Common Foot and Ankle Problems - Dr. Vladimir Zeetser - Podiatric Physician and Surgeon

Common Foot and Ankle Problems - Dr. Vladimir Zeetser - Podiatric Physician and Surgeon
Common Foot and Ankle ProblemsFoot and ankle problems usually fall into thefollowing categories:
Acquired from improper footwear, physical stress, or small mechanical changes within thefoot.

Arthritic foot problems, which typically involve one or more joint.

Congenital foot problems, which occur at birth, are generally inherited.

Infectious foot problems, which are caused by bacterial, viral, or fungal disorders.

Neoplastic disorders, usually called tumors, which are the result of abnormal growth oftissue and may be benign or malignant.

Traumatic foot problems, which are associated with foot and ankle injuries.

Aesthetic - for additional information, please click here.

The most commonly treated foot problems are:
(alldescriptions are mainly in laymen's terms)
Bunion Deformity (Hallux Abductovalgus)Stiff Big Toe (Hallux Limitus/Rigidus)Tailor's Bunion or BunionettePlantarflexed or Dropped MetatarsalHammertoeHeel Pain, Plantar Fasciitis and Heel Spur SyndromeFlat Foot DeformityIngrown NailsNeuromasHallux Pinch CallusGoutGanglion CystAnkle SprainsSesamoiditisPlantar Wart or VerrucaTendonitis (Achilles Tendonitis)Pump Bump (Haglund's Deformity)Shin SplintsStress Fractures
Bunion Deformity (Hallux Abductovalgus)

A bunion deformity is a misaligned big toe joint thatcan become swollen and tender, causing the big toe to deviate towards thesecond toe and a bump or bunion to form on inside (medial aspect) of the bigtoe joint. As time progresses, the anglebetween the first and second metatarsal bones increases and the bunion becomeslarger. Initially, it may be withoutsymptoms, however because of the deviation at the joint, arthritis may developand destroy the joint and cause pain.Bunions are generally thought to be hereditary, but their developmentcan be exacerbated and hastened by tight fitting or narrow shoes, flat foot andhypermobility deformity. It becomes very difficult to wear shoes comfortablyand depending on the patient's age, can lead to skin breakdown and wounds. Conservative therapy is typically only temporaryand thus surgery is frequently performed to correct the problem.

Stiff Big Toe (Hallux Limitus/Rigidus)

This is a condition that affects the same joint as abunion, however on the top rather than the side. This is the result of arthritic anddegenerative changes occurring at the joint from wear and tear. Typically,spurs or bony growths form on the top of the joint causing pain and restrictingmotion. Often, the joint becomespermanently ruined and cannot be salvaged.Initially, steroid injections or orthotics may relieve the pain, howeverin the long term, surgery is usually indicated and there are a variety ofoptions available depending on the individual situation. This can include simply shaving off anyexcess bone, shortening the metatarsal to decompress the joint, fusing thejoint, and replacing the joint with an implant.More recently, synthetic joint fluid has been used to lubricate thejoint with some success and this can buy time before surgery is performed.

Tailor's Bunion or Bunionette

This is the equivalent to a bunion but is present on the outside of the foot at the fifth metatarsal bone.Causes and treatments are generally the same as for a bunion deformity.

Plantarflexed or Dropped Metatarsal

Clinically, this can present as an isolated painful callus or bone pain at the ball of the foot usually under the second metatarsal.Although any of the lesser metatarsals can be affected, typically the second metatarsal is too long or angled downward more than the others.Conversely, the first metatarsal may be too short or angled upward.In either case, the pain (called Metatarsalgia) is usually beneath the second metatarsal and difficult to resolve conservatively.Custom orthotics can control the symptoms, but for more long term relief, a surgical procedure can be performed to reposition the bone into a more normal position, usually shortening and/or elevating the bone as well.


One of the most common conditions affecting the foot and usually stemming from muscle imbalance, in which the toe is bent into a contracted claw-like position. It occurs most frequently with the second toe, often when a bunion abuts and underlaps the toe, but any of the other three smaller toes can be affected.It can lead to painful corns, rubbing of the skin in shoes, wounds and general shoe fitting problems.Depending on the severity of the condition, conservative treatment is often ineffective and thus surgical correction is often necessary.This can include simply releasing a tendon in the toe, but often requires excising a small portion of bone.

Heel Pain, Plantar Fasciitis and Heel Spur Syndrome

This general category results in pain to the inside (medial aspect) of the heel which can occur suddenly or have a gradual onset.It occurs from excessive tension on the plantar fascia, the tendon attaching on the bottom of the heel bone, which results in microtearing and inflammation.With time and continued stress, the muscle pulls at its attachment to the heel bone and eventually produces a calcified spur visible on x-ray.

Typically described by patients as a very painful sensation upon arising in the morning and trying to make the first step of the day.After anywhere between 10-30 minutes, the pain subsides and the day progresses with a dull aching constant pain.Upon relaxing and being seated the pain tends to go away and then when the patient arises again to start walking the cycle starts all over again with very painful first step. Conservative treatment typically consists of injections, anti-inflammatory medications, stretching exercises, orthotics and sometimes physical therapy.For the 5-10% of patients that do not completely improve with conservative care, additional options remain.Prior to considering open surgery, a successful treatment called Extracorporeal Shock Wave Therapy (ESWT), first introduced as Ossatron, has been used for decades safely to procedure up to 92% success rates with one treatment.

