Can I Have Carpal Tunnel In My Ankle?

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel- arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.
Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.
Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.

Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:

• A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with fallen arches can produce strain and compression on the nerve.
• An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
• An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
• Systemic disease such as diabetes or arthritis can cause swelling, thus compressing the nerve.

Patients with tarsal tunnel syndrome experience one or more of the following symptoms:

• Tingling, burning, or a sensation similar to an electrical shock.
• Numbness.
• Pain, including shooting pain.

Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.
Sometimes the symptoms of the syndrome appear suddenly. Often they are brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.
It is very important to seek early treatment if any of the symptoms of tarsal tunnel occur. If left untreated, the condition progresses and may result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated.
The foot and ankle surgeon will examine the foot to arrive at a diagnosis and determine if there is any loss of feeling. During this examination, the surgeon will position the foot and tap on the nerve to see if the symptoms can be reproduced. He or she will also press on the area to help determine if a small mass is present.
Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Studies used to evaluate nerve problems- electromyography and nerve conduction velocity (EMG/NCV)- may be ordered if the condition shows no improvement with non-surgical treatment.
A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:

• Rest. Staying off the foot prevents further injury and encourages healing.
• Ice. Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
• 'Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
• Physical therapy. Ultrasound therapy, exercises, and other physical therapy modalities may be prescribed to reduce symptoms.
• Injection therapy. Injections of a local anesthetic provide pain relief, and an injection corticosteroid may be useful in treating the inflammation. 
• Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
• Shoes. Supportive shoes may be recommended.
• Bracing. Patients with flat foot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount pressure on the foot.

Sometimes surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate proceudre or procedures based on the cause of the condition.
If you are suffering from a tarsal tunnel syndrome, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Stretches For Hammertoes

Manual Toe Stretches

Stretching the affected hammertoe manually can help keep your joint flexible and be less likely to get stuck in

a bent position. Using your hands, bend the affected hammertoe into a more straightened-out position and then bend it back to the bent position. Working your toe muscles manually may help correct a minor imbalance that led to the development of the deformity. It will also help keep the hammertoe from becoming too rigid.

Toe Scrunches
Toe scrunches are another way of keeping your joints limber and the hammertoe flexible. This exercise is also known as "towel pick up" or "towel scrunch". Place a cloth on the floor and pick it up with your toes. Once you have mastered that, try picking up a larger item, like marbles. Toe scrunches are a great exercise because you can be doing something else, like reading, watching television, or even working at the same time.

Calf Exercises

Muscles imbalances can sometimes be the cause of hammertoes. When your muscles are weaker in one leg or foot, your gait can change and you might hold your foot differently, causing your toes to become hammertoed. Calf strengthening exercises help repair and prevent muscle imbalances that cause joint deformities.

Sit on the floor with your feet straight out ahead of you. Place a towel or resistance band around the sole of your foot and hold the end of the towel or band with both hands. Pull up with the towel as you arch your foot upward, toes toward the sky. If you are doing it properly, you will feel a pull in your hamstrings. 

Another great exercise for strengthening your calf muscles is the toe raise. Stand on a staircase, facing up stairs. Hold on to the banister and rise onto your toes. Hold the position for 5 seconds and repeat.
If you are suffering from hammertoes, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.

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Subluxation and Peroneal Tendon Injuries

A tendon is a band of tissue that connects a muscle to a bone. The two peroneal tendons in the foot run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains.
Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. Basic types of peroneal tendon injuries are tendonitis, tears, and subluxation.

Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon, or trauma (such as an ankle sprain). Symptoms of tendonitis include: pain, swelling, and warmth to the touch.
Acute tears are caused by repetitive activity or trauma. Immediate symptoms of acute tears include: pain, swelling, and weakness or instability of the foot and ankle.
As time goes on, these tears may lead to a charge in the shape of the foot, in which the arch may become higher.
Degenerative tears (tendonosis) are usually due to overuse and occur over long periods of time- often years. In degenerative tears, the tendon is like taffy that has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at risk for developing a degenerative tear. The symptoms of degenerative tears may include:

• Sporadic pain (occurring from time to time) on the outside of the ankle.
• Weakness or instability in the ankle.
• An increase in the height of the arch.

Subluxation- one or both tendons have slipped out of their normal position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include:

• A snapping feeling of the tendon around the ankle bone.
• Sporadic pain behind the outside ankle bone.
• Ankle instability or weakness.

Early treatment of subluxation is critical, since a tendon that continues to sublux (move out of position) is more likely to tear or rupture. Therefore, if you feel the characteristic snapping, see a foot and ankle surgeon immediately.
Because peroneal tendon injuries are sometimes misdiagnosed and may worsen without proper treatment, prompt evaluation by a foot and ankle surgeon is advised. To diagnose a peroneal tendon injury, the podiatrist will examine the foot and look for pain, instability, swelling, warmth, and weakness on the outer side of the ankle. In addition, an x-ray or other advanced imaging studies may be needed to fully evaluate the injury. The podiatrist will also look for signs of an ankle sprain and other related injuries that sometimes accompany a peroneal tendon injury. Proper diagnosis is important because prolonged discomfort after a simple sprain may be a sign of additional problems.
Treatment depends on the type of peroneal tendon injury. Option include:

• Immobilization. A cast or splint may be used to keep the foot and ankle from moving and allow the injury to heal.
• Medications. Oral or injected anti-inflammatory drugs may help relieve the pain and inflammation.
• Physical therapy. Ice, heat, or ultrasound therapy may be used to reduce swelling and pain. As symptoms improve, exercises can be added to strengthen the muscles and improve range of motion and balance.
• Bracing. The surgeon may provide a brace to use for a short while or during activities requiring repetitive ankle motion. Bracing may also be an option when a patient is not a candidate for surgery.

