A key to independence is the ability to move about unassisted, but for thousands of older people, foot and ankle problems may prevent pain-free mobility. In fact, the U.S. National Center for Health Statistics reports that lower extremity impairments-like ailments of the feet and ankles-are ranked as the top cause of activity limitation for older adults. Although heredity is to blame for some foot conditions, many foot ailments are the product of a lifetime of over-stressed and neglected feet. But your feet don’t need to hurt, and many of the over 300 different foot ailments may be treated or even prevented.

Make caring for your feet part of your regular routine, and your should enjoy no limits to your activities or exercise. Here are a few simple guidelines that people of all ages will benefit from:

- Wash and dry your feet carefully each day, inspecting them for any changes such as redness, swelling, sores, or cracks.

- As we age, our toenails thicken; if you can’t cut yours straight across by yourself, see a professional for help.

- See a professional for relief from corns and calluses, which are common among older adults.

- Make sure your shoes fit properly, and that you wear the correct shoes and socks for each activity.

- Shop for new shoes in the afternoon or evening, when feet are at their largest.

- Stretch and be active each day to maintain proper circulation.

- As you age, have your foot size checked regularly, since feet spread and may even slightly change in their structure over the years.

- Make an appointment with your podiatric physician at least twice a year.

Some of the more common foot and toe sports injuries include: turf toe, claw foot, stress fractures of the forefoot, metatarsal fracture, tarsal tunnel syndrome, inflammation of the extensor tendons of the toes, bunions, inflammation or rupture of the peroneus brevis tendon, Morton’s syndrome, Lisfranc’s injury, Navicular stress fracture, stress fracture of the talus, plantar fascia strain, blisters, inflammation of the flexor tendons of the toes, and also tibialis posterior tendinopathy.

Each sport has very specific foot and toe injuries that are common to that sport based on the activity level, and type of activity used during play. It is therefore easier to recognize common foot and toe injuries associated with each sport than one may think.

Turf toe occurs when there is vigorous upward bending of the big toe. It is common to happen to players when they play on artificial surfaces. Those who participate in martial arts are also prone to turf toe.

Contact sports like football will have more injuries such as fractures, strains from running and bruising from being hit. Football is a running game so foot and toe injuries are common. Common foot and toe injuries in football are turf toe (injury to the base of the big toe), Achilles Tendonitis (painful tendon at the back of the ankle), and also ankle sprain.

Sports that require quick movement, stops and goes such as tennis also involve foot and toe injuries.

In tennis the most common foot and toe injuries include ankle sprains, Achilles Tendon rupture, blisters on the feet, and plantar fasciitis, which causes pain on the bottom of the heel.

Preventing injuries requires that a sports participant be fit and in proper condition. Proper fitness is critical in preventing sports injuries. If you are not fit, fatigue will occur and injury will soon follow.

Proper training and good coaching are essential prevention tools for the sports enthusiasts. Many injuries can be avoided with proper training and the right coaching.  It is also important to wear the proper protective gear when playing any sports game. Appropriate gear includes mouth guards, and compulsory contact sports equipment like footwear, helmets, and pads.

The most common foot injuries include ligament strains, stress fractures, heel bruises, and swollen growth plates. Feet must absorb the weight of the player and take the full force of play. Teens especially suffer foot injuries because their feet are often different. High arches or flat feet can lead to injuries. To prevent this from happening special shoe inserts may be helpful.

When you re-injure a joint it becomes weaker and thus more prone to injury. It is important to take each injury seriously and to treat it properly. Treating an injury properly includes resting it. Minor injuries can have long-term implications if they are not treated properly.

Diagnosis

Not all thicken or yellowed toenails are caused by a fungal infection. Injury to a toenail can cause the toenail to grow in a thickened or malformed fashion. This can be due to an established fungal infection or may be due to the damage caused to the nail root when it was injured. In these instances, treatment with anti-fungal medications will not correct the malformed nail. Other causes of thickened toenails are small bone spurs that can form under the toenail and psoriasis. Taking a scraping of the toenail and culturing it makes the diagnosis.

