Soft Tissue and Skin Injuries
In general terms, almost all foot and leg problems fall into two broad categories- those that involve your bones, and those that do not, which are the soft tissue and skin problems. Your soft tissue and skin play crucial roles in your foot’s function. Soft tissues are anything that isn’t bone, and includes muscles, tendons, ligaments and nerves, just to mention a few. Your skin protects everything in your foot from environmental pathogens, foreign objects and trauma. Together, these actually make up the majority of your lower limbs. Anything that causes damage to these are considered soft tissue and skin injuries, and can lead to serious complications if not properly diagnosed and treated.
Corns and Calluses describe the formation of hard skin, usually on the tops of the toes, or the bottoms of the feet that are the product of excessive pressure between the skin and the bones inside the foot. Corns can be very painful, and have focal hard centers that overlie the bone beneath it that is the cause of the problem. The corns on the tops of toes are usually associated with hammertoes; lesions on the bottom or the side of the foot with hard central cores are often the result of a malpositioned bone, or a bone spur. Calluses describe hard skin that is more diffuse in its presentation, and are produced by excessive pressure or friction over an area of the foot. Calluses are most commonly found on the balls of the feet and on the heels and can also be very painful when you walk. Corns and calluses can be treated by paring down the hard skin regularly, which temporarily relieves the pain, by accommodating the pressured areas in the foot with padding or custom orthotics, or by surgically eliminating the underlying bone problem that caused the lesions.
Warts are benign skin lesions that are caused by viruses that use your skin and body as a host. Warts enter the skin through micro-cuts or breaks in the skin. They can develop anywhere on the body, but are most commonly found on the bottoms of the feet where they are called plantar warts. Warts can exist as a single lesion or in groups known as mosaic warts. Warts are very hearty lesions, with their own blood and nerves contained within their physical boundaries. Warts are contagious, and can be spread by touch. Here at Country Foot Care, the skilled doctors have many ways to treat warts that include the application of topical medications, using laser treatments or removing it surgically.
Athlete’s Foot presents as a skin rash that is caused by a foot fungus infection, and is often found with people who have hyperhidrosis, or excessive sweating. Your skin has a natural protective layer that is “washed away” when we perspire. This creates a pathway for the fungus to invade your skin. Athlete’s foot is commonly found on the bottoms of your feet or between your toes. It can look cracked and dry, or present with fluid-filled vesicles, and can affect a small portion of your foot or cover the entire bottom with a moccasin-like presentation. Treating athlete’s foot should include using a topical antifungal medication and addressing the excessive sweating problem. At Country Foot Care, we have antifungal medications, powders, and products for the treatment of hyperhidrosis that can help you treat this condition and stay active.
Dry skin, which is also called xerosis, is a common foot problem where the skin is not hydrated. This condition is most often found in the geriatric population as a normal part of the aging process. The environment can also influence the skin. Radiator heat is very dry, as is prolonged exposure to sunlight. Taken to the extreme, dry skin can crack and form fissures that can be a portal for infection. Daily use of topical moisturizing cream like those found in the product section of this website can help keep your skin well hydrated.
Ulcers are breaks in the skin that extend through the superficial skin layer and invade the deep tissue of the foot and leg. Ulcers are most commonly found in patients with compromised immune and circulatory systems like patients who are diabetic. Ulcer treatment includes addressing the underlying systemic condition, addressing any infection present, removing any direct pressure from the wound, and local wound care. Our podiatrists are often a part of a medical team of doctors who care for these patients.
Other skin lesions like moles, freckles and birthmarks are commonly found on the foot and legs, and are generally benign. If you notice a suspicious lesion which may appear dark, irregularly shaped or a skin lesion that bleeds, or you notice a change in shape, color or texture of an existing skin lesion, it should immediately be examined by a qualified physician like our doctors at Country Foot Care, who can perform a biopsy and determine if the lesion is truly benign or malignant.
Fungal nails are the most common problem found with feet. The nails present as discolored, brittle, thick nails with a malodor caused by the fungus often times present. There is a genetic predisposition associated with nail fungus. Nail fungus is mildly contagious, and can spread from one nail to another over time. The most effective treatment for nail fungus involves laser treatments of the condition. The doctors at Country Foot care are well trained and experienced using lasers to treat nail fungus, and are prepared to discuss the entire treatment regimen with you. Other treatments for nail fungus include topical medications that can be found in our products section of the website, cutting and thinning the nails regularly or using oral antifungal medications.
Ingrown toenails describe a very painful problem where one or both sides of a nail grow beneath the surface of the skin. Your shoe pressing on the side of an ingrown toenail causes pressure and pain, and can lead to an infection if the toenail breaches the skin. The skin that is being pressed by a chronic ingrown toenail can become hard and callused, which further contributes to the pain you experience. Temporary relief can be achieved when one of our doctors removes the offending nail border. In patients with a recurrent ingrown toenail, a minor in-office procedure can provide permanent relief with minimal discomfort.
Soft Tissue Masses Under The Skin
A neuroma is a nerve swelling or growth most commonly found between the toes, with the space between the third and fourth toes most commonly affected. Patients with neuromas often describe it feeling like they are “walking on a pebble”. They can also be associated with localized pain when the affected foot is squeezed into a tight shoe, or cause localized numbness and tingling. Conservative treatment of a neuroma includes fabricating a custom orthotic to take the pressure off of the nerve, injection therapy using either cortisone or sclerosing alcohol and physical therapy. Non-invasive shockwave treatments are also used to help alleviate pain with neuromas. When conservative treatments fail, surgical intervention is often indicated.
A plantar fibroma is a hard, benign mass commonly found in the arch of the foot that is attached to the plantar fascia. The mass may be large or small, and is usually not painful unless it is pressed against your shoe or the floor. Fibromas have a genetic link, and are most commonly found in older patients. If the fibroma is small and painless, treatment is usually not needed. If the mass grows or becomes painful cortisone injections and physical therapy can be used to attempt to shrink the mass. In some cases, surgical excision may be indicated.
Ganglion cysts are non-cancerous lumps that that develop around the joint between two bones or as an attachment to a tendon sheath. They are filled with clear jelly-like fluid, and can feel either hard or soft to the touch. People with these cysts may feel pressure when the ganglion is touched or rubs in a shoe, or pain if they press against a nerve. Draining a ganglion immediately relieve localized pressure, although recurrence is common, and may require surgical intervention.
Other common deep cysts include sebaceous cysts that form around sweat glands, mucoid cysts which often form at the small joints in toes, and inclusion cysts which can encapsulate skin at an old injury site, or a foreign body like a sliver of glass or a splinter that isn’t removed.