Nail fungus, a common condition
Nail fungus is a common condition that begins as a white or yellow spot under the tip of your fingernail or toenail. As the fungal infection continues, it may cause your nail to discolor, thicken, and crumble at the edge…and can affect several nails.
If your condition is mild, you may not need treatment. If it’s painful and has caused thickened nails, self-care steps and medications may help. But even if treatment is successful, nail fungus often does comes back.
When fungus infects the areas between your toes and the skin of your feet, it's called athlete's foot.
SymptomsYou may have nail fungus if you have one of the following:

• Thickened
• Whitish to yellow-brown discoloration
• Brittle, crumbly or ragged
• Distorted in shape
• A dark color, caused by debris building up under your nail
• Smelling slightly foul

While, nail fungus can affect fingernails, it's more common in toenails.
When to see a doctor
You may want to see a doctor if self-care steps haven't helped and the nail becomes increasingly discolored, thickened or deformed. If you have diabetes and think you're developing nail fungus, you should see a doctor.

Fungal nail infections are caused by various fungal organisms. The most common cause is a type of fungus called dermatophyte. Yeast and molds also can cause nail infections.
Fungal nail infection can develop in people at any age, but it's more common in older adults. As the nail ages, it can become brittle and dry. The resulting cracks in the nails allow fungi to enter. Other factors such as reduced blood circulation to the feet and a weakened immune system may also play a role.
Toenail fungal infection can start from athlete's foot (foot fungus), and it can spread from one nail to another. But it is uncommon to get an infection from someone else.
Risk factorsFactors that can increase your risk of developing nail fungus include:

• Being older with reduced blood flow, more years of exposure to fungi and slower growing nails
• Sweating heavily
• Having a history of athlete's foot
• Walking barefoot in damp communal areas like swimming pools and shower rooms
• Having a minor skin or nail injury or a skin condition, such as psoriasis
• Having diabetes, circulation problems or a weakened immune system

Contact our offices Laurel Foot & Ankle Center or Northern Virginia Foot & Ankle Associates and schedule an appointment today.To learn more about treating toenail fungus, go to Heel Pain Institute of America or Laurel Foot & Ankle Center or Northern Foot & Ankle Associates.
 

The majority of people with rheumatoid arthritis do develop foot symptoms.
Rheumatoid Arthritis (RA) is a tough diagnosis to receive, as it is an autoimmune disease that can cause severe pain and joint deformity and also happens to be incurable. However, the treatment options available are the most advanced they have ever been—and are allowing many people with RA who would have otherwise been destined for wheelchairs to live full and active lives.
 
One of the early signs of rheumatoid arthritis is stiffness, pain, and swelling in the hands and feet. The onset is gradual for some and immediate for others, but regardless, most people with RA wake up one day and realize that the joints in the ball or sole of their feet are too painful to walk on. At the same time, they might also notice their fingers stiffen while trying to open a jar, or that they can't bend certain finger joints while cooking because it's too painful. As the disease progresses, pain and stiffness may spread to the wrists, elbows, shoulders, knees, ankles, and hips. 
Parts of the Foot Affected by RAWhen it comes to the feet, RA typically affects the metatarsophalangeal (MTP)joints of the toes. When RA persistently affects the MTP joints, a gradual outward (lateral) shift in the toes can occur. This may cause both feet to develop bunions. RA may also cause shifting of the forefoot and loss of stability, which leads to toe contractures, such as hammertoes. Toe contractures and changes in toe joint flexibility will often lead to calluses and pain beneath the ball of the foot. All of these changes to a foot's structure and shape can make finding a comfortable shoe more difficult.
Other joints of the foot that can be affected by RA include the ankle joint and the talonavicular joint, which is part of the foot's arch. When the talonavicular joint is affected, the foot can become destabilized and flat feet can develop.
What distinguishes RA pain from the more common Osteoarthritis (OA)pain is that multiple joints are usually affected at the same time with RA and the joint symptoms are generally symmetrical, occurring on both sides of the body equally. Another feature that distinguishes RA from OA is the tendency for RA to cause a longer period of morning stiffness.
 