Treatment

It is best to treat the condition as soon as it is noticed. In early cases, over the counter medications may be sufficient. It is also important to treat any concomitant athlete’s foot that may be present. In more advanced cases, a prescription medication may be needed. There are effective topical and oral medications available for the treatment of fungal toenails. If sweating feet are a problem, changing shoes and socks during the day is recommended. There are some topical medications available that help to reduce the sweating of the feet. On occasion, your doctor may recommend removing the toenail.

Laser Treatment

When undergoing a laser toenail fungus treatment, a medical professional will apply a directed focused light source on to a toe that is infected. The laser toenail fungus treatment will target the fungal infection in the toenail and the area below called the toenail matrix. Laser toenail fungus treatment will destroy the fungal infection and should be relatively painless because the toenail is dead cells. The specific wavelength of the laser toenail fungus treatment targets only the living fungi.

Laser toenail fungus treatment is not a cure. A fungal infection is fungus living in cracks and pores of your toenail. If a lifestyle change is not made (throw your old shoes out) the fungi will return to the nails. Therefore laser toenail fungal treatment is part of an overall protocol which a physician will prescribe. This could include topical medicine or changes to your lifestyle.

• Any skates or other footwear that is not fitted correctly can cause foot pain.
• A medical condition that affects the way a person moves can cause or aggravate foot pain.
• Any high-impact skating or other strenuous training, cross training or recreational activities may injure the feet or ankles.

There are many kinds of ankle and foot problems that may affect any type of skating or sports activity.

Ankle Pain and Weak Ankles

Your ankles are one of the most commonly injured joints in your body. The weight of your entire body is supported by your small ankle which makes them very likely target for pain and injuries.

• Ankle sprains are one of the more common sports injuries.
• Achilles tendonitis is an overuse injury, meaning that repetitive use of this tendon results in little tears of the tissue.
• A stress fracture is another type overuse injury that involves the bone.
• Both oseoarthritis and rheumatoid arthritis can affect the ankle joint.

Skaters with weak ankles automatically feel unstable on skates and may feel extra pressure under their feet. Weak ankles also contributes to tired legs and feet at the end of a session. The real pain associated with weak ankles comes from rolling or twisting an ankle due to the instability.

Corns and Calluses

Corns and calluses are caused by rubbing, pressure or friction on skin. A corn is thickened skin on top of or in-between a skater’s toes that creates a protective layer of dead skin cells. It is cone-shaped and has a pressure-sensitive that points inward, pushes on nerves and causes foot pain. A callus is thickened and hardened skin on the soles of your feet that is more evenly spread and with no cone-shaped core.

Bunions and Bunionettes

Big toe (bunions) or little toe (bunionettes) are a common source of pain for skaters. A bunion is a deformity on the inside of the foot near the base of the big toe. A bunionette is a a lot like a bunion, but they are found on the outside of the foot.

Flat Feet and High Arches

Flat feet (pes planus) are a defect of the foot that is usually inherited. Skaters with flat feet have little or no arch on the bottom of their feet. Although most are born with flat feet, an adult’s arches can also fall. High arches (hollow feet) can cause problems, too. More people have hollow feet than flat feet.

Heel Problems

Heel pain in the front, back, or bottom of the heel and pain in the bottom of the foot are very common for skaters. Types of heel pain include:

• Irritation and inflammation of the large tendon in the back of the ankle is called achilles tendonitis
• Bursitis of the heel comes from many repetitions of a move or excessive pressure over an extended period of time.
• Excess pronation happens when the foot and ankle roll too far inward in an effort to accommodate movement.
• A hook of bone that forms on the heel bone is called a heel spur.
• Plantar fasciitis happens when the tissue that forms the arch of the foot gets inflamed.

Solutions

There are steps you can take to stop or prevent foot pain. Treatment begins with getting skates and footwear that are right for your feet. In fact, one of the most important things to help you treat or prevent skating injuries of all sorts and maintain or improve your skating is proper fitting equipment.

Some skaters with foot, ankle or even knee problems use inserts or orthotics to help align their skates properly. Some skaters may require custom fitting and prescriptions for special shoe supports or orthotics. Any skater who is not experiencing acute problems can try less expensive solutions to help relieve different types of foot pain.

