Foot and Ankle Conditions

A fracture is a partial or complete break of a bone. Fractures in the ankle can range from the less-serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula or both.

Ankle fractures are common injuries most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and, therefore, require an accurate and early diagnosis. They sometimes occur simultaneously.

Ankle pain is often due to an ankle sprain, but can also be caused by ankle instability, arthritis, gout, tendonitis, fracture, nerve compression (tarsal tunnel syndrome), infection or poor structural alignment of the leg or foot. Ankle pain can be associated with swelling, stiffness, redness and warmth in the area. The pain is often described as an intense, dull ache that occurs during weight-bearing activities and ankle motion.

Initial treatment may consist of rest, ice, elevation and immobilization, but may also include nonsteroidal, anti-inflammatory drugs (NSAIDs), such as ibuprofen, and physical therapy and cortisone injection.

For more information on ankle pain, see these foot and ankle conditions:
• Achilles tendonitis
• Ankle fracture
• Ankle sprain
• Gout
• Osteoarthritis
• Tarsal tunnel syndrome (nerve compression)

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue—like rubber bands—that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

A sprained ankle is often caused by rolling the ankle during sports, hiking or other physical activity.

Pain across the bottom of the foot at any point between the heel and the ball of the foot is often referred to as “arch pain.” Although this description is nonspecific, most arch pain is due to strain or inflammation of the plantar fascia (a long ligament on the bottom of the foot). This condition is known as “plantar fasciitis” and is sometimes associated with a heel spur.

In most cases, arch pain develops from overuse, unsupportive shoes, weight gain or acute injury. If arch pain persists beyond a few days, call AFAS for an appointment. A foot-and-ankle surgeon can diagnose the cause of your pain and provide treatment to prevent this condition from becoming worse.

If it is plantar fasciitis, you are probably a good candidate for shockwave therapy. We are the only provider in Alaska offering this high-tech, non-surgical treatment that has proven to be very effective. It’s also fast and surprisingly affordable.

Athlete’s foot is a skin infection caused by fungus. A fungal infection may occur on any part of the body; on the foot, it is called “athlete’s foot.” The medical term for it is “tinea pedis.” Fungus commonly attacks the foot because it thrives in a dark, moist, warm environment, such as a shoe.

Fungal infections are more common in warm weather, when feet tend to sweat more. Fungus thrives in damp areas, such as swimming pools, showers and locker rooms. Athletes often have sweaty feet and use the facilities where fungus is commonly found, thus the term “athlete’s foot.”

Athlete’s foot usually produces itchy, dry, scaling skin. It is commonly seen on the soles of the feet and between the toes. In advanced cases, inflammation, cracks and blisters may form; an infection caused by bacteria can also result. The fungus can spread to other areas of the body, including toenails and groin.

You can limit your chances of getting athlete’s foot by avoiding walking barefoot combined with good foot hygiene. Feet should be washed every day with soap and water and thoroughly dried, including between the toes. Feet should be kept as dry as possible. If your feet sweat a lot, you may need to change your socks during the day.

Osteomyelitis (an infection of the bone) can be caused by a variety of microbial agents (bacteria, fungus), the most common of which is staphylococcus aureus.

This serious infection can occur from a number of sources:
• It may enter bone through an injury, such as an open fracture with the bone ends piercing the skin.
• It can spread from elsewhere in the body or through the bloodstream.
• It can result from a chronic foot wound or infection, such as a diabetic ulcer.

​To diagnose the condition, your AFAS doctor will examine the area and may order blood tests and X-rays or other imaging studies. Treatment options include surgery, antibiotic therapy and hyperbaric oxygen therapy.

Again, this is a serious infection. Some of the possible symptoms are:
• fever
• fatigue
• nausea
• tenderness, redness or swelling in the affected area
• loss of range of motion

Bone tumors are caused by an abnormal growth of cells. They may be benign (noncancerous) or malignant (cancerous). Although rare, bone tumors can occur in the foot and ankle. They can be primary (originating in the bone) or secondary (originating in another part of the body).

Symptoms of a bone tumor may include:
• Fracture from slight injury
• Bone pain, often at night
• Occasionally a mass or swelling in the area

A bone tumor is first diagnosed with X-rays. Advanced imaging modalities may be used to further evaluate the tumor. Surgical removal by a foot-and-ankle surgeon may be required for a definitive diagnosis.

