Footworks column September 2011
By Alexandra Buk, DPM
Lumps On The Bottom Of The Foot

A few months ago we reviewed the most common mass found at the top of the foot: the ganglion cyst. Today we turn our attention to the bottom of the foot, where the two most common benign tumors found are plantar fibromas and rheumatoid nodules.

Plantar Fibromatosis

Plantar fascial fibromatosis, also known as Ledderhose’s disease, is a non-malignant thickening of the foot’s deep tissue layer known as the plantar fascia. In the beginning, when the nodules or cord just begin to grow, the disease is minor. Eventually the cords thicken and walking becomes painful. The disease is named after Dr Georg Ledderhose, a German surgeon who described the condition for the first time in 1894. A similar disease is Dupuytren’s disease, which affects the hand and causes bent fingers.

As in most forms of fibromatosis, it is usually benign and its onset varies with each patient. The nodules are typically slow growing and most often found in the central and medial portions of the plantar fascia,, near the highest point of the arch. Occasionally, the nodules may lie dormant for months or years only to begin rapid and unexpected growth. The lump is usually painless and the only symptoms occur when the nodule rubs on the shoe or floor. The overlying skin is freely moveable, and usually there is no contracture or curling of the toes in the early stages.

The typical appearance of the plantar fibromatosis on MRI is a poorly defined, infiltrative mass in the tissue next to the muscles on the bottom of the foot. Only 25% of patients show symptoms on both feet.

The root causes of plantar fibromatosis are unknown, however it has been noted that it is an inherited disease, and there are certain risk factors. The disease is more commonly associated with:

• A family history of the disease
• Higher incidence in males
• Palmar fibromatosis, 10-65% of the time
• Epilepsy patients
• Patients with diabetes

There is also a suspected link between incidence and alcoholism, smoking, liver disease, thyroid problems and stressful work involving the feet.

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ARTICLE LINK: http://arkfac.com/footworks-column/419/lumps-on-the-bottom-of-the-foot
RELATED TOPICS: bottom of the foot • fibromatosis • foot surgery • ledderhose's disease • plantar fibromatosis • rheumatoid arthritis • soft tissue tumors • tumor

By Dr Alexandra Buk

Summer is often the time we hear more about skin cancer. We are told by our doctors to avoid the sun if possible and always wear sunscreen when we are in the sun. But many people never think about their feet when they take preventative action, even though malignant melanoma (a serious type of skin cancer) can affect the legs and feet as well as other parts of the body.

Melanomas on the feet can occur in men and women, and while they usually develop in people over the age of 50, they can be found at any age. Lighter-skinned people are more likely to develop melanomas on sun-exposed areas of the body, but only one third of African-American patients who have melanoma develop it on sun-exposed areas. In the African-American population, melanomas most often develop on areas that are not exposed to the sun, such as the foot and under the toenails. Early detection is extremely important since malignant melanoma can spread (metastasize) rapidly.

Since melanomas on the foot and ankle often go unnoticed during their earliest stage, routine foot examinations can increase the likelihood of diagnosing and treating malignant melanomas. During routine examinations your podiatrist will always look for moles, or “nevi,” which are usually evenly colored, round spots on the skin or even under the nails. Most are small and don’t change in size or shape. However, the doctor will carefully examine any moles that look “abnormal.”

The podiatrist will use a common dermatological rule (the “ABCD” rule) to characterize the melanoma:

• Asymmetrical lesions
• Border irregularity
• Color variation
• Diameter greater than the size of a pencil eraser

Skin cancer is rarely painful, so routine podiatric medical visits are important for anyone with questionable lesions on the feet. Other signals to watch for are changes in color or a mole that becomes raised from the skin. Malignant melanomas in the feet usually occur between the toes, in and around the nails, and on the soles of the feet.

ARTICLE LINK: http://arkfac.com/articles/314/melanomas
RELATED TOPICS: ABCD rule • malignant melanoma • melanomas • patients • skin • skin cancer • summer • sunburn

By Dr Alexandra Buk

Summer is a great time to get outside and enjoy yourself. However, increased activity can often lead to problems with our feet and ankles, particularly ankle sprains. Many emergency rooms across the country see increases in sprained ankles during the summer months. Most of us have twisted and ankle at some point, either while doing something as simple as stepping off a curb, or while starting a heart-healthy activity such as walking outdoors. Sometimes, these “twists” can be more serious and need to be treated as quickly as possible.

If your ankle becomes swollen, painful or bruised after you injure it, you have most likely sprained your ankle. This means you have probably stretched and possibly torn the ligaments in your ankle. The first steps to take are easy to remember if you can recall the word “RICE.”

• R = Rest. Restrict your activity, and get off your foot/ankle.
• I = Ice. Gently place a plastic bag of ice wrapped in a towel on the injured area in a 20- minute-on, 40-minute-off cycle.
• C = Compression. Lightly wrap an elastic bandage around the area, taking care not to pull it too tight.
• E = Elevation. To reduce swelling and pain, sit in a position that allows you to elevate the foot/ankle higher than your heart.

If the sprain is mild, the podiatrist may not take x-rays. But with more severe sprains, you may need X-rays or advanced imaging studies to rule out broken bones, ligament or tissue damage, and cartilage damage in the foot and ankle. In addition, these studies can determine if there are growth plate injuries in children. To help your ankle heal, your podiatrist may prescribe a protective brace or some form of ankle support. At times, it may be necessary to immobilize the ankle in a soft or hard cast so that healing can occur more rapidly. Rest is particularly important, so in order to keep weight off your ankle, you may also be advised to use crutches for a defined period during healing. In addition, anti-inflammatory medications will probably be suggested to reduce pain and swelling.

After a specific period of time, you may be required to do some physical therapy, either at home or with a certified therapist. Since it is important to make sure the ankle is fully healed before returning to activities, the doctor may also recommend taping your ankle or wearing a supportive brace.

Send your summer foot care questions to Dr Buk at The Arkansas Foot and Ankle Clinic

Link back to the Doctor’s article regarding sandals, flip-flops, and summer shoes from last month.

ARTICLE LINK: http://arkfac.com/articles/308/sprained-ankle-sprains-article-foot-doctor
RELATED TOPICS: ankle • doctor • sprained • sprains • twisted