All severe foot or ankle conditions should be reviewed and treated by a podiatrist or physician to get an accurate diagnosis and treatment for the pain.

A Wound or Sore That Does Not Heal

If you have an open sore on your foot or ankle, you need to see a podiatrist. This is especially important if you have diabetes because it usually takes you longer to heal. You have a better chance of healing if you are seen by your podiatrist right away and treatment is started. If you have had an open sore for a long time, your chance of getting a skin or bone infection (osteomyelitis) increases.

Foot Discolorations

For the most part, both of your feet should look alike. If one foot is a lot different color than the other, there may be a problem. Redness may be an indication of an infection or gout. A blue or purple color may indicate a vein problem. Whiteness or paleness (pallor) may be a sign of decreased blood flow. If you have these color changes, you need to see a podiatrist.

Pain and Swelling in One Foot

If you have pain and swelling (edema) in one foot and not the other, this is not normal. You should see a podiatrist. There are many problems that could be causing the pain and swelling such as a broken bone, tendonitis, tendon rupture or infection. It is more common to have swelling in both feet and ankles and this could be due to lymphedema.

Numbness, Burning and Tingling

These three things can be signs of neuropathy, which can cause decreased sensation in your feet. Diabetes is one of the many things that can cause neuropathy. Diabetic neuropathy is a condition that needs to be followed by a podiatrist. Having neuropathy puts you at increased risk for developing foot ulcers.

Pain That Increases with Activity

If you have pain that gets worse with activity, this may be a sign of a stress fracture. You should not try to work through the pain; you should see a podiatrist. If you treat a stress fracture early, you can hopefully avoid more serious problems such as a stress fracture that will not heal or a stress fracture that turns into an actual broken bone.

Severe Pain Lasting more than 24 Hours

This is especially important if you have just had surgery. Do not be afraid to call your podiatrist. If there is a problem, it is better to deal with it sooner rather than later. Possible problems could be an infection, tight dressing, DVT (deep vein thrombosis) or compartment syndrome. There are many treatment options for dealing with pain, but the first step is to figure out what is causing the pain. See a podiatrist.

Foot Pain with Legs Elevated

If you have pain in your feet when you are lying in bed and the pain goes away when you dangle your feet off the side of the bed, this may be a sign of decreased blood flow or peripheral artery disease. This is a condition that needs to be addressed by a few different doctors. You may start with a podiatrist, but you may also need to see a vascular surgeon.

A Deformity that Progresses Suddenly

One example of such a deformity is charcot arthropathy. Charcot is a problem that can occur when you have diabetes. Signs and symptoms include pain, redness and a hot, swollen foot. Charcot can lead to the bones breaking and slipping out of place. If left untreated, the bones may heal in a bad position causing a foot deformity. You should see a podiatrist right away.

Arch of One Foot Flattens

If you notice that one foot seems flatter than the other, this could be a sign of tendon dysfunction or even rupture. A tendon that does not work properly can lead to the bones not being lined up and this can cause arthritis in the joints. If you treat the tendon problem early, this may prevent damage to your joints.

A Mole that Changes

A mole (nevus) that has a funny shape (or changes shape), gets bigger, bleeds or changes color needs to be examined more closely. These changes could be due to melanoma. You may start with a trip to the podiatrist, but may be referred to a dermatologist.

A Lump or Bump that Grows or Hurts

A lump or bump that is getting bigger and is painful should be looked at by a podiatrist. It may turn out to be a type of cyst, but there is also a chance it could be something more serious such as a tumor. Tumors in the foot are rare, but do sometimes occur.

Treatment

Treatment for ingrown toenails is relatively painless. The injection to numb the toe may hurt some, but a skilled doctor has techniques to minimize this discomfort. Once the toe is numb, the nail margin is removed and the nail root in this area is destroyed. Most commonly, the doctor will use an acid to kill the root of the nail, but other techniques are also available. It may take a few weeks for the nail margin to completely heal, but there are generally no restrictions in activity, bathing, or wearing shoes. Once the numbness wears off, there may be some very mild discomfort but rarely does this require pain medicine. A resumption of sports activities and exercise is generally permitted the following day.

