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Posts for category: Toes

By Dr Aarti Kumar
February 25, 2021
Category: Toes
                                  In-toe (Pigeon Toe) Gait
Parents often bring their children in for an evaluation with podiatrists because of the way they walk. They commonly refer to their children as "pigeon toed". Pediatricians are usually the first to hear of this concern and will recommend the patient for a podiatry evaluation. 
In-toe gait refers to the turning in of the feet while standing and walking. Most times it is not painful and parents are concerned with the structure or their child falling during activity because of the malalignment. 
When it comes to evaluating in-toe gait, podiatrists will do a thorough examination in the office both walking and off weightbearing to see where the deformity is coming from. In-toe gait could come from the twisting of the thigh bone or femur, the leg bone or tibia or the long bones in the foot called the metatarsals. 
Twisting of the femoral bone is called femoral anteversion and it can lead to the knees causing a "knock knee appearance" along with the feet looking in-toe. This is mostly due to tight hip ligaments which can be addressed with a lot of stretching and physical therapy. Rotation of the leg bone or tibia is known as internal tibial torsion which can come from developmental formation or the way toddlers sit-specifically in the "W position". Finally, the long bones of the foot can be twisted in reference to the rearfoot known as metatarsus adductus. This is most common in babies/infants especially due to a tight in-utero position. If caught early, stretching and splinting is all that is needed to fix this. 
In-toed gait is a common condition seen in the pediatric population but if it goes untreated, it can be seen in the adult population as well. 
If you feel like you notice your child or yourself walking with your feet curled in, come into one of our offices and see our podiatrists for a biomechanical and gait examination. We look forward to helping you!
By Dr David Ehrlich
December 31, 2020
Category: Toes

In-toeing is a common gait or walking abnormality in which children walk with an inward or internally rotated attitude of the foot or leg. It is often referred to as walking “pigeon-toed.” Aside from appearing irregular, this type of gait pattern can lead to hip, knee, or back pain, and can cause tripping and falling.

An inward posture that causes in-toeing in children can result from a deformity of the foot, leg, or hip. A careful history and physical exam will often reveal the level of the deformity. Sometimes imaging studies such as x-rays may be obtained to aid in the proper diagnosis. Internal rotation at the level of the hip, also known as femoral anteversion or internal femoral torsion, is common in children ages 2-7. Aside from displaying an in-toe gait pattern, these children will often sit in a “W” position because their internally rotated hips cause this position to feel more natural. Femoral anteversion typically resolves on its own by age 10. In severe or more persistent cases, devices such as braces and orthotics may be considered to help control some of the inward rotation of the hip.

Internal rotation at the leg or knee level is referred to as internal tibial torsion and is most common in toddlers. It is considered normal for the leg to have some level of internal rotation in children. As we age, the lower leg de-rotates and the deformity begins to resolve. As a result, the vast majority of children with internal tibial torsion outgrow the deformity by age 10-12. If a child does not outgrow the deformity, they may be fitted for an orthotic with a specialized device referred to as a gait plate, which encourages the child to land with their feet in a straight position when they walk.

In-toe walking caused by a foot deformity is referred to as metatarsus adductus because the metatarsal bones of the foot are deviated in an inward direction. This deformity is apparent at birth, before the child starts walking. Parents may describe their child’s foot as being “C shaped” and may even suspect that the child has club foot. If detected early, metatarsus adductus can be treated by applying weekly casts to improve the position of the feet. This technique is called serial casting. If diagnosed later in life, special shoes or orthotics may be used. In severe cases or in older children who have not responded to conservative techniques, surgery may be considered to reposition the foot into a straight position.

There are numerous reasons that a child may walk with an in-toe gait. No parent should assume that their child will simply outgrow this walking pattern. If you notice any abnormalities with how your child walks, do not hesitate to make an appointment with the doctors of Advanced Podiatry.

