Cottage Hill Podiatry Group PC

1371 Montlimar Dr.
Mobile, AL 36609
(½ Block North of Cottage Hill)

Phone: 251-304-0804

Why Do My Feet Hurt?

Many of our patients develop a pain in their arches, which is constant when they are on their feet. The pain can be anything from a dull ache to a sharp stabbing pain, which centers in the middle of the foot. On the bottom of the foot is a ligament (a rubber band type structure) called the plantar aponeurosis, it can also be called the plantar fascia. This band has many functions, but the main purpose is to absorb the shock of walking as the foot hits the ground. Like any structure, it can be damaged by positioning it wrongly during the "gait cycle," which is a sequence of moves that create the action of walking. When this happens, the aponeurosis can and does "rip." When you walk, the forces generated are much more than your weight alone. These forces continuously act upon this "rip" to inflict the constant pain felt while walking. To correct the problem, the Foot Doctor must support the damaged region and allow it to heel; we do this using various splinting methods and devices.

But, more importantly, we must find out why the trauma to the foot occurred (the problem that caused the "rip"). It is more important to fix the cause then to heal the aponeurosis. Because, if you do not control the cause, the problem will return. With arch pain, the causation breaks down into two areas involving direct trauma. You stepped on an uneven surface or a protruding object, and this action placed a dynamic force on a small area of the aponeurosis, causing it to rip. Or, the rip can be created by a constant long-term force, generated by a malposition of the foot; this, combined with climbing or standing on uneven surfaces, can result in a "rip."

Finally, there are also diseases that can occur which cause fibrous nodules (lumps) to form in the aponeurosis (the ligament), which result in constant irritation, but this is rare. Most importantly, in the majority of cases, the Foot Doctor can correct the problem.

Many patients point to every bump and deformity and call it a bunion. A bunion is a specific deformity of the big toe and first metatarsal bone (long bone behind the big toe) involving enlargement and malposition of the metatarsal head (end of the long bone just before the big toe). Bunions are hereditary in that they develop because, somewhere in the past, your mother or father or some relative had the problem and passed it on to you. It comes about from an imbalance in the structure of the foot. Because the foot is out of balance when you apply pressure on it, it must do something to compensate and control these forces. The foot compensates by spreading out and placing more foot on the ground. It does this by forcing the head (the end of the long bone) away from the foot, which in turn causes a buckling of the joint between it and the big toe. As time progresses, this pressure causes the region (the first metatarsal head) to enlarge due to the added forces (weight) on the region and we get a BUNION.

This is a progressive disease-it gets worse with time. However, if the problem is diagnosed early, the Foot Doctor can slow or even stop the progression. But, sadly, many times surgery is the only cure. Therefore, to prevent surgery, early diagnosis and correction is important. Do not wait until the pain is so great you must seek help; early diagnosis can result in stopping the bunion from forming and does not have to involve surgical correction.

Many people think that ingrown toenails are a simple infection that will go away with time, but anyone who has suffered the pain of a simple ingrown toenail realizes that not only are they a serious infection but also the pain can be intense. A toenail in grows from two major causes, the first and most prevalent is trauma. In this case you drop something on the foot or you kick or trip, placing undue force on the nail plate and drive it into the soft tissue of the toe. The second case arises from chronic trauma, in which the position of the toe or deformity of the nail plate causes a constant rubbing of the nail plate on the shoe slowly redirecting the nail into the soft tissue. In both cases the nail plate breaks (cuts through) the skin open and bacteria set up in the wound site. As the bacteria multiply and the toe swells the nail is engulfed into the soft tissue and severe pain arises. It is important to know that this results in an infection that can spread throughout the body even though it initiates in the toe! In fact in a diabetic this is one of the major problems that lead to amputation!

The positive aspect of the ingrown nail is that it is so prevalent in our office during the last 30 years that it has become a simple problem to fix, and prevent from returning.

When patients tell me they have heel pain, the first question I ask is, "Can you tell me about the first step you take out of bed in the morning?" The answer falls into two categories:

  1. "The first step is devastating; I force myself to walk and it gets a little better but the pain does not go away!"
  2. "The first step is fine but, as the day progresses, my feet get worse and by the end of the day-I'm limping!"

Heel pain comes about by many causes, but the main reason for pain is biomechanical, in nature (the physics of how the foot works). As with any machine, to function properly, the foot must work in a certain order. When this sequence is disrupted, the bones become out of position, the muscles contract out of order and the ligaments stretch and rip. Subsequently, the nerves become inflamed and the foot swells and becomes irritated. In the case of heel pain, the problem arises in the positioning of the heel bone (the calcaneus), which should lie flat on the ground. When we examine a foot with heel pain, we note the position of the calcaneus. Many times we find it rolling over and flattening the arch. We refer to this condition as pronation.

Signs of Pronation: look at your shoes…

  1. The outside of the heel is worn away.
  2. The region of the shoe adjacent to the big toe is scuffed.
  3. The shoe has a twist to it.

On the bottom of your foot is a ligament called the plantar aponeurosis. A ligament is an elastic band that, in this case, attaches the heel to the balls of your foot. Its function is to absorb the shock of the foot hitting the floor much like the leaf spring on the back of a pickup truck. But, if the foot pronates (collapses inward), it will twist (torque) the aponeurosis and thus tighten it, pulling the foot to the floor (much like overloading that pickup) so that it cannot absorb the shock of the foot hitting the floor. It can cause the ligament to tighten enough to make it rip from the heel. We call this injury a plantar fasciitis, and this in turn can create a heel spur (as the heel bone grows out to reattach to the torn ligament).

