Biographical Sketch

Dr. Pietrocarlo is a podiatrist who has been practicing in the Milwaukee area for the past 25 years. He is a graduate of the Ohio College of Podiatric Medicine. His special interests are in the area of foot surgery and sports medicine. He has authored numerous articles on foot and ankle problems in athletes. His professional affiliations include Clinical Instructor, Medical College of Wisconsin, Diplomat, American Board of Podiatric Surgery, Fellow, American College of Foot and Ankle Surgeons and Member, American College of Sports Medicine.

The foot is one of the most common areas of injury in avid walkers, climbers, hikers and skiers. This is predictable when one considers the myriad of factors affecting the feet during these activities. These include shoe gear, structural variations in the feet, environmental factors, uneven terrain, cumulative mileage and impact factors to name a few.

The purpose of this article will be to cover some of the most common injuries. Each condition will be defined, the cause will be explained, symptoms present and treatment and prevention.

Friction Blisters
Definition: A friction blister is a build up of fluid or blood between the epidermis and dermal layer of skin caused by shearing forces applied to the skin.

Causes include:

• Ill fitting shoes (socks)
• Skin moisture
• Pressure points on the foot

• Drainage using a sterile instrument (pin or knife cleaned with alcohol)
• Leave roof of blister intact
• Apply antibiotic dressing

• Reduce perspiration by applying topical antiperspirant
• Identify areas of friction and pad them with moleskin
• Check shoe fit
• Wear socks that wick away moisture (polypropylene)
• Apply Vaseline to areas of friction

Athlete’s Foot
Definition: Athletes foot infections are caused by a fungal infection of the skin. There are a variety of fungal organisms that can cause such infections.

Causes:

• Moisture, heat and darkness, all of which occur in your shoes

• Itching, weeping, oozing and skin macerations
• Symptoms most commonly occur in the web spaces between the toes.
• Chronic cases may cause dry, scaly redness on the soles of the feet

• Change socks frequently if wet or use moisture wicking socks (acrylic).
• Cleanse feet often.
• Apply topical anti-fungal creams until symptoms resolve and anti-fungal powders for preventative maintenance.

• Keep feet dry
• Use an anti-fungal powder in shoes and socks.

Warts
Definition: A benign skin growth caused by a papilloma virus. A common skin condition in the foot.

Cause:

• Exposure to other individuals or surfaces that harbor the virus.
• Excessive perspiration of the feet can be a contributory factor

• Warts appear as painful bumps on the feet. They often bleed easily and are often confused as corns and calluses.
• They can occur on the soles of the feet (plantar warts) or toes.
• They are often painful when squeezed side to side

• Initial treatment can be performed with over the counter products. Most of these include salicylic acid in various concentrations
• Periodic paring down with a pumice stone
• If unresponsive then seek professional help from your physician or podiatrist

• Avoid going barefoot in communal environments (showers)
• Keep feet dry

Black Toenails
Definition: A black toenail (subungual hematoma) in a build up of blood beneath the nail plate. If may be acute, due to stubbing the toe or dropping a heavy object on the toe or chronic, due to repeated friction of the nail.

Cause:

• Acute or chronic injury to the nail.
• Improper fitting shoes (too short, not enough room in the toe box)
• Repeated jamming of toes in boots, especially going downhill grades

• Acute pain in the toenail
• Minimal pain but discoloration of the nail
• Occasional bleeding and drainage from beneath the nail

• If pain is acute, the hemorrhage beneath the toenail must be drained.
• In the field this can be done by heating a paperclip or sharp instrument and applying it to the nail plate until drainage occurs.
• If you have access to a physician or clinic, they can decompress the nail with a high-speed drill or electrocautery.
• Chronic non-painful cases can be left alone. The nail will often grow out and eventually fall off leaving a new nail beneath it.

• Careful fitting of shoes and socks.
• Avoidance of acute injuries to the toes

Corns and Calluses
Definition: Corns and calluses are thickening of the skin caused by excessive localized pressure due to foot deformities or improper fitting shoes.

Cause:

• Improper fitting shoe
• Foot deformities such as bunions, hammertoes and flat feet.

• Painful thickening of skin usually over a bone prominence
• Most common areas are the toes and balls of feet

• Debride painful calluses with a pumice stone.
• Apply moisturizing creams daily.
• Pad areas of irritation with protective materials including moleskin, felt and tape.
• Seek professional help from a podiatrist if symptoms persist.

• Check shoe fit to make certain there are no pressure points on the foot.
• Pad any bony prominences to avoid development.

Stress Fractures
Definition: A stress fracture is a partial or incomplete fracture of the bone due to repeated stress. The feet and ankles are the most common areas of involvement.

Cause:

• Repeated cyclic activities
• May be predisposed to women with osteoporosis
• Often occurs in non-conditioned athletes not accustomed to long walking or hiking.
• Certain athletes may be predisposed due to structural abnormalities in the feet.

• Sudden onset of pain and swelling over the bone without a history of acute injury
• Most common area in the foot is the metatarsal area (in-step area) although the heel and other areas are often injured.

• Immobilization and rest
• Discontinue strenuous activities until symptoms resolved
• Seek medical evaluation and x-rays. Bone scan may be necessary if x-rays are negative.

• Slowly work into strenuous activities.
• Wear good supportive shock absorbing shoe gear.
• If you suspect that you may have osteoporosis, seek medical advice from your physician

Plantar Fasciitis
Definition: A chronic degenerative process causing inflammation of the plantar fascia (arch ligament) and often the development of a heel spur.

Cause:

• Foot type often predispose to plantar fasciitis (i.e. flat or high arch feet)
• Improper shoes for your particular activity
• Overuse
• Obesity
• Surface terrain

• Acute pain in the heel upon arising in the morning or after arising from a period of rest. The pain often extends into the arch area.
• Symptoms are often improved after being on your feet for a while but often return later in the day.

