with equinus. In addition, the patient is treated for the equinus itself through one or more of the following options:

  • Night splint. The foot may be placed in a splint at night to keep it in a position that helps reduce tightness of the calf muscle.
  • Heel lifts. Placing heel lifts inside the shoes or wearing shoes with a moderate heel takes stress off the Achilles tendon when walking and may reduce symptoms.
  • Arch supports or orthotic devices. Custom orthotic devices that fit into the shoe are often prescribed to keep weight distributed properly and to help control muscle/tendon imbalance.
  • Physical therapy. To help remedy muscle tightness, exercises that stretch the calf muscle(s) are recommended.

When is Surgery Needed?
In some cases, surgery may be needed to correct the cause of equinus if it is related to a tight tendon or a bone blocking the ankle motion. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.


Fractures of the Fifth Metatarsal

What is a Fifth Metatarsal Fracture?
Fractures (breaks) are common in the fifth metatarsal – the long bone on the outside of the foot that connects to the little toe. Two types of fractures that often occur in the fifth metatarsal are:

  • Avulsion fracture. In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This type of fracture is the result of an injury in which the ankle rolls. Avulsion fractures are often overlooked when they occur with an ankle sprain.
  • Jones fracture. Jones fractures occur in a small area of the fifth metatarsal that receives less blood and is therefore more prone to difficulties in healing. A Jones fracture can be either a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress, or trauma. They are less common and more difficult to treat than avulsion fractures.

Other types of fractures can occur in the fifth metatarsal. Examples include mid-shaft fractures, which usually result from trauma or twisting, and fractures of the metatarsal head and neck.

Symptoms
Avulsion and Jones fractures have the same signs and symptoms. These include:

  • Pain, swelling, and tenderness on the outside of the foot
  • Difficulty walking
  • Bruising may occur

Diagnosis
Anyone who has symptoms of a fifth metatarsal fracture should see a foot and ankle surgeon as soon as possible for proper diagnosis and treatment. To arrive at a diagnosis, the surgeon will ask how the injury occurred or when the pain started. The foot will be examined, with the doctor gently pressing on different areas of the foot to determine where there is pain.

The surgeon will also order x-rays. Because a Jones fracture sometimes does not show up on initial x-rays, additional imaging studies may be needed.

Non-surgical Treatment
Until you are able to see a foot and ankle surgeon, the “R.I.C.E.” method of care should be performed:

  • Rest: Stay off the injured foot. Walking may cause further injury.
  • Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • Compression: An elastic wrap should be used to control swelling.
  • Elevation: The foot should be raised slightly above the level of your heart to reduce swelling.

The foot and ankle surgeon may use one of these non-surgical options for treatment of a fifth metatarsal fracture:

  • Immobilization. Depending on the severity of the injury, the foot is kept immobile with a cast, cast boot, or stiff-soled shoe. Crutches may also be needed to avoid placing weight on the injured foot.
  • Bone stimulation. A pain-free external device is used to speed the healing of some fractures. Bone stimulation, most commonly used for Jones fractures, may be used as part of the treatment or following an inadequate response to immobilization.

When is Surgery Needed?
If the injury involves a displaced bone, multiple breaks, or has failed to adequately heal, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.


Lisfranc Injuries

The Lisfranc Joint
The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. This is important for maintaining proper alignment and strength of the joint.

How Do Lisfranc Injuries Occur?
Injuries to the Lisfranc joint most commonly occur in automobile accident victims, military personnel, runners, horseback riders, football players and participants of other contact sports, or something as simple as missing a step on a staircase.

Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot.

Types of Lisfranc Injuries
There are three types of Lisfranc injuries, which sometimes occur together:

  • Sprains. The Lisfranc ligament and other ligaments on the bottom of the midfoot are stronger than those on the top of the midfoot. Therefore, when they are weakened through a sprain (a stretching of the ligament), patients experience instability of the joint in the middle of the foot.
  • Fractures. A break in a bone in the Lisfranc joint can be either an avulsion fracture (a small piece of bone is pulled off) or a break through the bone or bones of the midfoot.
  • Dislocations. The bones of the Lisfranc joint may be forced from their normal positions.