A bunion is typically a progressive deformity of the great toe joint causing a large prominence of bone (bunion) on the side of the joint and deviation of the great toe towards the lesser toes – in other words, the bunion is pushing your big toe towards your smaller toes.

Bunion pain is associated with rubbing of the bump in shoes and/or motion of the joint. Soreness may be found under the ball of the foot in the presence or absence of a callus. Occasionally, redness or even a wound can form over the boney prominence. Drifting of the great toe into the lesser toes can contribute to hammertoes and poor alignment of the joint. With longstanding bunion, arthritis can develop and be seen on X-ray as wearing away of the joint. This arthritic process is what causes bunion pain with motion of the great toe.

Although certain poorly fitted shoes may contribute to symptoms and progression of bunion deformity, there is little evidence that shoes in and of themselves cause bunions. There are many examples of indigenous people who have never worn shoes yet experience very severe bunions. Bunions are typically an inherited, family trait that may progress.

Bursitis is an inflammation of a small, fluid-filled sac, called a “bursa,” located near a joint, bone or tendon. The bursa, which protects the area from friction, can become inflamed from repetitive motion or irritation from shoes. In the foot, the heel and toes are most often affected.

Symptoms of bursitis include:
• localized redness
• swelling
• pain

Treatment may include resting the affected area, local ice therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, padding or corticosteroid injections to help reduce inflammation and relieve pain.

Calf pain can result from many different causes. Sometimes something as simple as over-activity causes strain in the calf muscle, or dietary imbalances may cause cramping in the calf.

However, calf pain may be a symptom of more serious problems, as well. Poor blood flow to the legs (peripheral vascular disease) may cause cramping in the calf when walking or sitting with the legs elevated. A blood clot in the calf (deep vein thrombosis) is a very serious problem and also produces pain in the calf.

Calf pain can also be the result of injuries, such as tearing of the calf muscle or tendonitis. In any case, it is not something that should be ignored. A foot-and-ankle surgeon should be seen for a thorough examination and diagnosis to determine whether the cause is due to a serious health problem, an injury or merely overuse.

A callus is a thickened area of skin on the foot caused by pressure and repeated rubbing, such as from a shoe or sock. The rubbing causes the skin to produce a layer of protective skin (a callus). Calluses vary in size and can become painful.

There are a number of treatments for painful calluses. People who have calluses are cautioned against performing “bathroom surgery,” as this can lead to cuts and infection. A foot-and-ankle surgeon can evaluate the cause of the calluses and recommend the treatment most appropriate for your condition. However, if the underlying cause of the callus is not treated or removed, the callus may return.

Ligaments surrounding the joint at the base of the second toe form a capsule, which helps the joint function properly. Capsulitis is a condition in which these ligaments have become inflamed. Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis—also referred to as “predislocation syndrome”—is a common condition that can occur at any age.

It’s best to treat capsulitis before your toes are pushed out of alignment. But we can also treat advanced-stage capsulitis.

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 include 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.

Charcot foot is a condition that causes weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture and, with continued walking, the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.

Charcot foot is a serious condition that can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that patients living with diabetes—a disease often associated with neuropathy—take preventive measures and seek immediate care if signs or symptoms appear.

Chronic ankle instability is a condition characterized by a recurring giving way of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually, the giving way occurs while walking or doing other activities, but it can also happen when standing. Many athletes, as well as others, suffer from chronic ankle instability.

People with chronic ankle instability often complain of:
• A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
• Persistent (chronic) discomfort and swelling
• Pain or tenderness
• The ankle feeling wobbly or unstable

Clubfoot (congenital talipes equinovarus) is a deformity that is present at birth in about one of every 1,000 children. It occurs in males more often than females and can affect one or both feet.

The feet of an infant with clubfoot point down and inward. It is not painful, but it must be corrected to avoid a lifetime of disability.

Parents can be assured that, in most cases, clubfoot can be effectively treated if it is undertaken as early as possible. Casting of the legs and feet is usually successful, but in some cases, surgery may be required.

Custom orthotics are medical devices prescribed by a foot-and-ankle doctor. These shoe inserts, which support and align the foot and lower extremities, are formed by making a plaster mold of the foot.

Additional valuable information:
• Flat feet
• Heel pain

The blood supply of the leg is transported by arteries and veins. The arteries carry blood from the heart to the limbs; veins carry blood back to the heart. The leg contains superficial veins, which are close to the surface, and deep veins, which lie much deeper in the leg. Deep vein thrombosis (DVT) is a condition in which a blood clot (a blockage) forms in a deep vein. While these clots most commonly occur in the veins of the leg (the calf or thigh), they can also develop in other parts of the body.

