Common Conditions

Toenail fungal infection is one of the most prevalent infections seen in the United States today and some people are more hereditary suseptible in having it.

fungus usually grows in dark, moist areas and can invade the body through minor cuts, or after injury or irritation in which the toenail becomes separated from the bed. The fungus can cause the nail to thicken and become discolored, often yellow or brown. A foul-smelling debris can accumulate under the nail leading to pressure and pain. After confirming the presence of toenail fungus infection , It is best to treat the infection in early stages when the nail starts to thicken or becomes discolored.

In the past it used to be that in the early stages, an oral medication was given which had some series side effects in the body especailly on the liver if taken for too long. In case a patient was unable to take the oral medication or the infection was to advanced, the infected nail was surgically removed by administering local anesthesia in the office.

Now however, Dr. Harounian has incorporated the newest and the most effective pinpointe laser machine in to his practice to get ride of all the fungal infection with no pain and no known side effects in only 30 minutes. The procedure is quick and easy and entails lasering all 10 toes regardless of how many are infected, to minimize the risk of reinfection.

The two most common causes of heel pain are heel spurs and plantar fasciitis. The chief diagnostic sign of these problems is: pain in the bottom of the heel when first standing, which gradually improves with walking. This pain may return with continued walking. The treatment involves correcting the underlying causitive problems.

The plantar fascia is the thick ligamentous band in the bottom of the foot which is attached to the heel, and runs forward to insert into the ball of the foot. Plantar fasciitis is an inflammation of this band at its attachment to the heel.

Causes: Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body’s weight, and the foot flattens and this places a great deal of pressure and strain on the plantar fascia. There is very little “give” to the plantar fascia, so as it stretches only slightly, it pulls on its attachment to the heel. If the foot is properly aligned this pull causes no problems. However, if the foot is ” pronated” (the foot rolls inward, causing a break down of the inner side of the shoe), the arch falls excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which inturn pulls abnormally hard on the heel.

The same pathology occurs with “supination” (the rolling of the foot outward, causing a break down of the outer side of the shoe). Supinated feet are relatively inflexible, usually have a high arch, and a short or tight plantar fascia. Thus as weight is transferred from the heel to the remainder of the foot, the tight plantar fascia does not stretch at all, and pulls with great force on its attachment to the heel.

In both cases, the abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation, and swelling. If this process continues, the plantar fascia partially tears away from the heel. The body will fill in this torn area with calcium; eventually it becomes bone, and a heel spur results.

Bunions are misaligned big toe joints that can become swollen and tender, causing the first joint of the big toe to slant outward, and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. Surgery by a podiatric physician is frequently recommended to correct the problem.

The foot is a highly mechanical apparatus, made of many bones and other coordinated structures. The foot carries the entire weight of the body and propels us forward when we stand, walk, and run. Several common deformities of the toes are Claw Toe , Hammer Toe , and mallet toe often cause pain and a loss of function in the use of the foot. Failure to treat these conditions may contribute to the development of serious and disabling changes in habitual ways of walking and carrying the body.

Claw Toe , mallet toe , and Hammer Toe are all deformities of the toes. While they are somewhat similar in appearance, each has specific characteristics. Variations in the three conditions are caused by differences in the direction the joints of the affected toes bend, as well as in degrees of deformity.

Toe deformities are often congenital, occurring for example, in some people with muscular dystrophy. People with high arches, or those who have a tendency to rotate their feet inward while walking are susceptible to deformities of the toes, as are those with rheumatoid or osteoarthritis and people with diabetes.

Proper evaluation is the first step in understanding toe deformities and the problems they present. Seeking early evaluation for disorders of the toes and feet is always a good choice, and can make a significant difference in controlling the condition.

Hammertoe is a structural deformity in which abnormal biomechanics cause the toe(s) to contract at one, two or all three of the joint within that toe. Normally Hammertoes by themselves are not painful, but by wearing shoes,as the prominent knuckle of the toe rubs against the shoe, it becomes irritated and can lead to what is called a corn

Temporary relief of painful symptoms can be achieved by having a podiatrist debride (trim) the corn . However, When the area becomes rigid and nonflexible with increased swelling and pain, a surgical correction might become necessary to alleviate symptoms.

Corns and callouses are both similar in that the extra skin forms in response to pressure on the skin. In the case of corns , the extra skin forms between the toes. In the case of callouses, the extra skin forms on the outside of the foot. Corns are usually from the knuckle joints on one toe pressing on the knuckle joint on the adjacent toe. Usually, a seed or central nucleus is seen when examining the corn . Callouses occur due to many causes but the most common cause is incorrect padding in the shoes, flat feet, a bone spur and hammertoes . In rare instances, the painful callouses is an abnormal sweat gland that has become impacted with hard skin and the small nerve going to the sweat gland becomes painful.

The names given to corns and callouses by doctors are numerous based on where the corn is occurring and how the skin is forming the callous or corn .

Shin plints: Shin splints are the typical first injury to walkers and runners

A stress fracture pain is likely to be a continuous pain and restricted to one spot. Do not run. If you have a more diffuse pain or tenderness in the lower third of the leg on the inside, or along the entire shin, a fracture is less likely. Pain is felt on extending the toes and weight bearing. It hurts if you press the area with your finger. Physiologically, it’s an inflammation of the tendons or muscle in this area. Pain eases when you’re well warmed up, but resumes at the end of exercise.