Flat Foot Deformity

This condition can be congenital or acquired and typically results in hyperpronation of the subtalar joint in the foot.A variety of other causes occur as well.Gradually, the medial arch collapses and the foot becomes progressively flatter.As the deformity continues, the shape of the foot is drastically altered and the bones, joints and soft tissue structures deteriorate.If caught early in life, this can be corrected with relatively simple surgical procedures such as a subtalar joint implant.Later in life, this becomes more difficult and more extensive surgery may be required.Conservative care typically consists of high quality custom foot orthotics.

Video of CSI in the News
Nexa CSI Brochure
Ingrown Nails

Toenails whose corners or sides dig painfully into the skin. Ingrown toenails are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity and poor foot structure. Women are much more likely to have ingrown toenails than men.Sometimes ingrown nails can be prevented by trimming toenails straight across, selecting proper shoe style and size and seeking care early.If the ingrown toenail becomes painful and/or infected, treatment consists of removing the offending nail border under local anesthesia to relieve pressure and pain.If the condition repeatedly occurs, a permanent correction can be performed either chemically or surgically, depending on the specific situation.


Enlarged benign growths of nerves, most commonly between the third and fourth toes. They are caused by tissue rubbing against and irritating the nerves. The symptoms include burning, numbness or cramping between the toes or in the ball of the foot.Pressure from ill-fitting shoes or abnormal bone structure can also lead to this condition. Treatments include orthoses (shoe inserts) and/or cortisone or alcohol injections, but surgical decompression or removal of the nerve is sometimes necessary.New techniques such as cryoablation (freezing the nerve) or radiofrequency ablation have shown promise as well.

Hallux Pinch Callus

This is a painful callus seen along the side of the great toe.A simple procedure removes the bony prominence which is the underlying cause of the hard callus formation.


This usually presents as a red, hot, swollen joint (most commonly the big toe joint).The pain is usually severe and causes limping.This is a metabolic disorder associated with elevated uric acid levels in the blood, mainly from dietary sources.If untreated, long term damage to the joint can occur, occasionally requiring surgery.In most cases, the condition can be managed with medication alone.However, during intermittent flare-ups, cortisone injections can be administered to relieve symptoms.

Ganglion Cyst

This is usually a benign soft tissue mass filled with a thick jelly like fluid.They often arise from a joint capsule or tendon sheath.A lump beneath the skin can cause pressure on a nearly nerve or pain in shoes.These fluid-filled masses are fairly common and can be present in many locations on the foot, but usually on the top.Without symptoms, they can be left alone; however, if they continue to enlarge and cause pain, the fluid can be drained.If the mass continues to fill with fliuid, it may require surgical removal.

Ankle Sprains

An ankle sprain is an injury to one or more ligaments to the ankle joint, usually on the outside (lateral aspect).These typically occur from twisting motions of the joint during a fall or from direct trauma.Early aggressive treatment typically yields the best results and fastest recovery.Ignoring the problem can lead to chronic ankle pain and a permanently weak and unstable ankle.Surgery is rarely indicated unless other associated injuries are sustained.


This presents as pain directly beneath the 1st metatarsal (big toe joint) caused by inflammation or damage to any of the two small bones (sesamoids).Treatment includes offloading in a special shoe, orthotics, cortisone injections and occasionally surgical removal of bone fragments.

Plantar Wart or Verruca

Caused by strains of Human Papilloma Virus (HPV), this is probably the most difficult to resolve dermatological condition on the feet.Due to the high recurrence rate, a multitude of treatment options are available, but most are ineffective for warts on the bottom surface of the foot.Dr. Zeetser typically utilizes an injectable anti-cancer medicine with the highest clinical success rate.

Tendonitis (Achilles Tendonitis)

Inflammation of a tendon or the tissue surrounding it is called tendonitis.Pain is typically felt with motion of the tendon or weightbearing.Any tendon in the foot may be involved, however the Achilles tendon is most commonly affected.Conservative treatment includes anti-inflammatories, physical therapy, orthotics, and topical analgesics.Dr. Zeetser utilizes an injectable non-steroidal anti-inflammatory medication, without the risks of cortisone, to provide effective relief of symptoms.In severe or chronic cases, surgery may be indicated, and new techniques such as ESWT or the TOPAZ procedure can be employed.
Click here for additional information on newer techniques.

Pump Bump (Haglund's Deformity)

This is typically seen on the back of the heel as an enlarged swelling underneath the Achilles tendon.Usually caused by an enlarged bone mass with overlying tissue swelling on the back of the heel, which may take years to develop.The bump typically becomes enlarged and painful from rubbing on the back of shoes or "pumps."Conservative treatment consists of heel lifts, shoe padding, orthotics and occasionally injections.If this fails, surgery may be necessary to remove the bone and tissue mass.

Shin Splints

Pain to either side of the leg (tibia) bone, caused by muscle or tendon inflammation.It is commonly related to excessive foot pronation (collapsing arch), but may be related to a muscle imbalance between opposing muscle groups in the leg.Proper stretching, physical therapy and corrective orthotics can help prevent or alleviate shin splints.

Stress Fractures

This presents as a gradual onset of pain (usually in the midfoot) caused by overuse.Stress fractures are small incomplete cracks in bone and with early diagnosis and treatment, the condition typically heals completely. Untreated, they may become complete fractures, requiring casting, immobilization and occasionally surgery and may result in long term complications.

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