DVT can be very dangerous and is considered a medical emergency. If the clot (also known as a thrombus) breaks loose and travels through the bloodstream, it can lodge in the lung. This blockage in the lung, called a “pulmonary embolism,” can make it difficult to breathe and may even cause death. Blood clots in the thigh are more likely to cause a pulmonary embolism than those in the calf.

Some of the common symptoms of deep vein thrombosis are:
• Swelling in one leg
• Pain in one leg

Diabetes often leads to peripheral neuropathy, a condition in which nerve function deteriorates in the body’s extremities, causing gradual loss of feeling in the legs and feet.

You may experience numbness, tingling in the extremities, shooting pains, or a burning sensation. An inability to sense pain in the affected areas is very problematic because without it, patients often do not seek treatment for cuts, bruises, burns, or blisters that heal poorly and will result in minor skin problems or worst, become infected.

“Fallen arches” is a term commonly used to describe a flatfoot condition that develops during adulthood. This should not be confused with other causes of flatfoot that may develop during childhood or adolescence.

Most cases of fallen arches develop when the main arch-supporting tendon (the posterior tibial tendon) becomes weakened or injured, causing the arch to gradually become lower. With time, the shape of the foot changes and secondary symptoms start to appear.

Common problems associated with fallen arches include:
• Plantar fasciitis
• Tendonitis
• Increased fatigue
• Arthritis of the foot and ankle.

Flat feet, or fallen arches, is a condition in which little or no arch is formed at the bottom of the foot, thus causing the feet to rest flat on the ground. Flat feet can be an inherited condition or an acquired condition that develops over time.

A flat foot (or feet) can limit activities for some people, while others experience no difficulties. If left untreated, a flat foot can lead to excessive pronation of the feet, which can cause bunions, heel pain, hammertoes, shin splints, knee, and hip and back pain.

Frostbite occurs when a body part is exposed to extreme cold. If conditions are cold enough for the water within the tissues to freeze and form ice crystals, cell death can occur. The feet, hands, ears and nose are particularly prone to frostbite due to their location away from the body’s core.

Mild exposure to cold typically produces pain and irritation of the skin. Greater exposure may produce burning and numbness as well as blistering and reversible damage to the outer skin layers. Eventually, there will be complete loss of sensation and permanent damage to all layers of the skin, arteries, muscles and tendons.

Frostbite can be prevented by limiting exposure and keeping the feet as warm and dry as possible. If, however, frostbite is suspected, the feet should be rapidly rewarmed by immersion in warm water (approximately 100 degrees Farenheit). Avoid vigorous rubbing/massaging and dry heat (such as from a hair dryer), as burns may result if numbness is present.

To avoid infection, blisters or damaged skin should be treated with antibiotic cream and loose bandages, and medical attention should be sought as soon as possible.

Gangrene occurs when there is a lack of blood supply to tissue, depriving it of oxygen, thereby causing death and decay of the tissue. The two types of gangrene are wet (caused by bacterial infection) and dry (no infection). The most common causes of gangrene are diabetes, arteriosclerosis, tobacco abuse, burns and frostbite.

Treatment for gangrene includes surgical removal of the dead tissue and use of antibiotics when infection is present.

Looking for more information?
• Peripheral Arterial Disease
• Diabetes

Hammertoe conditions occur when a normal foot becomes flat and the flexor muscles overpower the smaller muscles, causing the outer two joints of the toe to bend downward. In this unnatural position, the inside of the shoe rubs against the bent toe joints, gradually causing calluses to form on the tops of the toes.

Early treatment is important when hammertoe first begins to develop so toes don’t become rigid.

Heel pain can occur with excessive exercise, occupations that require you to spend a lot of time on your feet, inadequate warm-up before physical activity or poorly fitted shoes.

Also see Plantar fasciitis

An ingrown toenail occurs when the skin on the side of a toenail grows over the edge of the nail, or when the nail grows into the skin.

Ingrown toenails can develop for many reasons. Here are some examples:
• Toenails that are too large
• Toes that curl from arthritis
• Stubbing a toe or having one stepped on
• Frequent running
• Trimming nails incorrectly
• Excessively tight stockings
• Shoes with narrow toe boxes

Bedridden patients commonly develop ingrown toenails if the bed sheets are tucked-in tightly.

The foot contains 26 bones and more than 30 joints. Many people experience pain involving one or more of these joints. The pain may be accompanied by swelling, tenderness, stiffness, redness, bruising and/or increased warmth over the affected joints.