 
 
An RA sufferer will often experience stiffness in affected joints for one or more hours after awakening, compared with an OA sufferer, whose joint stiffness may diminish after a few minutes of stretching in the morning.
While not everyone will have foot involvement with RA, the majority of people do have some level of it. However, the most important thing to note is that there are many pharmacological treatment options as well as lifestyle interventions that can make a tremendous difference in managing all aspects of the disease, including its foot manifestations. A close relationship with your rheumatologist as well as your foot doctor, who will work to relieve your pain and inflammation, halt joint damage, and improve your sense of well-being—will ensure the best outcomes possible throughout the course of your disease. 
 
Contact our offices Laurel Foot & Ankle Center or Northern Virginia Foot & Ankle Associatesand schedule an appointment today.
To learn more about aching feet, go to Heel Pain Institute of America or Laurel Foot & Ankle Center or Northern Foot & Ankle Associates.

Of the thousands of species of fungi, there are only a few that can cause disease or discomfort in people. Invasive fungal disease is relatively rare in healthy persons because of our sophisticated immune systems. However, serious fungal diseases frequently occur in immune compromised patients.
Compromised immunity
Uncontrolled HIV infection, for example, makes many people vulnerable to lethal fungal diseases. Cancer treatments and diabetes can also compromise a person’s immunity. In addition, corticosteroids, immunosuppressant’s and prolonged courses of antibiotics can also make the body more susceptible to fungal infections.
Put this list of fungal infections on your radar
1. Athletes Foot is a fungal infection of the feet with itching, scaling and redness.
2. Ringworm can appear in the form of a red or silver rash anywhere on the body. It is usually ring-shaped.
4. Onychomycosis is a fungal infection of the toenails or fingernails that can involve any component of the nail, including the matrix, bed or plate. It can cause pain, discomfort and disfigurement. Yeast and molds also cause nail infections.
5. Tinea Versicolor or pityriasis versicolor is a common condition that causes small patches of skin to become scaly and discolored. They can be darker or lighter than the surrounding skin, or even red or pink. The condition is caused by a yeast called Malassezia, which lives on the skin of most people without causing any problems.
6. Cutaneous Candidiasis can involve almost any skin area of the body, but mostly occurs in warm, moist, creased areas such as the armpits and groin. Candida is the most common cause of nappy rash in infants. Candida is also common in people who are obese or have diabetes. Antibiotics, steroid therapy and chemotherapy increase the risk of cutaneous Candidiasis. Candida can also cause infections of the nails
Contact our offices Laurel Foot & Ankle Center or Northern Virginia Foot & Ankle Associatesand schedule an appointment today.
To learn more about compromised immunity and foot disease, go to Heel Pain Institute of America or Laurel Foot & Ankle Center or Northern Foot & Ankle Associates.

ESWT originated during World War II. Submarine sailors were injured from the sonic booms from depth charges because the shock waves damaged tissues of internal organs, including the lungs. The mechanisms that altered the tissue were researched and in the 70s shock waves were used for lithotripsy to treat kidney stones. By the 90s practitioners were using the modality to treat painful tendons, ligaments and fascia.
The mechanical effect of ESWT creates air bubbles in the fluids of tissue. The bubbles expand and burst creating shearing forces. The shearing forces cause cell changes. The cellular changes are ones that promote healing and tissue growth. Pretty amazing!
When patients decide to have the treatment, it can be painful. The treatment has side effects. There can be bruising, skin redness, little blood blisters. It’s very rare, but it can cause nerve and blood vessel damage. Geez, that doesn’t sound too good, does it?!! Still, there are many people who swear by the treatment. And, the listed side effects are rare.
At Laurel Foot & Ankle and Northern Virginia Foot & Ankle, we don’t do ESWT. We have many other ways (that we think are better) to treat the pain and dysfunction you are experiencing. But, we thought you might find this interesting.
Contact our offices Laurel Foot & Ankle Center or Northern Virginia Foot & Ankle Associatesand schedule an appointment today.
                                                                                        
To learn more about EPAT, the revolutionary, non-invasive, FDA approved, and highly effective treatment for your feet, go to Heel Pain Institute of America or Laurel Foot & Ankle Center or Northern Foot & Ankle Associates.