Symptoms
The symptoms of a Lisfranc injury may include:

  • Swelling of the foot
  • Pain throughout the midfoot when standing or when pressure is applied
  • Inability to bear weight (in severe injuries)
  • Bruising or blistering on the arch are important signs of a Lisfranc injury. Bruising may also occur on the top of the foot.
  • Abnormal widening of the foot.

Diagnosis
Lisfranc injuries are sometimes mistaken for ankle sprains, making the diagnostic process very important. To arrive at a diagnosis, the foot and ankle surgeon will ask questions about how the injury occurred and will examine the foot to determine the severity of the injury.

X-rays and other imaging studies may be necessary to fully evaluate the extent of the injury. The surgeon may also perform an additional examination while the patient is under anesthesia to further evaluate a fracture or weakening of the joint and surrounding bones.

Non-surgical Treatment
Anyone who has symptoms of a Lisfranc injury should see a foot and ankle surgeon right away. If unable to do so immediately, it is important to stay off the injured foot, keep it elevated (at or slightly above hip level), and apply a bag of ice wrapped in a thin towel to the area every 20 minutes of each waking hour. These steps will help keep the swelling and pain under control. Treatment by the foot and ankle surgeon may include one or more of the following, depending on the type and severity of the Lisfranc injury:

  • Immobilization. Sometimes the foot is placed in a cast to keep it immobile, and crutches are used to avoid putting weight on the injured foot.
  • Oral medications. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Ice and elevation. Swelling is reduced by icing the affected area and keeping the foot elevated, as described above.
  • Physical therapy. After the swelling and pain have subsided, physical therapy may be prescribed.

When is Surgery Needed?
Certain types of Lisfranc injuries require surgery. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient. Some injuries of this type may require emergency surgery.

Complications of Lisfranc Injuries
Complications can and often do arise following Lisfranc injuries. A possible early complication following the injury is compartment syndrome, in which pressure builds up within the tissues of the foot, requiring immediate surgery to prevent tissue damage. A build-up of pressure could damage the nerves, blood vessels, and muscles in the foot.

Arthritis and problems with foot alignment are very likely to develop. In most cases, arthritis develops several months or longer following a Lisfranc injury, requiring additional treatment.


Malignant Melanoma of the Foot

What is Malignant Melanoma?
Melanoma is a cancer that begins in the cells of the skin that produce pigmentation (coloration). It is also called malignant melanoma because it spreads to other areas of the body as it grows beneath the surface of the skin. Unlike many other types of cancer, melanoma strikes people of all age groups, even the young.

Melanoma in the Foot
Melanoma that occurs in the foot or ankle often goes unnoticed during its earliest stage, when it would be more easily treated. By the time melanoma of the foot or ankle is diagnosed, it frequently has progressed to an advanced stage, accounting for a higher mortality rate. This makes it extremely important to follow prevention and early detection measures involving the feet as well as other parts of the body.

Causes
Most cases of melanoma are caused by too much exposure to ultraviolet (UV) rays from the sun or tanning beds. This exposure can include intense UV radiation obtained during short periods, or lower amounts of radiation obtained over longer periods.

Anyone can get melanoma, but some factors put a person at greater risk for developing this type of cancer. These include:

  • Fair skin; skin that freckles; blond or red hair
  • Blistering sunburns before the age of 18
  • Numerous moles, especially if they appeared at a young age

What Should You Look For?
Melanoma can occur anywhere on the skin, even in areas of the body not exposed to the sun. Melanoma usually looks like a spot on the skin that is predominantly brown, black, or blue—although in some cases it can be mostly red or even white. However, not all areas of discoloration on the skin are melanoma.

There are four signs—known as the ABCDs of melanoma—to look for when self-inspecting moles and other spots on the body:

Asymmetry — Melanoma is usually asymmetric, which means one half is different in shape from the other half.

Border — Border irregularity often indicates melanoma. The border—or edge—is typically ragged, notched, or blurred.

Color — Melanoma is typically a mix of colors or hues, rather than a single, solid color.

Diameter — Melanoma grows in diameter, whereas moles remain small. A spot that is larger than 5 millimeters (the size of a pencil eraser) is cause for concern.

If any of these signs are present on the foot, it is important to see a foot and ankle surgeon right away. It is also essential to see a surgeon if there is discoloration of any size underneath a toenail (unless the discoloration was caused by trauma, such as stubbing a toe or having something fall on it).