Joint pain may be caused by trauma, infection, inflammation, arthritis, bursitis, gout or structural foot problems. This type of foot pain is initially treated with rest, elevation and limitation of walking/weight-bearing. Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and ice can help reduce local inflammation and pain.

Custom orthotics may also be prescribed to support the foot and reduce pain. A foot-and-ankle surgeon at AFAS can best determine the cause of joint pain and recommend the appropriate treatment.

Need more information?
• Bunions
• Capsulitis of the Second Toe
• Osteoarthritis of the Foot and Ankle

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. It is important for maintaining proper alignment and strength of the joint.

Injuries to the Lisfranc joint most commonly occur in victims of automobile accidents, military personnel, runners, horseback riders, football players and participants of other contact sports. But it can be caused by 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.

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.

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 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.

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

Morton’s neuroma is an enlarged nerve that usually occurs between the third and fourth toes. The pain can be sharp or dull and is worsened by wearing shoes and walking.

Pain is usually less severe when the foot is not bearing weight. Flat feet can cause the nerve to be pulled, thus causing irritation and possibly enlargement of the nerve. The syndrome is more common in women than men, possibly because women wear more confining shoes and high heels.

Staphylococcus aureus is a type of bacteria that can be spread through the skin or open wound contact and is known to cause serious illness and infection if contracted.

In recent years, certain types of staph bacteria, such as drug-resistant MRSA (methicillin-resistant staphylococcus aureus), have become more common in high-traffic community areas, such as pool decks, locker rooms and schools. Those walking barefoot and suffering from common, relatively minor foot problems, such as cuts, cracks in the skin, athlete’s foot, eczema, ingrown toenails, puncture wounds or corns and calluses, can be at higher risk for infection. These conditions can cause minor tears in the skin, which can act as portals for the bacteria to enter the body.

AFAS foot-and-ankle doctors recommend simple steps to help prevent community-associated MRSA infections:

• Wash and bandage cuts.
• See a doctor within 24 hours for any puncture wound.
• Never perform “bathroom surgeries” to cut or dig out an ingrown toenail.
• Keep feet clean and dry to prevent fungal infections, such as athlete’s foot.

Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage (the connective tissue found at the end of the bones in the joints) protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one’s ability to easily perform daily activities.

Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Some people refer to osteoarthritis simply as arthritis, even though there are many different types of arthritis.

Osteoarthritis appears at various joints throughout the body, including the hands, feet, spine, hips and knees. In the foot, the disease most frequently occurs in the big toe, although it is also often found in the midfoot and ankle.

Osteoporosis, which means “porous bone,” is a condition in which bones become weak and thin due to lack of calcium and/or vitamin D. People with osteoporosis have an increased risk of bone fractures (breaks).

Osteoporosis is often called the “silent disease” because many people do not realize they have it. However, pain can occur when a bone becomes so weak that it breaks.

Osteoporosis is most commonly seen in women over age 50, but younger people and men can also have it. While the bones of the spine, hip and wrist are the most common bones to become fractured as a result of osteoporosis, metatarsals and other bones in the feet can be affected. In fact, some people first find out they have osteoporosis because of a fracture in the foot.

Commonly referred to as “poor circulation,” peripheral arterial disease (PAD) is the restriction of blood flow in the arteries of the leg. When arteries become narrowed by plaque (the accumulation of cholesterol and other materials on the walls of the arteries), the oxygen-rich blood flowing through the arteries cannot reach the legs and feet.

The presence of PAD may be an indication of more widespread arterial disease in the body that can affect the brain, causing stroke, or the heart, causing a heart attack.

Most people have no symptoms during the early stages of PAD. Often, by the time symptoms are noticed, the arteries are already significantly blocked.

Common symptoms of PAD include:

• Leg pain (cramping) that occurs while walking
• Leg pain (cramping) that occurs while lying down
• Leg numbness or weakness
• Cold legs or feet
• Sores that will not heal on toes, feet or legs
• A change in leg color
• Loss of hair on the feet and legs
• Changes in toenail color and thickness

If any of these symptoms are present, it is important to discuss them with a foot and ankle doctor. Left untreated, PAD can lead to debilitating and limb-threatening consequences.

Pigeon toes (intoeing) is a condition in which the feet point inward when walking. It is commonly seen in children and may resolve in very early childhood with no treatment or intervention.

