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Posts for category: Toes

By Dr Christopher Chung
April 03, 2022
Category: Toes
Tags: Toe Walking  

Have you ever noticed your child walking around on his/her tiptoes and wondered if it’s a real medical condition needing medical treatment or if it’s “just a phase”? Or have you ever noticed as an adult how your walking pattern causes your heel to lift off before your other foot has made contact on the ground? This is commonly known as toe-walking or having an equinus gait.

What Is Toe-Walking?

Despite popular belief, toe-walking is not a condition strictly involving children. It can be found in adults as well, though it is more common in children. Toe-walking is traditionally defined as the way in which the patient walks on their “tiptoes” or “balls of their feet” with their heels lifted off the ground, unlike a normal heel to toe gait. This condition is also known as an equinus gait pattern and it is typically regarded as hereditary trait wherein the Achilles tendon is shorter or tighter than normal. There are several ways to spot and treat this condition. And no, simply telling your child to “stop walking that way” isn't going to work. 

Is This Normal?

A very common question is “is toe-walking normal?”. Yes, it is normal to see your child toe-walking particularly in the early stages when they are 3 years of age or younger. However if the child is above the age of 3 and they do not display a normal heel to toe gait pattern, this can be an early sign of toe-walking. There are a few reasons why this might happen. First and foremost would be that there is a strong correlation with a hereditary component. Underlying neurological conditions such as cerebral palsy, autism, or even pathologies/injuries related to the posterior muscle group can be factors. 

Are There Different Types?

There are 3 main types of this deformity: uncompensated, fully compensated, and partially compensated:

- Uncompensated is the most noticeable and recognizable. The tension force of the tight achilles is not being compensated or counteracted by other joints or tendons in the foot. This is when the person walks on the balls of their feet without the heels ever contacting the floor as they walk. 

- Fully compensated usually demonstrates a greater arch collapse due to the surrounding joints compensating for the tight Achilles. Though this type of compensation does not produce a bouncy gait and the manner in which the person walks appears to be normal, this is in fact the worse type. The ligaments holding the bone structure together are more laxed leading to a lower arch. A collapsed or flattened arch translates to inadequate and inefficient push off of the great toe, producing a slower cadence. This means patients in this category quickly fatigue and are likely to abstain from physical activities such as exercise and sports. 

- Partially compensated is a milder form of the fully compensated foot. It normally is associated with a “bouncy” gait. The contracting force only partially affects neighboring joints and ligaments which means the heel lowers to the ground more than if it were uncompensated but not enough to produce a stable heel to toe gait. 

What Are The Available Treatments?

Physical therapy and stretching exercises can help to gently and serially stretch the tight tendon over time. Certain leg braces such as an AFO or night splints can be utilized as well to lengthen the tendon, though these methods rely heavily on patient compliance. Serial casting with below knee casts can be done if the toe walking gait is diagnosed at an early age. Botox injections can also help stretch the tight muscle complex, though it is rare. When conservative measures fail, surgical tendon lengthening of the posterior muscle compartment of the leg can assist in achieving a more plantigrade foot. It is noteworthy however that if the primary cause for the gait is related to cerebral palsy, autism or other neurological issues, these issues need to be examined and options need to be evaluated in tandem with a neurological consult.

By Dr David Ehrlich
November 09, 2021
Category: Toes
Tags: Turf Toe Injuries  

Turf toe is a hyper extension injury of the great toe joint. It is caused by a sudden, painful, upward flexion motion of the great toe, which can occur with trauma or with certain sports activities. Individuals who play turf or field sports such as soccer or football are particularly susceptible to this painful injury. When the toe becomes hyper extended, the soft tissue structures underneath the toe become stretched and injured. After the injury, patients begin to experience pain, swelling, and stiffness around the great toe joint. Additionally, extending the great toe elicits pain. Although the diagnosis is often made by taking a detailed history and performing a physical exam, x-rays may be taken in the workup to rule out bony injuries and fracture.

Luckily, turf toe responds well to conservative treatments. Resting, icing, and avoiding barefoot walking will help to reduce symptoms. Staying away from high impact activities is also crucial following the injury. Physical therapy may also help to reduce pain and prevent stiffness. Most importantly, custom molded orthotics will help to support the great toe joint and provide long term relief. Certain accommodations may be added to the orthotic device which offload the painful joint.

The great toe joint bears a tremendous amount of stress during the gait cycle. Do not delay treatment if you have any discomfort in this area! Seek immediate consultation with one of the doctors of Advanced Podiatry.

By Dr Arden Smith
August 24, 2021
Category: Toes
Tags: Toe Cramps  
Many of us have experienced cramps in our legs and feet. But, when those cramps work their way down to our toes, they can be incredibly painful. A toe cramp can make you feel like your feet and/or toes are in a vice. Most muscle cramps are harmless, but when they tighten and pull, it can feel like an emergency.
If your foot is cramping, try stretching, or massaging it slowly. When stretching the toe, do not pull the toe in a jerking motion. That could cause a muscle injury. Instead, try slowly pulling your toe to stretch it, or massage your foot by gently rolling it over a round object like a golf ball.
Remember that dehydration isn’t the only thing linked to muscle cramps, or spasm – low electrolytes and nutrients are, too. So, try to get your electrolyte levels up by eating a quick snack, Specifically, eating a banana would be a good choice.
If you suffer from foot or toe cramps please call one of our Advanced Podiatry offices in Manhasset, Huntington, Maspeth, Plainview, or Coram and one of our award-winning, expert podiatrists will be happy to evaluate your problem, answer your questions, and discuss treatment alternatives with you.
By Dr Arden Smith
August 09, 2021
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 a week, hitting at least a 5K, roughly 3 miles, per run.
In most cases, black toenails in runners are not something to worry about, and for some 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.
If you do notice a color change in your toe nails, it is always better to be safe than sorry. If in doubt give one of our Advanced Podiatry offices a call and one of our award winning expert doctors will be happy to evaluate your problem and answer any of your questions.
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!

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