Top 100 Podiatry Blog


With the explosion in participation in youth soccer in recent decades, becoming more familiar with soccer shoes will help podiatric physicians advise patients on preventing lower extremity injuries. This author provides a guide to soccer shoe anatomy, field conditions and fitting shoes.

Soccer is the fastest growing youth sport in America. According to the United States Youth Soccer Association, annual registration of youth soccer players is on the rise.1 The latest 2014 data showed an almost 90 percent increase in the number of players since 1990.
According to the U.S. Youth Soccer Association statistics, the gender breakdown for membership is 52 percent boys and 48 percent girls.2 The median player age is 11.5 years.

With an increase in the number of youth soccer players comes an increase in the number of injuries. A recent Pediatrics study reviewed almost 3 million emergency room visits for soccer-related injuries, between 1990 to 2014.3 This study found that the annual injury rate for young soccer players jumped by 111 percent during that 24-year period.

In youth soccer, the existing literature shows a high proportion of lower extremity injuries, which predominately affect the ankle, knee and thigh.3-5 With regard to musculoskeletal injuries, adolescent females tend to suffer more knee injuries and adolescent males suffer more ankle injuries.6

Based on this high incidence of lower extremity injuries, it is important that podiatrists familiarize themselves with the design, fit and function of adolescent soccer shoes. Doing so will enable us to make appropriate recommendations in order to reduce lower extremity injuries in this sport.

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A 6-year-old male who likes to play sports presents with painful great toenails that have been present in the current condition since birth. They are painful in various shoes. His mother has taken him to other physicians who stated that the condition is not caused by nail fungus but they have offered no other solution. The patient has no pertinent past medical or birth history, no medications and no history of this on any other digit.
Upon examination, his bilateral hallux toenails are discolored, thickened, rough in appearance and deviated laterally. No lesions are present on the other toenails or fingernails.

Key Questions To Consider

  1. What are the main characteristics of this condition?

  2. What is the most likely diagnosis?

  3. What is your differential diagnosis?

  4. What is the characteristic nail deformity in this condition?

  5. What is the treatment?


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Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear, or being overweight. Heel pain is also common among children ages 8–13 due to a rise in sports activity between these ages.

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The foot plays a unique role in downhill skiing. Subsequently, several of the pa- technologies that are experienced commonly by skiers are unique to the sport of skiing. The question then arises, whom should the skier consult when experiencing foot pain while skiing?

Many of the pathologies suffered by skiers are simply secondary to poor-fitting boots or lack of support inside the boot. Many of these skiers can benefit greatly by working with an experienced and skilled boot fitter in a ski shop. In fact, most of the problems suffered by skiers can likely best be taken care of by a boot fitter.

There are, however, several conditions commonly experienced by skiers that, in most cases, are best treated by a medical professional who can better diagnose a specific pathology and offer a comprehensive plan of treatment for that pathology.

An example of a common condition that is experienced by skiers and may be best treated by a medical professional (although often in concert with a boot fitter) is Morton’s neuroma.

A boot fitter may be able to adjust a boot to reduce medial-lateral compression of the foot inside the boot and produce a footbed that will help transfer pressure off the ball of the foot.

A podiatrist, however, can also provide direct treatment of the neuroma—through injections, for example—along with, in many cases, being able to produce an in-boot orthosis that is more effective at transferring pressure off the metatarsal head region.

Pes Planus
Another condition commonly experienced by skiers, and the one on which this article focuses, is arch pain experienced by the skier with pes planus.

Plantar Intrinsic Stress Syndrome
The most common condition treated in downhill skiers by the author is a complaint of a deep, searing arch pain, often described as a deep ache that happens only when skiing. Invariably, the patients who present with this complaint have a pes planus foot type.

They describe a pain that often starts immediately upon starting to ski, but will worsen with more intense effort such as when skiing steeper slopes or more challenging terrain such as moguls. Usually, the pain is mid-arch and plantar-medial. Much like a compartment syndrome, the symptoms abate when the activity is stopped. It is rare that patients can recreate these symptoms when doing any other activity.