• Initially cutting back on athletic activities
• Icing daily
• Use of anti-inflammatory medications
• Plantar fascia night splint
• An arch support
• Calf stretching exercises
• If symptoms fail to improve consult with your podiatrist or physician. For prescription anti-inflammatory medications, physical therapy and possible prescription orthotics

• Supportive shoe gear
• Flexibility exercises for the calves
• If you have flat feet, consider an arch support

Haglund’s Deformity
Definition: A Haglund’s deformity is defined as an abnormal prominence of the posterior and superior aspect of the heel.

Causes:

• Often a congenital problem
• More common in women

• Blister and callus formation over the posterior aspect of the heel
• Repeated irritation and often swelling of the heel
• A noticeable bony enlargement of the back of the heel

• Calf stretching
• Icing
• Protection from irritation by padding the boot or heel with moleskin, felt or foam
• Surgery if symptoms become chronic

• Careful boot fitting to avoid irritation

Achilles Tendonitis
Definition: A traumatic or degenerative condition of the conjoined tendon of the calf muscle at or above its attachment to the heel.

Cause:

• Lack of Achilles tendon flexibility
• Uphill walking, hiking or climbing
• Foot imbalances such as flat or high arch feet may be a predisposing problem.

• Localized pain and swelling along the tendon.
• Pain when squeezing the tendon.

• Calf stretching exercises before and after activities
• Temporary heel lift in shoe or boot to relax the tendon
• Icing
• Anti-inflammatory medication
• Arch supports if you have flat feet
• Use of night splint to stretch the tendon
• Avoidance of hills
• Possible physical therapy if symptoms fail to improve
• Immobilization in a cast if symptoms fail to improve

• Flexibility exercises for the calves
• If you have a particular foot deformity compensate by wearing an arch support
• Slowly build up to hill climbing

Neuroma:
Definition: A neuroma represents an entrapment or compression of a nerve in the ball of the foot usually between the third and fourth toes.

Cause:

• Tight fitting shoes
• Repeated flexion of the toes
• Injury to the ball of the foot

• Numbness, burning and pain to the adjacent third and fourth toes
• Symptoms are exacerbated by tight fitting shoes or repeated flexion of the toes

• Shoes that area adequately wide
• Stiffer toed shoes rather than those with flexible soles
• Metatarsal padding
• Possible steroid injection of the neuroma by your podiatrist or physician
• Surgical removal if symptoms are unresponsive to conservative care

• Shoes that re of adequate width
• Stiffer soled shoes

Ankle Sprains:
Definition: An ankle sprain is a traumatic twisting injury usually involving the outer (lateral) ligaments of the ankle. The severity of the injury can vary from merely stretching the ligaments to a severe tear.

Cause:

• Acute inversion of the ankle usually due to uneven terrain

• Acute pain, swelling and often discoloration over the outer aspect of the ankle
• Often the outer ankle bone is very sore
• A feeling of weakness in the ankle and inability to bear full weight
• Discoloration will often occur on other areas of the foot as well

• Ice, elevation, rest, compression
• Splinting of the ankle
• Anti-inflammatory medication
• Examination by your podiatrist or physician to rule out a possible fracture or complete tear of the ligaments
• Crutches if necessary
• Physical therapy to reduce pain and symptoms and to rehabilitate the ankle

• Supportive boot
• Exercises for both strength and flexibility of the ankle
• If you are prone to ankle sprains, a supportive brace may be helpful

Bunion Deformity
Definition: A bunion is a complex deformity of the great toe joint resulting in a progressive dislocation. There is a progressive deformity of the foot with the metatarsal bone protruding and the large toe moving in the opposite direction.

Cause:

• Hereditary factors
• Women are more prone than men
• Flat footedness
• Tight fitting shoes

• Persistent pain, irritation, redness and blister formation over the prominent toe.
• Difficulty finding comfortable shoes
• Often associated with other deformities including hammertoes

• Wider shoes to accommodate for the deformity
• Softer upper on the shoes to avoid irritation
• Arch supports when indicated (flat feet)
• Padding of the bunion to avoid irritation in shoe
• Surgery if deformity is significant and unresponsive to conservative care

• Careful shoe fit
• Arch supports when indicated

Hallux Rigidus
Definition: Hallux rigidus represents degenerative arthritis of the large toe joint. This is one of the most common areas of the foot to experience arthritis.

Cause:

• Major trauma to the joint
• Repeated minor injuries to the joint
• Hereditary variation in the alignment of the joint

• Pain and stiffness in the large toe
• Inability to push off with the large toe
• Enlargement of the great toe joint with resultant shoe irritation

• Stiff soled shoes with a deep toe box to accommodate for the deformity
• Icing
• Anti-inflammatory medications
• Orthotics
• Surgery to correct the deformity. Various surgical procedures can be performed ranging from cleaning up the joint, joint fusion or joint replacement

• Avoiding of injury with stiff toed shoes

Hammer Toes
Definition: A hammertoe is a deformity of the lesser toes characterized by contraction of the toe.

Cause:

• Hereditary
• Poor shoes
• Foot imbalances (high and low arch)
• Often associated with bunion deformity

• Painful irritation of the top of the toes
• Corn formation
• Pain on balls of feet

• Deep toe box shoes
• Padding to avoid irritation
• Surgery if all measures fail

• Shoes with deep toe box
• Arch support if indicated

Summary

This article should serve to familiarize you with some of the more common foot and ankle injuries that can occur in outdoor recreational activities. There are many other conditions that can occur that are not included. If there are any doubts as to the type of injury or failure to respond to treatment, you should consult your local podiatrist.