By Dr Tyler Miranda
December 29, 2020
Category: Toes
Tags: pinky toe  
While looking down at their feet many people will wonder: What's going on with my little toes? They might look like they are curled in, bent, red, or swollen. They may be painful or have skin lesions like corns and calluses. An abnormal or unsightly nail is frequently noticed as well. Upon further inspection one may notice a skin irritation or rash between the 4th and 5th toes.
Why are they like this?
A slight curvature of the 5th toe is very common and comes from a combination of genetic and environmental factors. As slight imbalance of the soft tissues can cause imperfect alignment of the bones. Tight or pointy shoes and high heels can also encourage the bend in the toe to increase. 
If the nail is unsightly or abnormal it may be a sign that that nail is sustaining repetitive friction, rubbing, small trauma. These can all be the result of the toe bending as well as tight shoes. 
If the nails sustains damage, cracking, lifting it can allow for moisture, debris and fungus to invade, causing a long term problem needing medication.
The skin in between the 4th and 5th toes is at increased risk when the toes are curled. The toe position will trap moisture and encourage the proliferation of fungus, causing an athletes foot.
Do I need to address this issue?
If the toe is symptomatic if needs to be addressed. If the area is painful, itching, red, or irritated it should be evaluated. A present infection needs prompt attention to prevent spread to other areas of the feet and other individuals in the household.
If the deformity of the toe looks to be progressing or getting worse it should be addressed before it becomes severe.
If the toe abnormality also comes with a larger foot deformity a thorough evaluation of the entire foot and it mechanics should be performed
What can be done to fix it?
There are many options for proper management of these issues depending on the diagnosis and severity
Wider shoes, alternative styles of shoes, padding can help.
Specific types of pads and splints can help
Paring or shaving of painful calluses
Medication for skin rash between the toes along with proper foot hygiene
Addressing the abnormal nail: biopsy of the nail to confirm fungus, topical or oral medication, pinpoint Laser to eliminate the infection
Custom foot orthotics to slow or eliminate the progression of the deformity by supporting the bony and soft tissue structures in the feet
Surgical correction of the toe to realign the joints 
If you have an issue with your 5th toe we at Advanced Podiatry would be happy help you get it resolved.
By Dr Arden Smith
February 18, 2020
Category: Toes
Tags: black toenails  
Sorry to be the bearer of bad news, but if you run regularly, you can pretty much expect a blackened toenail, or two at some point in time.
When you get your first one, it’s kind of a sign that you’ve moved your training to a higher level. That’s because black toenails in runners tend to become more common the more you run, and the longer you go. People who run a mile or two at a time, and a couple of days a week, are less likely to experience them than those who train multiple days of the week, hitting at least  5K, roughly 3 miles, per run.
In most cases, black toenails in runners are not something to worry about, and for most people, it just comes with the miles. Some runners even consider it a badge of honor to get their first one, but they can be annoying and unsightly when flip-flop season rolls around.
A black toenail is most often caused by a subungual hematoma, a collection of blood under the toenail. If it is painful, please call one of our Advanced Podiatry offices in Manhasset, Huntington, Plainview, or Maspeth as soon as possible and see one of our expert podiatrists at Advanced Podiatry. You will receive almost instantaneous relief with drainage of the hematoma.
By Dr Joseph DiStefano
July 17, 2018
Category: Toes

Issues with the nails are some of the most common reasons for a trip to your friendly neighborhood podiatric specialist.  We see everything from nail blisters to bone spurs come walking (pun intended) through our doors.  Here is a quick cheat sheet of some of the signs and symptoms of the common ailments that we see.  All due respect to WebMD of course. 

Ingrown nails: We see these every day.  They can range from mild discomfort when you wear a certain pair of shoes, to a full-blown infected toe. Signs that something is wrong usually start very subtly; so coming in for an evaluation at the first sign of trouble is the surest way to prevent a more involved visit. Ingrown nails will often become chronic if they are not properly treated (aka pedicures), so the sooner you schedule, the sooner we can get you pain-free.

Fungus: Also something we see every day, many times throughout the day. Our feet live in our shoes. Days, weeks, months and even years (gross) of sweat collect on the insoles and serve as the perfect environment for fungus to grow: damp, dark and moist. With a proper diagnosis, we can offer cutting-edge treatments and kick that fungus to the curb! 

Pincer nails: These can occur for many reasons, but they always present in the office with the same complaints. The patient notices their nails have an extreme curve, which will cause pain and often infection on the sides where the nail meets the skin.

Onychodystrophy: This is the fancy doctor way of saying, “thickened nails.” Impressive, I know. Often, we will come across a nail that is misdiagnosed as having a variant of fungus or other pathology and doesn’t improve with treatment. Fear not loyal reader, we have many tricks up our sleeves to help your nails look as normal as possible.

Psoriasis: Often, one of the manifestations of autoimmune disease is seen in the peripheral tissues of the hands and feet.  Always be sure to tell your podiatrist everything about your medical history, no matter how small or insignificant it may seem. 

This is just a small taste of the most common things we treat on a daily basis. The take-home message is the same though. Come on in! 

And eat your heart out WebMD.

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Advanced Podiatry of Manhasset at the Americana

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