Gout is a condition that often affects your feet, especially in the big toe, because of too much uric acid in your body. The affected area may feel very painful. Some describe the pain as feeling like your foot is on fire.
This condition occurs in many forms and in four stages. You may experience gout that comes and goes or develop more chronic gout over time that damages your joints.
Gout can be aggravated for many reasons, such as from eating certain foods, and occurs most commonly in men between 40 and 50 years old and in postmenopausal women.
Your doctor can treat gout and may recommend healthy lifestyle habits to manage symptoms.
Causes of gout
Gout is a complex disease. There are a variety of factors that can play a role in causing it. Certain conditions, such as blood and metabolism disorders, can cause your body to produce too much uric acid. Drinking too much alcohol can also lead to excess uric acid.
Some foods can also cause gout when you eat too much of them. These include:

• shellfish
• red meat
• organ meat
• sweet juices
• salt

You can also develop gout if your body isn’t eliminating uric acid properly. If you’re dehydrated or starved, it can make it difficult for your body to excrete uric acid. This causes it to build up as deposits in your joints.
Contact our offices Laurel Foot & Ankle Center or Northern Virginia Foot & Ankle Associates and schedule an appointment today.
To learn more about Athlete’s Foot or Gout and your feet, go to Heel Pain Institute of America or Laurel Foot & Ankle Center or Northern Foot & Ankle Associates.

Preventing toenail fungus may not be at the top of your to-do list, but perhaps it should be. Fungi are nearly everywhere in our environment, and they really love dark, moist, warm places, like the inside your shoes. You definitely need to be aware of any changes in color or texture- both an indication that you could have a nail fungus.
 
What Exactly is Nail Fungus?
Toenail fungus is an infection that makes its way into your skin through cuts or cracks. Toes are a great environment for the fungus because they are very often warm and damp. There are different kinds of fungi that can, in some cases, spread to other toenails, skin, or even your fingernails.

A Guide to Symptoms
Thicker than normal, warping and odd shaped nails could all be symptoms of nail fungus. Sometimes the nails will break very easily, and they can look yellow.  A white dot can also appear on the nail and then grow larger. When fungus builds up under your nail, it can loosen and even separate the nail from the bed. The fungus can also spread to the skin around your nail.
 
Who Gets Toenail Fungus?
Almost anybody can get toenail fungus. Although, certain groups are more prone. Men – are much more likely to get it than women. Age - the older you are the better the odds you will get toenail fungus. Also, there’s an increased risk for people who have diabetes, athlete's foot, weak immune system, smoke, or whose family members have it as well. Prior injuries to toenails are also a risk factor.
 
When Should You Seek Help?
Since there are different types of toenail fungus, and the infection can look like other conditions, it’s really best to get a diagnosis as soon as possible. A podiatrist can in all likelihood diagnose very quickly, but may need to take a small sample of the infected area to confirm the diagnosis.
 
Treatment
A variety of treatments may be needed, and that’s another reason to have a podiatrist make the diagnosis. A podiatrist can also determine the severity of the problem and immediately recommend the best treatment or combination of treatments.
Treatments might Include:

• Topical cream that goes directly on the nail
• Topical nail lacquer
• Antifungal prescription pill
• Nail smoothing
• Laser therapy
• Shoe treatment
• In some cases, oral antibiotics may be prescribed
• Removing the damaged area of the nail or skin
• Finally, there is a possibility of surgery to remove the nail

Prevention
Here below is a list of the best ways to avoid toenail fungus.