There are very few complications associated with this procedure. Reoccurrence of the ingrown toenail can occur a small percentage of the time. Continuation of the infection is possible which can be controlled easily with oral antibiotics. On occasion, the remaining nail may become loose from the nail bed and fall off. A new nail will grow out to replace it over several months. With removal of the nail margin, the nail will be narrower and this should be expected.

To prevent ingrown toenails it is recommended to wear properly fitting shoes and to trim the toenails straight across and not too short.

Look for swelling, redness, pain or unusual tenderness or perhaps some numbness or burning sensation over the base of the great toe or ball of the foot.  Prolonged walking, standing and inappropriate shoe gears may aggravate your symptoms predisposing us to this painful deformity.

Surgical Correction of Severe Bunion Deformity

If the bunion is more sever in nature surgery is performed further back on the bone in order to straighten the big toe. When surgery is performed in this area of the bone, there is greater instability of the bone after it is cut and moved into a corrected position. Generally, the surgeon will require the patient to wear a below-the-knee cast and use crutches for three to eight weeks. Initial bone healing takes six to eight weeks. This period of time can take longer in people who smoke.

The overall success rate and satisfaction of patients who have had bunion surgery is quite high. The most common complaint of patients is the healing time. This is particularly true if the patient is not adequately prepared or informed as to what to expect. Most patients experience minimal pain following the procedure and this pain is easily controlled with pain medication prescribed by the surgeon.

Possible Complications

Potential complications associated with the surgery are infection, over or under-correction of the bunion, joint stiffness, delays in healing or non healing of the bone, or healing of the bone in the wrong position. Most of these complications can be avoided by following the surgeon’s instructions. Walking on the foot without the protection of a post-operative shoe or cast, or against the surgeons advice can lead to a dislocation of the bone where it has been cut. This results in delays in healing, non-healing of the bone or healing of the bone in the wrong position. Allowing the bandage to get wet increases the risk of infection. The most critical time for an infection to occur is within the first three days following surgery. Infection can also occur following this period of time but is less common.

Joint stiffness following bunion surgery is common, but generally improves with time. Postoperative physical therapy is useful to improve the movement of the joint but is not always necessary.

Bunions on Both Feet- Considerations with Regard to Surgery

If a person has bunions on both feet, many surgeons feel that their patients recover quicker and with fewer complications if the surgery is performed on one foot at a time. Many surgeons prefer to wait a minimum of four to five weeks between surgeries. Other surgeons prefer that their patients wait longer between surgeries.

Place of Service and Anesthesia Considerations

Most often the bunion surgery is preformed in an outpatient surgery center or hospital. Some surgeons will perform this procedure in their office. Anesthesia for the surgery can range from a straight local anesthesia, given by injection into the area of surgery, to a general anesthesia with the administration of an anesthetic gas. A very common form of anesthesia is a combination of a local anesthesia and medicine given intra-venous to make the patient drowsy. This is commonly called twilight anesthesia.

Generally there is very little blood loss during surgery. Most often the surgeon will use some form of tourniquet to stop bleeding during surgery. Because the surgery can be performed in a relatively short period of time the use of a tourniquet is very safe. Technically, the tourniquet can be left in place for as long as 90 minutes safely in most cases. Surgeons who perform bunion surgery are very knowledgeable in the use of tourniquets. The potential for the need for a blood transfusion with bunion surgery is nearly non-existent.

Can My Bunion Come Back?

It is important to understand that bunion surgery does not correct the cause of the bunion. Therefore there is the possibility that the bunion can reoccur. How quickly a reoccurrence will occur is difficult to predict. It may take several years or just a matter of months for the bunion to begin to come back. Bunions are caused by abnormal movement of a set of joints below the ankle joint in the foot called the subtalar joints. To help prevent the bunion from reoccurring the patient should be prescribed a functional orthotic. These are custom-made shoe inserts that correct the abnormal function of the foot. Generally they will fit in normal shoes without requiring the use of larger shoes. Most foot surgeons will suggest the use of orthotics following bunion surgery to help prevent the reoccurrence of the deformity.