Understanding the pain cycle:

  1. In the evening, you go to bed and feel a throbbing as the blood rushes down to the foot to aid in healing the stretched and/or torn ligament.
  2. You get up in the morning and by that time the rip has healed (scab) but is not strong enough to bear weight. So, when you take the first step, the ligament rips open ("That first step in the morning is devastating!!!"). And, as you walk, it continues to rip until it completely rips open, thus relieving the pressure ("It gets better as I walk but never gets good.").
  3. OR, you get up in the morning and the site has healed sufficiently to bear weight, but, as time passes, the continued forces placed on the healing site are too much and the site starts to rip open again-because the cause of the problem is still present (the pronation).

Correction of the problem must be aimed at both correcting the symptoms and, more importantly, correcting the causation-the biomechanical imbalance. Pain is a warning that something is wrong, so just getting rid of the pain allows the body to continue adding to the damage. This is why, at the Foot Doctor, we concentrate on the cause, in that correcting the cause corrects for the pain. To correct the problem, we undertake a course of orthotic therapy, which employs a prosthetic (a device that goes into your shoes) that rebalances the foot and prevents pronation from occurring, as well as treating the rip, allowing it to heal sufficiently to stop tearing. Medication alone cannot control the forces generated during the act of walking. Medication only blocks the pain. The Foot Doctor has been trained specifically in problems relating to the foot. The Foot Doctor can and will fix the problem-not just hide the pain.

Warts form on all surfaces of the body but when they grow on the foot they become extremely problematic. Warts are a viral infection that get into the skin cell and mutate them into warts.

In the foot they can be found on both the top of the foot (dorsal aspect) and on the bottom of the foot (plantar aspect). This is why they are called plantar warts which are the most prevalent type and the harder to get rid. This is because the skin on the bottom of the foot (plantar) is thicker then on the rest of the body (two additional layers of cells).

Warts result from an airborne virus which gets into the skin through a crack; they then multiply and engulf the skin cells transforming them into wart cells. This is one of the reasons that going barefoot is not a good idea, the foot is already prone to trauma and shoes do give it a level of protection. But if warts do arise and start to spread please contact our office and we will plan a therapy to work with your life style and not against it, for in many cases it can take anywhere from minutes to weeks to remove and prevent the return of warts and we understand that our patients have to work and attend school and must be able to walk.

We at Cottage Hill Podiatry can provide this tailored therapy for our patients. Please contact us to discuss your problems.

The problem of fungus nails is epidemic in our area. This result from environmental conditions that we in the Deep South have, that are specific to our region. Specifically we live in a region of intense heat and humidity, and we are surrounded by water, so that if we are not wet from sweat we are from the creek, stream, lake, bay or gulf all of which have differing levels of pollutants. One of which is fungus. This fungus can also be airborne and and will grow in certain conditions. Specifically it likes dark, hot, humid (wet) areas, with a source of nutrients.

In the human being a foot placed into a closed shoe provides this perfect environment for a fungus to grow, add to this 90+ degree weather with 90+ humidity and fungus will grow like wild fire. When we note the discolored thickened nail plate the fungus has already done its damage, for the fungus initially attacks the roots of the nail and then spreads to the nail bed and plate.

To correct the infection one has to treat all surfaces of the nail, and in many cases both topical and oral medications must be used (and monitored) .

We at Cottage Hill Podiatry have dealt with fungus for the past thirty years and understand what is necessary to correct and control fungus.

Arthritis comes in numerous forms resulting from specific causes. Specifically there are forms of arthritis that arise from disease, trauma, and the most prevalent type, osteo-arthritis, that caused by degeneration of the joint due to aging.

In all cases we note a "wearing out" of the joint, specifically the smooth surface of the interior of the joint the articular cartilage wears away exposing the rough bone underneath. This results in bone rubbing on bone, building up friction (heat) which in turn causes fluid to infuse into the joint to control the heat (swelling) which in turn increases the pressure within the joint and limits motion. All of which result in PAIN!!

It is important to understand the causation of the arthritis and correct the cause of the arthritis as well as treating the breakdown of the joint. This involves not only knowledge of the problem but also the necessary diagnostic equipment to evaluate the problems.

The doctors at Cottage Hill Podiatry have 30 years of experience in dealing with arthritic problems and will examine and discus various choices to treat and control your problems.

Presently, diabetes is on the climb, with new cases reported on a daily basis. Type #2, or adult onset diabetes, is now found in children as young as 6 years of age due to the epidemic of juvenile obesity. We are also finding that, with our hectic lifestyles, our dietary choices are shifting to ease of selection over proper diet; this is causing the average individual's weight to increase at an alarming rate.

The Foot Doctor has been trained in understanding the complications that arise in diabetes. These complications stem from the fact that diabetes is a disease of the peripheral blood circulation (small distant blood vessels), which fails as time progresses. Research has shown that the little toe is the furthest point from the heart, and therefore the foot has the majority of tiny vessels that breakdown first in the diabetic. We find this results in severe pain, burning, numbness and ulcerations (the skin dies and opens up a hole in the foot).

It is the function of the Foot Doctor to stop this from occurring. Through modern medical advancements, the Foot Doctor at Cottage Hill Podiatry Group will hopefully never have to amputate a toe or foot, as has happened in the past. (NOTE: In 30 years of practice, we have not lost one toe!!!!)