CONDITIONS AND TREATMENTS

CORRECTIVE AND PRESCRIPTION SHOES

Nail fungus, otherwise known as Onychomycosis, has been recognized as being a very difficult type of fungal infection to treat. It is a cosmetic condition that most often affects the toenails. Risk factors for nail fungus include increased age, male gender, diabetes, nail trauma, hyperhydrosis, peripheral vascular disease, athlete's foot, immunodeficiency, poor hygiene, and chronic exposure of the nails to water. There are many species of fungus that can infect the nail. Often in nail infections several types of fungus will be present at the same time. All nail fungus infections result in thickened, discolored, and distorted nails.

Nailfungas

 

 

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 are misaligned big toe joints.  

 

 

Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. The arch develops in childhood, and by adulthood, most people have developed normal arches.

 Flat feet  

 

Heel Spurs
Plantar fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot. Our practice can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.

Heel Spurs  

 

Hammertoes
Hammertoe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, resembling a hammer. Left untreated, hammertoes can become inflexible and require surgery.

Hammertoes 

 

Ingrown nails when the nail grows into the flesh instead of over it -- usually affect the toenails, particularly the big toe. People with curved or thick nails are most susceptible, although anyone can suffer from ingrown nails as a result of an injury, poorly fitting shoes, or because of improper grooming of the feet. Diabetics and people with vascular problems need to be aggressive in treating and preventing minor foot ailments such as an ingrown toenail because they can develop into serious medical problems such as loss of a limb.

Ingrown nails 

Warts normally grow out of the skin in cylindrical columns. These columns do not fuse when the wart grows on thin skin such as the face. On thicker skin, the columns fuse and are packed tightly together giving the surface the typical mosaic pattern. Black dots can sometimes be seen in a wart. These are actually blood vessels that have grown rapidly and irregularly into the wart and have thombosed or clotted off.

Wart                                                                                                                   



Proper footwear is an important part of an overall treatment program for people with diabetes, even at the earliest stages of the disease. If there is any evidence of neuropathy, wearing the right footwear is crucial.

As a general rule, people with diabetes should choose shoes that:

  • Accommodate, stabilize, and support deformities, such as Charcot Foot, loss of fatty tissue, hammertoes, and amputations. Many deformities need to be stabilized to relieve pain and avoid further damage. In addition, some deformities may need to be controlled or supported to decrease further progression of the deformity.
  • Limit motion of joints. Limiting the motion of certain joints in the foot can decrease inflammation, relieve pain, and result in a more stable and functional foot.
  • Reduce shock and shear. A reduction in the overall amount of vertical pressure, or shock, on the bottom of the foot is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear.
  • Relieve areas of excessive pressure. Any area where there is excessive pressure on the foot can lead to skin breakdown or ulcers. Footwear should help to relieve these high pressure areas, and therefore reduce the occurrence of related problems.

Prescription Footwear

Many diabetics need special prescription footwear. The various types include:

  • Custom-made shoes. When extremely severe deformities are present, a custom-made shoe can be constructed from a cast or model of the patient's foot. With extensive modifications of in-depth shoes, even the most severe deformities can usually be accommodated.
  • External shoe modifications. In these cases, the outside of the shoe is modified in some way, such as adjusting the shape of the sole or adding shock-absorbing or stabilizing materials.
  • Healing shoes. Immediately following surgery or ulcer treatment, special shoes may be necessary before a regular shoe can be worn. These include custom sandals (open toe), heat-moldable healing shoes (closed toe), and post-operative shoes.
  • In-depth shoes. An in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4-inch to 1/2-inch of depth throughout the shoe. This extra volume accommodates inserts, or orthotics, as well as deformities commonly associated with a diabetic foot. In-depth shoes are usually designed to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot.
  • Orthoses or shoe inserts. Also known as orthotics, an orthosis is a removable insole which provides pressure relief and shock absorption. Both pre-made and custom-made orthotics or shoe inserts are commonly recommended for patients with diabetes, including a special total contact orthosis, which is made from a model of the patient's foot and offers a high level of comfort and pressure relief.