The child should be examined by a foot-and-ankle doctor if the intoeing causes significant tripping, difficulty with normal activity, pain, difficulty with shoes or is not resolved in early childhood.

There may be structural problems causing the intoeing, which require treatment by a foot and ankle surgeon.

Raynaud’s phenomenon is a condition that results in a bluish-white discoloration of fingers and toes, often as a result of exposure to cold. Stress, smoking and certain medications may trigger or worsen symptoms. The color change, which occurs from spasms in small blood vessels, becomes red then returns to normal when blood flow resumes.

The condition most often affects women, with symptoms varying depending on the severity of the condition. Because there are no specific blood tests to diagnose this condition, the diagnosis is based on symptoms.

However, your doctor may order blood tests to determine whether the Raynaud’s phenomenon is associated with certain autoimmune diseases or other medical conditions.

Treatment for Raynaud’s phenomenon is aimed at prevention and protection of the toes and fingers.

Shin splints is a term to describe pain and swelling in the front of the lower legs. It is an inflammation in the shin resulting from the repeated pull of a muscle in the leg from the shin bone (tibia).

Pain usually appears after and is aggravated by repetitive activities, such as running or walking. Contributing causes are flat feet, calf tightness, improper training techniques, worn-out or improper shoes/sneakers as well as running or walking on uneven surfaces.

This condition usually occurs bilaterally (both legs) and can be alleviated by rest, use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, icing, a change in training habits, stretching exercises and properly fitted shoes.

AFAS doctors and nurses can treat the condition, recommend proper shoe gear and evaluate whether orthotics are needed. If not treated, shin splints may eventually result in a stress fracture of the shin bone.

Depending on the sport, your feet and ankles can certainly take a beating from repetitive play. For more information on injury-risk factors while playing your favorite sport, see the topics listed below.

• Baseball
• Basketball
• Field Hockey
• Football Injuries
• Golf Injuries
• Lacrosse
• Rugby
• Running
• Soccer
• Softball
• Tennis
• Volleyball

AFAS doctors and nurses offer a range of treatment options for virtually every sports injury.

Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel—arteries, veins, tendons and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.

Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve:

• A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with fallen arches can produce strain and compression on the nerve.
• An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon or arthritic bone spur.
• An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
• Systemic diseases, such as diabetes or arthritis, can cause swelling, thus compressing the nerve.

Ulcers, which are open sores in the skin, occur when the outer layers of the skin are injured and the deeper tissues become exposed.

Ulcers can be caused by excess pressure due to ill-fitting shoes, long periods in bed or after an injury that breaks the skin. They are commonly seen in patients living with diabetes, neuropathy or vascular disease. Open wounds can put patients at increased risk of developing infection in the skin and bones.

The signs and symptoms of ulcers may include drainage, odor or red, inflamed, thickened tissue. Pain may or may not be present.

Diagnosis may include X-rays to evaluate possible bone involvement. Other advanced imaging studies may also be ordered to evaluate for vascular disease, which may affect a patient’s ability to heal the wound.

Ulcers are treated by removing the unhealthy tissue and performing local wound care to assist in healing. Special shoes or padding may be used to remove excess pressure on the area. If infection is present, antibiotics will be necessary. In severe cases that involve extensive infection or are slow to heal, surgery or other advanced wound-care treatments may be necessary.

Varicose veins are usually due to improperly functioning valves within the veins. The veins typically appear prominent or look raised.

The condition can cause swelling of the legs, ankles and feet. The skin may become discolored due to leakage of blood into the surrounding tissues, and ulcers may form on the skin.

Plantar fasciitis, or heel pain, can occur with excessive exercise, occupations that require you to spend a lot of time on your feet, inadequate warm-up before physical activity or poorly fitted shoes. The two structures primarily associated with heel pain are the plantar fascia (a band of connective tissue along the bottom of the foot that supports the arch) and the flexor digitorum brevis muscle. When these muscles experience prolonged stretching, bone spurs and tears damage are created.

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 they typically appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents and the elderly.

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.

There are two types of plantar warts:

• A solitary wart, which 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.

The symptoms of a plantar wart may include:

• Thickened skin. A plantar wart often 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.

The most common cause of yellow discoloration in the toenails is a fungal infection. The fungus often develops underneath the nail, resulting in it becoming thick, raised and yellow in color.

Other potential causes for yellow discoloration of the nail include diabetes mellitus and lymphedema (chronic leg swelling). Yellow staining of the nails can also occur in individuals who use nail polish. A stained nail may take several months to grow out.