• Cleanliness- Use soap and water to wash your feet, and dry well, including between toes. Wear shower shoes in wet public places like locker rooms and swimming pools.
• Keep Feet Dry. Choose socks that wick moisture away. Change them regularly.
• Trim nails straight across, not at an angle and to the proper length (shorter than the end of your toe).
• Use clean tools. Nail clippers and files should be washed with soap and water, and wiped down with rubbing alcohol.
• Take a break from nail polish. The nail bed needs to "breathe," to allow the fungus to go away.

 
If you notice changes in color or texture, have pain or notice any of the other symptoms described above, then it’s time to contact us for a diagnosis and the best in recommended care.
Contact our offices Laurel Foot & Ankle Center or Northern Virginia Foot & Ankle Associates and schedule an appointment today.
To learn more about Diabetes and your feet, go to Heel Pain Institute of America or Laurel Foot & Ankle Center or Northern Foot & Ankle Associates.

The two main foot problems that affect people with diabetes are:

Diabetic Neuropathy
Over time, diabetes can cause nerve damage that makes it hard for people to feel sensation in their extremities.
This condition also makes it difficult for a person to feel a foot irritation or notice when their shoes are rubbing. This lack of sensation and awareness leads to an increase in the risk of cuts, sores, and blisters developing.

Peripheral Vascular Disease
Diabetes leads to changes in the blood vessels and arteries. In peripheral vascular disease, fatty deposits block these vessels beyond the brain and heart. It tends to affect the blood vessels leading to and from the extremities, reducing blood flow to the hands and feet.
Reduced blood flow can lead to pain, infection, and slow healing wounds. Severe infections may lead to amputation.

Symptoms
Symptoms vary from person to person. Symptoms of diabetic foot problems can include the following:

• loss of feeling
• numbness or tingling sensation
• blisters or other wounds without painful
• skin discoloration
• skin temperature changes
• red streaks
• wounds with or without drainage
• painful tingling
• staining on socks
• deformed foot appearance

If an infection is present in a foot, a person may also experience some of the following:

• fever
• chills
• uncontrollable blood sugar
• shaking
• shock
• redness

Anyone who experiences any of the symptoms of an infection should seek emergency treatment.
Complications Diabetic neuropathy and peripheral vascular disease are serious conditions that must be monitored closely. Both cause complications that can have serious negative effects. These complications may include:

• foot ulcers, or wounds, that do not heal
• infections, including skin infections, bone infections, and abscesses
• gangrene, when an infection causes tissue death
• foot deformity
• Charcot's Foot (fractures or dislocations in the foot that may cause deformities)

When To See A Doctor

Seek immediate medical attention if there are changes to the feet such as skin color, persistent sores, tingling, and swelling of the foot or ankle.

People who have diabetes should see a doctor regularly as part of their care. Immediate medical attention should take place if any of the following is perceived:

• changes in foot skin color
• swelling in the foot or ankle
• temperature changes in the feet
• persistent sores on the feet
• pain or tingling in the feet or ankles
• ingrown toenails
• athlete's foot or other foot fungal infections
• dry and cracked skin on the heels
• signs of infection

Treatment Surgical and nonsurgical treatments for diabetic foot problems vary according to the severity of the condition.

Nonsurgical treatment Nonsurgical options are normally the first method of treatment for diabetic foot problems. Some of these include:

• keeping wounds clean and dressed
• immobilization devices, such as a cast boot or total contact cast
• close observation of gangrene toes until self-amputation occurs, when the toes fall off due to lack of blood flow

Surgical treatment When nonsurgical treatment fails to heal diabetic foot problems, surgery may be considered. Surgical options include:

• removal of decaying or dead tissue
• amputation, varying from toe or part of the foot to amputation of the leg below the knee, or above the knee in some cases
• surgical stabilization of Charcot's Foot
• arterial bypass for peripheral vascular disease, or endovascular surgery with placement of stents

 
Contact our offices Laurel Foot & Ankle Center or Northern Virginia Foot & Ankle Associates and schedule an appointment today.