Diagnosis
To diagnose melanoma, the foot and ankle surgeon will ask the patient a few questions. For example: Is the spot old or new? Have you noticed any changes in size or color? If so, how rapidly has this change occurred?

The surgeon will also examine the spot to determine whether a biopsy is necessary. If a biopsy is performed and it reveals melanoma, the surgeon will discuss a treatment plan.

Prevention and Early Detection

Everyone should practice strategies that can help prevent melanoma—or at least aid in early detection, so that early treatment can be undertaken.

Precautions to avoid getting melanoma of the foot and ankle, as well as general precautions, include:

  • Wear water shoes or shoes and socks—flip flops do not provide protection!

  • Use adequate sunscreen in areas that are unprotected by clothing or shoes. Be sure to apply sunscreen on the soles as well as the tops of feet.

  • Inspect all areas of the feet daily—including the soles, underneath toenails, and between the toes.

  • If you wear nail polish, remove it occasionally so that you can inspect the skin underneath the toenails. Avoid UV radiation during the sun’s peak hours (10 a.m. to 4 p.m.), beginning at birth. While sun exposure is harmful at any age, it is especially damaging to children and adolescents.

  • Wear sunglasses that block 100% of all UV rays—both UVA and UVB.

  • Wear a wide-brimmed hat.

Remember: Early detection is crucial with malignant melanoma. If you see any of the ABCD signs—or if you have discoloration beneath a toenail that is unrelated to trauma—be sure to visit a foot and ankle surgeon as soon as possible.


Plantar Wart (Verruca Plantaris)

What is a Plantar Wart?
A wart is a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, and the elderly.

There are two types of plantar warts:

  • A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional “satellite” warts.
  • Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.

Causes
Plantar warts are caused by direct contact with the human papilloma virus (HPV). This is the same virus that causes warts on other areas of the body.

Symptoms
The symptoms of a plantar wart may include:

  • Thickened skin. Often a plantar wart resembles a callus because of its tough, thick tissue.
  • Pain. Walking and standing may be painful. Squeezing the sides of the wart may also cause pain.
  • Tiny black dots. These often appear on the surface of the wart. The dots are actually dried blood contained in the capillaries (tiny blood vessels).

Plantar warts grow deep into the skin. Usually this growth occurs slowly, with the wart starting small and becoming larger over time.

Diagnosis and Treatment
To diagnose a plantar wart, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a wart.

Although plantar warts may eventually clear up on their own, most patients desire faster relief. The goal of treatment is to completely remove the wart.

The foot and ankle surgeon may use topical or oral treatments, laser therapy, cryotherapy (freezing), acid treatments, or surgery to remove the wart.

Regardless of the treatment approaches undertaken, it is important that the patient follow the surgeon’s instructions, including all home care and medication that has been prescribed, as well as follow-up visits with the surgeon. Warts may return, requiring further treatment.

If there is no response to treatment, further diagnostic evaluation may be necessary. In such cases, the surgeon can perform a biopsy to rule out other potential causes for the growth.

Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove warts themselves. This can do more harm than good.


Rheumatoid Arthritis in the Foot and Ankle

What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints.

RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability.

When joints become inflamed due to RA, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, causes swelling and damage to the joint’s cartilage and bones.

Symptoms Affecting the Foot and Ankle
Foot problems caused by RA commonly occur in the forefoot (the ball of the foot, near the toes), although RA can also affect other areas of the foot and ankle. The most common signs and symptoms of RA-related foot problems, in addition to the abnormal appearance of deformities, are pain, swelling, joint stiffness, and difficulty walking.

Deformities and conditions associated with RA may include:

  • Rheumatoid nodules (lumps), which cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking
  • Dislocated toe joints
  • Hammertoes
  • Bunions
  • Heel pain
  • Achilles tendon pain
  • Flatfoot
  • Ankle pain

Diagnosis
RA is diagnosed on the basis of a clinical examination as well as blood tests.

To further evaluate the patient’s foot and ankle problems, the surgeon may order x-rays and/or other imaging tests.