In some cases, surgery may be needed to repair the tendon or tendons and perhaps the supporting structures of the foot. The podiatrist will determine the most appropriate procedure for the patient's condition and lifestyle. After surgery, physical therapy is an important part of rehabilitation.
If you are suffering from a subluxation peroneal tendon injury, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.

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My Second Toe Hurts: Capsulitis

Ligaments surrounding the joint at the base of the second toe form a capsule, which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed.
Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort, and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis- also referred to as predislocation syndrome- is a common condition that can occur at any age.
It is generally believed that capsulitis of the second toe is a result of abnormal foot mechanics, where the ball of the foot beneath the toe joint takes an excessive amount of weight-bearing pressure.

Certain conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of the foot. These most commonly include a severe bunion deformity, a second toe longer than the big toe, an arch that is structurally unstable, and a tight calf muscle.
Because capsulitis of the second toe is a progressive disorder and usually worsens if left untreated, early recognition and treatment are important. In the earlier stages- the best time to see treatment- the symptoms may include:

• Pain, particularly on the ball of the foot. It can feel like there's a marble in the shoe or a sock is bunched up.
• Swelling in the area of pain, including the base of the toe.
• Difficultly wearing shoes.
• Pain when walking barefoot.

In more advanced stages, the supportive ligaments weaken leading to failure of the joint to stabilize the toe. The unstable toe drifts toward the big toe and eventually crosses over and lies on top of the big toe- resulting in crossover toe, the end stage of capsulitis. The symptoms of crossover toe are the same as those experienced during earlier stages. Although the crossing over of the toe usually occurs over a period of time, it can appear more quickly if caused by injury or overuse.
An accurate diagnosis is essential because the symptoms of capsulitis can be similar to those of a condition called Morton's neuroma, which is treated differently from capsulitis.
In arriving at a diagnosis, the foot and ankle surgeon will examine the foot, press on it, and maneuver it to reproduce the symptoms. The podiatrist will also look for potential causes and test the stability of the joint. X-rays are usually ordered, and other imaging studies are sometimes needed.
The best time to treat capsulitis of the second toe is during the early stages, before the toe starts to drift toward the big toe. At that time, non-surgical approaches can be used to stabilize the joint, reduce the symptoms, and address the underlying cause of the condition.
The podiatrist may select one or more of the following options for early treatment of capsulitis:

• Rest and ice. Staying off the foot and applying ice packs helps reduce the swelling and pain. Apply an ice pack, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
• Taping/splinting. It may be necessary to tape the toe so that it will stay in the correct position. This helps relieve the pain and prevent further drifting of the toe.
• Stretching. Stretching exercise may be prescribed for patients who have tight calf muscles.
• Shoe modifications. Supportive shoes with stiff soles are recommended because they control the motion and lessen the amount of pressure on the ball of the foot.
• Orthotic devices. Custom shoe inserts are often very beneficial. These include arch supports or a metatarsal pad that distributes the weight away from the joint.

Once the second toe starts moving toward the big toe, it will never go back to its normal position unless surgery is performed. The podiatrist will select the procedure or combination of procedures best suited to the individual patient.
If you are suffering from capsulitis of the second toe, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Bunching in My Foot: Morton's Neuroma

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. Intermetatarsal describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot.
The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.

People with certain foot deformities- bunions, hammertoes, flatfeet, or more flexible feet- are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports. An injury or other type of trauma to the area may also lead to a neuroma.
If you have a Morton's neuroma, you may have one or more of these symptoms where the nerve damage is occurring:

• Tingling, burning, or numbness
• Pain
• A feeling that there's something in the shoe or a sock is bunched up

The progression of a Morton's neuroma often follows this pattern:

• The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.
• The symptoms may go away temporarily by removing the shoe, massaging the foot, or by avoiding aggravating shoes or activities.
• Over time the symptoms progressively worsen and may persist for several days or weeks.
• The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

To arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests or imaging studies may be performed.
The best time to see your podiatrist is early in the development of symptoms. Early diagnosis of a Morton's neuroma greatly lessens the need for more invasive treatments and may avoid surgery.
In developing a treatment plan, your podiatrist will first determine how long you've had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.
For mild to moderate neuromas, treatment options may include:

• Padding. Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
• Icing. Placing an icepack on the affected area helps reduce swelling.
• Orthotic devices. Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.
• Activity modifications. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves. 
• Shoe modifications. Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
• Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
• Injection therapy. Treatment may include injections of cortisone, local anesthetics or other agents.

Surgery may be considered in patients who have not responded adequately to non-surgical treatments. Your podiatrist will determine the approach that is best for your condition. The length of recovery period will vary, depending on the procedure performed.
Regardless of whether you've undergone surgical or nonsurgical treatment, your surgeon will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities to reduce the repetitive pressure on the foot.
If you are suffering from a Morton's neuroma, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.

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