To learn more about Diabetes and your feet, go to Heel Pain Institute of America or Laurel Foot & Ankle Center or Northern Foot & Ankle Associates.

Your ankle pain may be caused by Tarsal Tunnel Syndrome

What Is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is a compression 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.  That narrow path is called the tarsal tunnel.
The tunnel is covered with a thick ligament that protects and maintains the structures contained within the tunnel—arteries, veins, tendons and nerves. One of these structures is the posterior tibial nerve.

Causes
Tarsal tunnel syndrome is caused by anything that produces the compression listed above:

• A flat-footed person 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 or 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 diseases, such as diabetes or arthritis, can cause swelling, which compresses the nerve.

Symptoms
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 or the calf.
Symptoms are often brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising or beginning a new exercise program.

Ill-fitting shoes can cause black toenails

Black or darkened toenails are essentially bruised nails and can result from a variety injuries or problems. Darkened nails may occur as a result of the toe hitting the end or the top of the shoe toe area. Sometimes, the bruise can lead to a fungal nail infection.

Treatment may include trimming the nail back and applying a topical anti-fungal medication. If the skin under the nail is ulcerated, a topical antibiotic ointment should be applied.

Diabetic patients should contact our office for evaluation if they experience any change in the color of toenails. The pressure causing the bruised nail may lead to a small sore under the toenail, which can lead to infection.

We’ve compiled a lit of helpful tips for buying the right show to avoid black toenails and other issues resulting in bad shoe fit for running, hiking or walking.

Heel
Your heel should fit snug, but not tight. Laced up (but not tied), you should be able to slide your feet out. Lacing your shoes up through the final eyelet minimizes slippage. There will be some heel movement, but it shouldn’t be uncomfortable. Any irritation you feel in the store will be amplified once you are out and about.

Instep
A shoe’s upper should feel snug and secure around your instep. If you feel pressure and tightness, you need more space. If an otherwise great shoe has hot spots or pressure under the laces, try some alternative lacing techniques before moving on to the next shoe.

Width
Your foot should be able to move side-to-side in the shoe’s forefoot without crossing over the edge of the insole. You should be able to pinch a quarter inch of upper material along the widest part of your foot. If the shoe is too narrow, you’ll feel the base of your little toe sitting on the edge of the shoe last.

Length
Feet swell and lengthen over a run, so make sure there’s a thumb’s width of space between your longest toe (which might not be the big toe) and the end of a shoe. A shoe fitter can measure this while you stand with your shoes laced up. Your toes should also wiggle freely up and down. Wiggle room protects against front-of-the-foot issues like black toenails.

Flex
Check the flex point before you put on the shoe. You can do this by holding the heel and pressing the tip of the shoe into the floor. The shoe should bend and crease along the same line your foot flexes. An improperly aligned flex point can lead to arch pain or plantar fasciitis. A lack of flexibility can lead to Achilles tendon or calf strain.

Feel
You need to pinpoint shoes that match your foot’s contours and movements. You can’t get a good feel by just standing. So, take your shoes for a quick jog, either on a store’s treadmill, or just down a hallway. Back off the amount of support if you feel your arch cramping. Your shoe should support your stride, not try to alter it.

Tight-fitting shoes lead to blisters and black toenails. Play the piano with your toes, meaning the fit should be roomy enough in the forefoot, but not sloppy.

Contact our offices Laurel Foot & Ankle Center or Northern Virginia Foot & Ankle Associates and schedule an appointment today.

To learn more about Black toenails, go to Heel Pain Institute of America and Laurel Foot & Ankle Center or Northern Virginia Foot