Treatment by the Foot and Ankle Surgeon
While treatment of RA focuses on the medication prescribed by a patient’s primary doctor or rheumatologist, the foot and ankle surgeon will develop a treatment plan aimed at relieving the pain of RA-related foot problems. The plan may include one or more of the following options:

  • Orthotic devices. The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking, and give needed support to improve the foot’s mechanics.
  • Accommodative shoes. These are used to relieve pressure and pain and assist with walking.
  • Aspiration of fluid. When inflammation flares up in a joint, the surgeon may aspirate (draw out) fluid to reduce the swelling and pain.
  • Steroid injections. Injections of anti-inflammatory medication may be applied directly to an inflamed joint or to a rheumatoid nodule.

When is Surgery Needed?
When RA produces pain and deformity in the foot that is not relieved through other treatments, surgery may be required. The foot and ankle surgeon will select the procedure best suited to the patient’s condition and lifestyle.


Sesamoid Injuries in the Foot

What is a Sesamoid?
A sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint.

Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe “pushes off” during walking and running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.

Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. They are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequent wearing of high-heeled shoes can also be a contributing factor.

Types of Sesamoid Injuries in the Foot
There are three types of sesamoid injuries in the foot:

  • Turf toe. This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Turf toe may result in an injury to the soft tissue attached to the sesamoid or a fracture of the sesamoid. Sometimes a “pop” is felt at the moment of injury.
  • Fracture. A fracture (break) in a sesamoid bone can be either acute or chronic.
    • An acute fracture is caused by trauma – a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint.
    • A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest.
  • Sesamoiditis. This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure to the sesamoids. Often, sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.

Diagnosis
In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient’s walking and evaluate the wear pattern on the patient’s shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.

Non-Surgical Treatment
Non-surgical treatment for sesamoid injuries of the foot may include one or more of the following options, depending on the type of injury and degree of severity:

  • Padding, strapping, or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension.
  • Immobilization. The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot.
  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the pain and inflammation.
  • Physical therapy. The rehabilitation period following immobilization sometimes includes physical therapy, such as exercises (range-of-motion, strengthening, and conditioning) and ultrasound therapy.
  • Steroid injections. In some cases, cortisone is injected in the joint to reduce pain and inflammation.
  • Orthotic devices. Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot.

When is Surgery Needed?
When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.


Tarsal Coalition

What is a Tarsal Coalition?
A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage, or fibrous tissue, may lead to limited motion and pain in one or both feet.

The tarsal bones include the calcaneus (heel bone), talus, navicular, cuboid, and cuneiform bones. These bones work together to provide the motion necessary for normal foot function.

Causes
Most often, tarsal coalition occurs during fetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or a previous injury to the area.

Symptoms
While many people who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature, usually around ages 9 to16. Sometimes there are no symptoms during childhood. However, pain and symptoms may develop later in life.

The symptoms of tarsal coalition may include one or more of the following:

  • Pain (mild to severe) when walking or standing
  • Tired or fatigued legs
  • Muscle spasms in the leg, causing the foot to turn outward when walking
  • Flatfoot (in one or both feet)
  • Walking with a limp
  • Stiffness of the foot and ankle

Diagnosis
A tarsal coalition is difficult to identify until a child’s bones begin to mature. It is sometimes not discovered until adulthood. Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot and ankle. The findings of this examination will differ according to the severity and location of the coalition.

In addition to examining the foot, the surgeon will order x-rays. Advanced imaging studies may also be required to fully evaluate the condition.

Non-surgical Treatment
The goal of non-surgical treatment of tarsal coalition is to relieve the symptoms and reduce the motion at the affected joint. One or more of the following options may be used, depending on the severity of the condition and the response to treatment:

  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
  • Physical therapy. Physical therapy may include massage, range-of-motion exercises, and ultrasound therapy.
  • Steroid injections. An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary.
  • Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.
  • Immobilization. Sometimes the foot is immobilized to give the affected area a rest. The foot is placed in a cast or cast boot, and crutches are used to avoid placing weight on the foot.
  • Injection of an anesthetic agent. Injection of an anesthetic into the leg may be used to relax spasms and is often performed prior to immobilization.

When is Surgery Needed?
If the patient’s symptoms are not adequately relieved with nonsurgical treatment, surgery is an option. The foot and ankle surgeon will determine the best surgical approach based the patient’s age, condition, arthritic changes, and activity level.