Ingrown toenails are one of the most common reasons for toe pain, especially the big toe.  Ingrown toenails occur when the sides of the toenail grows into the skin.  The digging into the skin of the nail leads to a range of symptoms including redness and pain.  Often the skin on the affected side of the toe will appear swollen and may be firm. The skin may even start to grow over the nail.  In some cases there may be drainage from the toenail as well.

There are a couple of different possible causes of ingrown toenails including wearing shoes that are too tight and squeeze the toes.  As well cutting toenails too short or rounded can cause the nail to grow into the skin.  Injury like stubbing the toe can lead to an ingrown toenail.   Also some people are born with curved nails and are prone to develop ingrown toenails.

The condition needs to be treated in order to avoid infection, a common complication of an ingrown toenail.  Treatment at home consists of soaks and trimming the nail.  Sometimes at home treatments will not sufficiently remove the nail and can cause the condition to worsen.  Treatment by a podiatrist consists of removing the ingrown part of the nail through a procedure called a partial nail avulsion.  The doctor will first numb the toe then cut the edge of the toenail which is growing incorrectly.  The removed side of nail may take months to regrow.  It is also recommended following the procedure to wear sandals or avoid tight shoes.

If you are suffering from pain or infection caused by an ingrown toenail, make an appointment at one of our four offices located in Daytona Beach, Port Orange, Palm Coast, and Orange City, Florida.  The physicians at Atlantic Foot and Ankle Associates will treat your condition as conservatively as possible and get you back on your feet.

By Dr. Matthew Hentzel

With summer right around the corner comes the season of sandals, beaches, and therefore exposed toes.  Toenail fungus often discourages many from wanting to expose their toes by causing a series of changes to the nails.  Toenail fungus is a very common condition referred to as onychomycosis.  Onychomycosis may start out as just a small area of yellow or white discoloration of the nail.  As the fungus spreads the discoloration may spread and worsen and the nail may thicken.  There may also seem to be an accumulation of material under the nail and possibly an odor.  The condition may eventually become painful as well.

There are a variety of risk factors for developing onychomycosis.  First of all, fungi best survive in dark and damp areas.  With that said, public places such as pools and showers are very common places for fungi to grow and be transmitted.  As well personal footwear can influence the development of onychomycosis.  Wearing shoes and socks and perspiring or having wet feet can also encourage development.  Trauma also leaves the nail susceptible to invasion by fungi.  Onychomycosis is often also seen in aging populations often due to decreased blood supply.

To diagnose onychomycosis your physician will first evaluate the toes clinically.  A sample may be taken to undergo laboratory testing such as a potassium hydroxide smear or a periodic acid-schiff stain.  Once the diagnosis is confirmed treatment will begin.  It often takes months to make sure the fungus is completely eradicated.   Atlantic Foot and Ankle Associates offer several options for the treatment of onychomycosis.  Medications for toenail fungus can be topical or oral.  One of the most common methods of treatment is the oral medication terbinafine (Lamisil).  This medication has to be taken for approximately 90 days.  We also offer a topical treatment called Formula 3, which is available at all four of our offices located in Palm Coast, Daytona Beach, Port Orange, and Orange City, Florida.   There is also a new, FDA approved treatment for onychomycosis called laser therapy.  Please visit the Florida Laser Center website to learn more about laser therapy, which is now available in our Daytona Beach location.

Onychomycosis can be prevented by taking actions such as keeping feet dry or allowing ventilation when wet as well avoiding being barefoot in areas where fungi are likely to grow.  If you are one of the 30 million Americans suffering with toenail fungus, please do not hesitate to get treatment so you can get back to the beach and show off your beautiful toes!

By Dr. Sona Ramdath Jr.

With the NCAA tournament well under way, players are most likely doing their best to avoid any type of injury.  An injury common in athletes refers to posterior tibial tendonitis; however, this injury can occur in nonathletes as well.  The posterior tibial tendon courses along the back of the leg then on the inside of the ankle to the arch of the foot.  It functions to support the arch of the foot.

Posterior tibial tendonitis can occur due to injury or overuse.  There are certain risk factors to the development of posterior tibial tendonitis including being overweight, diabetes, and flat feet.  When the tendon’s function is compromised the arch of the foot may drop placing even more pressure on the tendon which can lead to inflammation.

Symptoms of posterior tibial tendonitis include tenderness or pain on palpation of the course of the tendon.  There may also be pain on the inside of the foot and ankle in walking.  Standing on the tips of the toes may also elicit pain due to weakness.  These symptoms progress as the condition advances.   Treatment of the condition includes non-steroidal anti-inflammatory reactions, applying ice for about 20 minutes two times daily, and rest.  Increasing the arch support of the shoe or adding orthotics can also help control the condition. 