Causes – Running with the weight too far forward; striking the ground with the first third of the foot; over-striding; shoes too tight around the toes; inflexible shoes; weak arches may be present; tight calf muscles stress the shin structures;running or walking on hard surfaces; overpronation; overtraining is its trademark; beginners are very susceptible

Compartment Syndrome is a muscle pain due to the muscles growing faster than the sheath surrounding them. It includes one form of shin splints; it also affects the other smallish muscles of the lower leg. Ice and anti-inflammatories can help, but surgery may be required to allow the muscle more room to expand. Some muscles grow so much that they constrict the blood flow into the sheath…resulting in necrosis (a medical emergency) of the muscle. Patients should always check with their podiatrist for a more precise diagnosis and treatment.

Ankle sprains are caused by a twisting or force on the ankle bones of the foot,causing one or more ligaments on the outside of the ankle to be stretched or torn. If this doesnot get properly treated, ankle sprains could develop into long-term problems.

Fracture (break) of your ankle usually happens due to a fall, an accident or hard blow. There are different types of fractures that occur depending upon the severity of the injury. Spiral, hairline, open and crushed bones are names used to describe fractures .

Dr. Harounian is an expert in fracture care and will perform x-rays to determine the type of fracture you have. We sometimes need to realign the bones, this is done through a process called reduction. Casting of the fracture , a walking boot, brace or splint are used to hold the bone in place during healing.

Bone and Heel Spurs are bony projections that usually form along joints.

Bone spurs ( Osteophytes) form due to the increase in a damaged joints surface area. This is most commonly from the onset of arthritis. for more information visit Bone and Heel Spurs.

Neuromas are enlarged benign growths of nerves, most commonly between the third and fourth toes. They are caused by tissue rubbing against and irritating the nerves. Pressure from poorly-fitting shoes or abnormal bone structure can also attribute to this condition as well.

In our family foot center, Dr. Harounian uses a high technology ultrasound to better see where the nerve irriation is and through injecting cortisone at the precise location and wearing special shoes or inserts pain should be relieved. In more advanced cased, sometimes surgical removal of the growth is necessary.

Diabetes is usually associated with poor circulation of blood flow, decrease sensation due to nerve damage, and slower healing ability to infections or open sores. Therefore, it is very crucial for the diabetic patients to see a podiatrist for a through examination of their lower extremities pulse and sensation, skin, toenails, muscle strength, and foot wear.

Some examples of diabetes related foot problems may include:

In the skin: dry skin causing “cracks” or “cuts” skin discoloration causing “itching” and irritation open sores called “pressure ulcers” that may get infected or can be difficult to heal.

In the toes: fungal thick toenails making it difficult wear shoes burning, sharp pains in your leg, feet, or toes that interfere with your sleeping

In the circulation: cramping pain in the legs when walking due to poor circulation gangrene of the toes or foot that may lead to amputation

Foot Deformities: Bunions , Hammer Toe , Heel Spurs , Ingrown Toenails , and other foot deformities all have more of an increase risk in foot complications in the diabetic patients.

Ingrown Toenails which are often painful are usually the result of trimming your toenails too short, particularly on the sides of your big toes.

One should avoid tapering the corners so that the nail curves with the shape of your toe. In the case of ingrown toenail , the sides of the nail curls down and digs into your skin. Shoes that are too tight or short may also cause that.

Ingrown toenail start out hard, swollen and tender, and later, may become sore, red and infected. Your skin may start to grow over the ingrown toenail . In order to treat it:

Antibiotics are sometimes prescribed if an infection is present. In case of an acute infection, Part of your ingrown toenail (partial nail plate avulsion) may need to be surgically removed by administering a local anesthesia.

For additional information visit ingrown toenails.

Wart ,or verruca, is a pea-size or smaller bump on the skin caused by a virus that infects the top layer of skin cells. They can be skin-colored, white, or pink. Wart are believed to be transmitted through direct or indirect contact (via a gym or shower floor) with a person carrying the virus. This virus, called human papilloma virus (HPV), is easier to “catch” if there is a cut or an abrasion on the skin.

Plantar warts occur on the bottoms of the feet. They frequently are studded with pinpoint dark spots, which are tiny, clotted blood vessels. When they occur on portions of the feet that bear weight, they are flattened by the weight placed on them, and can be quite painful. They can be confused with corns ; however, corns

Treatment: A podiatrist can remove a common wart by freezing it with liquid nitrogen, by using laser vaporization, or by surgically removing it in a procedure called curettage and electrodesiccation. Your doctor should explain that no single treatment is guaranteed to work, and a given form of treatment may need to be repeated several times. Unfortunately, the wart virus can be very resistant to therapy. Even after an apparent complete cure, it may pop up again in the same spot years later. Seeing a podiatrist is recommended to better evaluate the situation and to prevent the spreading of this virus.

The adult acquired flatfoot which is four times more common in women than men is a progressive, symptomatic (painful) deformity resulting from gradual stretch (attenuation) of the tibialis posterior tendon as well as the ligaments that support the arch of the foot. Although most flat feet are not painful, particularly those flat feet seen in children. In the adult acquired flatfoot, pain occurs because soft tissues ( tendons and ligaments) have been torn.

The geriatric patients have many of the same foot problems as the younger patient but their condition is often complicated by poor circulation, arthritis, bursitis, neuritis or other inflammatory conditions.

Just remember that your feet should not hurt because you are getting older. Many of your conditions can be alleviated by modern foot care.

Rheumatoid arthritis and osteoarthritis are two common forms of arthritis that affect millions of Americans, especially those over age 45. Rheumatoid arthritis affects the entire body whereas osteoarthritis is isolated to the joints.

Surgery to reconstruct the joint may be needed if arthritis causes chronic problems that cannot be controlled by medication, orthotics or physical therapy.