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Trust me, you aren’t the only one! It is one of the most common problems I see. The best way to combat this problem is to attack it with full soon as possible.
Heel pain can have many different causes. The patients that generally suffer most from this condition are the ones on their feet a lot. Continuous standing; walking on a daily basis; starting a repetitive activity, such as a new exercise routine, without proper shoes, can put a lot of stress and strain on the ligaments in the foot. It eventually results in inflammation and pain.
The good news is, heel pain is treatable. If treatment is sought early, all but a small percentage of affected patients will experience relief with conservative therapies. These include: limiting activities, footwear modifications, and stretching exercises. Procrastination can cause the pain to become not only chronic, but debilitating as well.

Major causes of heel pain and their treatment. While there can be many reasons for heel pain, generally it is categorized into four major causes: plantar fasciitis, Achilles tendonitis, bursitis and nerve pain. Diagnosing the specific issue depends on the exact location of the pain and how the pain affects the mechanical movement of the leg.

Plantar fasciitis — This is the most common cause of heel pain. It’s an inflammation of the band of tissue (the plantar fascia), that extends from the heel, to the metatarsal heads.
When patients suffer from this ailment, the fascia becomes irritated and then inflamed, resulting in heel pain or pain in the arch of the foot. Plantar fascia pain is a tell-tale sign that there are mechanical issues going on in how the foot works.
We typically treat plantar fasciitis first with non-surgical strategies, such as stretching exercises; rest; footwear modifications; orthotic devices; night splints and injection therapy. While most patients respond well to conservative treatments, some require surgery to correct the problem.
The injection therapy is something that would have to be administered by your GP, as it is not something that falls within my scope of practice.

Achilles tendonitis — Also known as inflammation of the Achilles tendon, can also be a cause of heel pain. We often see this “overuse” condition in athletic patients who play high-impact sports, like basketball or tennis.
They often have a sudden increase of repetitive activity involving the Achilles tendon, which puts too much stress on the tendon too quickly, leading to micro injuries.
To treat this condition, you can immobilize the foot with a walking boot or cast, along with physical therapy application, orthotics, and ice to help repair the tendon. If the tendon is severely damaged, or if nonsurgical treatments don’t work, surgery may be necessary.

Bursitis — Another cause of heel pain commonly seen, is where the “fat pad” of the heel exhibits redness and swelling from inflammation of the small fluid-filled sac inside the heel, called the bursa. The bursa, which protects the heel from friction, can become inflamed from repetitive motion or irritation from shoes.
In the case of bursitis, the heel and the toes are most often affected. Treatment may include resting the foot, ice, anti-inflammatory drug therapy, padding, and corticosteroid injections to reduce the inflammation and relieve pain. Surgery may be necessary if conservative methods do not provide relief.

Nerve pain — Is a somewhat less common cause of heel pain. When the nerves are involved, it feels more like a burning or electrical pain, shooting or radiating down the foot from the heel, typically towards the toes. A patient will often tell me their heel “burns.” There are medications that may help with nerve pain, but in this instance, the patient tends to need nerve decompression surgery, a procedure to help “untrap” the nerve.
These patients tend to have several misdiagnoses, before they visit with a specialist to correctly remedy their pain.
Whatever your heel pain, I always encourage people to see a podiatrist or orthopaedic surgeon for a proper diagnosis. We specialise in the lower limbs, and our training helps us to effectively get to the bottom of what is ailing our patients. When conservative therapies do not provide relief after several months, steroidal injections are the next step. If still no relief, surgery may be considered.

Your feet mirror your general health . . . cherish them!

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Image: © ogiana/Thinkstock

Your big toe deserves some sympathy. Its position and length set it up for stubbing and other injuries. Shoes press in on the toe from the side and down on it from the top. Moreover, the toe also bears much of the body's weight with each step. And the result of the constant wear and tear is often a bunion. The medical name for bunion, hallux (big toe) valgus (turned away from the midline), provides a pretty good description of the way this problem creates a bump at the side of the foot.