If untreated and with continued overuse, posterior tibial tendonitis can progress to posterior tibial tendon dysfunction (PTTD), causing a progressive flatfoot deformity.   In addition to the above symptoms this may lead to arthritis and a change in gait, or the way a person walks.  The change in gait may even lead to pain in other areas involved in mobilization such as the knees, hip, and back.   With this said, it is important once symptoms begin to seek medical attention and to follow physician instructions to avoid progression.

If you are suffering from posterior tibial tendonitis, please do not wait to see a podiatrist.  The physicians at Atlantic Foot and Ankle Associates take a conservative approach for all types of injuries.   Make an appointment at one of our four offices conveniently located in Palm Coast, Orange City, Daytona Beach, and Port Orange and get back to walking pain free!

By Dr. James Rust

Although Adele won six Grammy Awards, celebrity fashion on the Red Carpet is still a hot topic in the news.  A key feature of fashion is of course shoes, particularly high heels.  High heels, as fashionable as they are, often contribute to many foot pathologies. 

Wearing high heels which often have a narrow toe box can encourage the formation of a bunion, a swelling at the big toe joint.  Bunions may not be aesthetically pleasing and may also cause pain and difficulty in finding appropriately fitting shoewear.   To avoid the formation of bunions, the American Podiatric Medical Association (APMA) recommends not wearing shoes with heels taller than 2 inches.  However, of course high heels are not the sole cause of bunions, genetics and biomechanics are also contributing factors.

High heels may also exacerbate the symptoms of a neuroma, a benign nerve tumor that often brings feelings of pain, numbness, or tingling.  The APMA again recommends shoes with heels no higher than 2 inches due to the stress placed on the forefoot where the neuroma is often located.

Wearing high heels constantly may also shorten the Achilles tendon which may lead to pain and tendonitis.  High heels may also alter the direction and pull of the Achilles tendon causing a deformity known as the “pump bump” (Haglund’s deformity) which may become painful.

Last but not least, high heels are infamous for the foot pain associated with them.  With the heel lifted, more pressure and body weight is placed on the ball of the foot.  This can change the position of the foot during gait (or movement).

Certain steps may be taken to prevent serious complications from high heels.  At Atlantic Foot and Ankle Associates, we recommend that you limit the amount of time wearing heels.  When wearing heels, chose a pair with a wider toe box and a smaller heel.  Also, stretch your calves to avoid any complications with your Achilles tendon.

If you’ve suffered from the pain that wearing high heels cause, come in and see us at Atlantic Foot and Ankle Associates.  We have four offices conveniently located in Palm Coast, Daytona Beach, Port Orange, and Orange City, Florida.  You don’t need to suffer any longer!

By Dr. Dennis McBroom

Having never considered myself much of an athlete, let alone spent any time running, in 2004 I strangely convinced myself to run a half marathon.  The Detroit Free Press Marathon really appealed to me because it offered what no other marathon does: two international border crossings and an underwater mile through the Detroit-Windsor Tunnel.  With less than two months to train, I hit the pavement. 

Autumn in Michigan is nothing short of breathtaking.  Vibrant colors of changing leaves helped take my mind off the pain I was experiencing in just about every part of my body.  I did most of my training at a beautiful park with a scenic eight-mile pathway winding through hills and woods, often with views of the lake the path surrounded (which inevitably sparked my on-and-off-again love affair with running).  The cool temperatures were ideal, and two months later, I ran the half with an overall time of 2:13.  Being a novice runner, I had no idea if that was good or bad – I was just happy I finished.

The experience of participating in such an amazing event had me convinced; next year I was going to run the full marathon!  I was going to keep training throughout the year so I would be prepared and ready for next fall’s event!  And then winter set in.  Snow, sleet, slop.  Yuck.  As much as I despise the cold (and running in snow), my disdain for treadmills is even stronger.  

Fast-forward seven years.  The on-and-off-again love affair continues.  Although running has consistently been a part of my exercise regimen, there has been no distance training to speak of.  I now live in Florida where the weather is optimal for outdoor activities.  I had heard about a small group of runners that trained a few times a week, and decided to give it a whirl.  Within a couple of months, I’m back up to eight-mile distance runs on the on the beach (talk about beautiful scenery), and the rest is an up-hill battle at the bridge. 

I’ve always had some knee issues when running distance, but for the first time I’m finding other pains creeping in (maybe I’m just getting old).  As the Director of Marketing and Community Relations at Atlantic Foot and Ankle Associates, I have full access to five of the best podiatrists in Daytona Beach, Port Orange, Palm Coast, and Orange City.  A runner’s dream! 

When I began experiencing heel pain, (especially when I first got out of bed in the morning), I learned that I was suffering from Plantar Fasciitis, a condition common to runners.  Being the typical hard-headed runner, I wasn’t willing to hang up my shoes just yet.  With the help of custom orthotics made at our office, I have been able to continue training and have run three 5k’s, and a 10k (that is a picture of me getting my 2^nd place award at the Daytona Speedway 5k race).   My heel pain is going away and I am looking forward to the next event!

By Marisa Aitken