How bunions develop

Dr. James P. Ioli, chief of the podiatry service at Harvard-affiliated Brigham and Women's Hospital, cites several reasons some women develop bunions, including the following.

Improper footwear. Women are 10 times more likely than men to develop bunions, and our choice of shoes — particularly those that are too narrow across the base of the toes — can make them worse. Pointed-toe shoes (which force the big toe inward) and high heels (which put more pressure on the toes) are major culprits.

Genetics. Bunions run in families, because foot shape and structure are hereditary, and some types are more prone to bunions than others. Low arches, flat feet, and loose joints and tendons all increase the risk. The shape of the metatarsal head — the top of the first bone in the foot at the joint with the big toe — also makes a difference: if it's too round, the joint is less stable and more likely to deform when squeezed into shoes with narrow toes.

Occupations. People whose jobs involve a lot of standing and walking — such as serving in restaurants, teaching, and nursing — are susceptible to bunions. So are ballet dancers, whose feet suffer severe repetitive stress.

Arthritis. Bunions are also associated with arthritis, which damages the cartilage within the joint.

Pregnancy. Women can develop bunions and other foot problems during pregnancy because hormonal changes loosen the ligaments and flatten the feet.

Uneven legs. About 85% of people have legs of different lengths because of genetics, scoliosis, fractures, or other injuries. Occasionally, the discrepancy results in an uneven gait and a bunion on the foot of the longer leg.

What you can do about bunions

Painful bunions interfere with walking and exercising. The following can prevent them from getting worse.

Take stock of your shoes. Shoes should have a wide, flexible sole to support the foot and enough room in the toe box to accommodate the bunion and a sturdy back to keep the heel of your foot snugly in place. You may need to have some of your shoes stretched to make room in the toe box for the bunion. Stay away from heels higher than an inch.

Add some padding. You can protect bunions with moleskin or gel-filled pads, available at drugstores. If you have a single bunion because your legs are different lengths, wearing a lift in the other shoe may relieve pressure on the bunion.

Soothe the sore joint. Ice packs and nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen (Advil, Motrin), may relieve pain.

See a podiatrist. These health professionals can evaluate your bunion and provide additional solutions, including custom-fitted shoe inserts to stabilize your foot, cortisone injections to relieve pain and inflammation, ultrasound therapy, and surgery to realign the joint. "The goal of surgery is to improve joint function," Dr. Ioli says. "We can't make the foot or bunion area perfect, but we can make it better."

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In my sports medicine practice, the majority of injuries come from runners and triathletes. However CrossFit workouts are presenting with injuries to the Foot, Ankle and Leg at an alarming rate.

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Research has established that strenuous exercise, such as marathon running, activates clot formation by increasing markers of coagulation. In response, clot breakdown activates in coordination with the coagulatory system following exercise. This phenomenon where in healthy athletes, post exercise clot breakdown is approximately equal to clot formation, is termed homeostatic activation.

While exercise induced homeostatic activation is not harmful for most individuals, marathon running and other strenuous exercise may disproportionately activate the coagulatory system, increasing the risk for venous thrombosis (VTE) and contributing to reports of Deep Venous Thrombosis (DVT), Pulmonary Embolism (PE) or both. This is of increasing concern...

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Foot Pain affects the whole body

We make feet feel better so your whole body feels good too.

At Wolf Podiatry, we care about the whole person, not just your feet. That being said, feet get taken for granted. We make sure they don’t by making you more aware of just important your feet are for your overall health. Feet are important because they support the entire body. When you have foot pain it affects your whole body.

Your feet may be the first symptom of other health issues. That’s why we take a whole-person approach when we meet with you. A diabetic is going to have different concerns and issues than an athlete or child. Each may have foot pain, but for different reasons. That’s why it’s important for us to con...

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Phone. 760-230-9031