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Dr. Horlebein will be joining Advanced Regional Ankle & Foot Care LLC as a full time physician in Altoona PA, as of June 1st 2023. Feel free to call our office with any scheduling inquires/questions!

July 2022

Tuesday, 26 July 2022 00:00

Congenital Foot Problems

A congenital foot problem is a problem affecting the feet, toes, and/or ankle that a child is born with. Several issues with a child’s feet can occur congenitally. Such problems include clubfoot, vertical talus, tarsal coalition, polydactyly, macrodactyly, and cleft foot. Some of these problems have a genetic basis, with someone in their family history having a gene causing the condition, and some are simply an anomaly.

The following are specifics about a few of these conditions:

-    Clubfoot, also called congenital talipes equinovarus or talipes equinovarus, is When the tendons of the foot shorten, the bones are of an unusual shape, and the Achilles tendon is tight, causing an inward and downward pointing of the foot. The soles of the feet might also face each other. In most cases of clubfoot, both feet are affected. If not treated, the affected child will walk on the sides of their feet or ankles.

-    Polydactyly is a condition where the child has more than five fingers or toes on either or both feet. Presentation usually consists of a nubbin or small lump of tissue without a bone, a toe that is partially formed but has no joints, or an extra toe.

-    Vertical talus is where the talus bone forms in the wrong position, other bones in the foot do not line up properly, the front of the foot points up, and the bottom of the foot is stiff, has no arch, and usually curves out. This can occur in one or both feet and if left untreated, can lead to serious disability or discomfort as the child grows.

-    Tarsal coalition is when there is an abnormal connection of two or more bones in the foot leading to severe, rigid flatfoot. The tarsal bones, located toward the back of the foot and in the heel, are the ones affected. This condition is often present at birth, but signs of the disorder usually come on in early adolescence.

-    Cleft foot is a rare condition where the foot has missing toes, a V-shaped cleft, and other anatomical differences. Surgery can often help improve the foot’s function since the heel remains normal and is what is most needed for walking. The main issues with this affliction are whether the affected foot can fit into a shoe and the shape and appearance of the foot.

-    Macrodactyly is when the toes are abnormally large due to overgrowth of the underlying bone or soft tissue. Having this condition makes it harder for the child to use the affected foot for certain activities.


 

Tuesday, 26 July 2022 00:00

Causes of Overlapping Toes

Of the many possible congenital foot problems that may manifest at some point during your life, overlapping toes are among the most common. This condition can occur when one or more toes overlap others in a seemingly permanent way. This condition most commonly involves the pinky toe, but in some cases, the big toe and the second toe might also be affected. There are several potential causes of overlapping toes to be aware of. Frequently, overlapping toes can be caused by hereditary issues. For example, you may have inherited a bone structure in your feet that makes overlapping toes more likely. Additionally, overlapping toes may be caused by the wearing of certain kinds of footwear. For instance, wearing high heels or pointy-toe shoes for prolonged periods can twist the toes into unnatural positions that may eventually lead to this condition. Other shoes that have small toe boxes can produce a similar effect. Lastly, aging can be a cause of overlapping toes. As an individual ages, their toes naturally roll in more which can lead to overlapping toes. If you believe you have overlapping toes or are at risk of developing this condition, reach out to a podiatrist. 

Congenital foot problems require immediate attention to avoid future complications. If you have any concerns, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor can provide the care you need to keep you pain-free and on your feet.

Congenital foot problems are deformities affecting the feet, toes, and/or ankles that children are born with. Some of these conditions have a genetic cause while others just happen. Some specific foot ailments that children may be born with include clubfeet, polydactyly/macrodactyly, and cleft foot. There are several other foot anomalies that can occur congenitally. What all of these conditions have in common is that a child may experience difficulty walking or performing everyday activities, as well as trouble finding footwear that fits their foot deformity. Some of these conditions are more serious than others. Consulting with a podiatrist as early as possible will help in properly diagnosing a child’s foot condition while getting the necessary treatment underway.

What are Causes of Congenital Foot Problem?

A congenital foot problem is one that happens to a child at birth. These conditions can be caused by a genetic predisposition, developmental or positional abnormalities during gestation, or with no known cause.

What are Symptoms of Congenital Foot Problems?

Symptoms vary by the congenital condition. Symptoms may consist of the following:

  • Clubfoot, where tendons are shortened, bones are shaped differently, and the Achilles tendon is tight, causing the foot to point in and down. It is also possible for the soles of the feet to face each other.
  • Polydactyly, which usually consists of a nubbin or small lump of tissue without a bone, a toe that is partially formed but has no joints, or an extra toe.
  • Vertical talus, where the talus bone forms in the wrong position causing other bones in the foot to line up improperly, the front of the foot to point up, and the bottom of the foot to stiffen, with no arch, and to curve out.
  • Tarsal coalition, when there is an abnormal connection of two or more bones in the foot leading to severe, rigid flatfoot.
  • Cleft foot, where there are missing toes, a V-shaped cleft, and other anatomical differences.
  • Macrodactyly, when the toes are abnormally large due to overgrowth of the underlying bone or soft tissue.

Treatment and Prevention

While there is nothing one can do to prevent congenital foot problems, raising awareness and receiving neonatal screenings are important. Early detection by taking your child to a podiatrist leads to the best outcome possible.

If you have any questions please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic tools and technology to treat your foot and ankle needs.

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Tuesday, 19 July 2022 00:00

Sports Related Foot And Ankle Injuries

Foot and ankle injuries are common among people who participate in sports. Several factors contribute to this. They include failing to stretch or warm up properly, not wearing the proper type of shoe and not taping or providing other types of support for the ankle or foot. The most common foot and ankle injuries suffered by people involved in sports are plantar fasciitis, ankle sprains and Achilles tendon damage or ruptures. If not treated properly, they can lead to permanent disability.

Treating these injuries is relatively simple if they are identified and addressed early. Many athletes dismiss the initial aches and pains associated with injury as just soreness or tired muscles. Their first response is usually to try to work through it. This can lead to serious problems. Many minor injuries are made far more serious when athletes continue to put strain and pressure on them. That attitude can change a mild strain into a serious strain and a minor tear into a rupture. Athletes should have unusual aches and pains evaluated by a skilled medical professional.

Plantar fasciitis is a painful injury. It is inflammation of the plantar fascia, the thick band of tissue running from the heel to the base of the toes. If left untreated, it can lead to a degenerative disease called plantar fasciosis. There are several effective treatments for this ailment. Doctors often prescribe rest, massages, stretching, night splints, physical therapy, anti-inflammatory medication, corticosteroids or surgery, usually in that order. The most effective treatment for plantar fasciitis is orthotics, which offers foot support. Surgery is occasionally used as a last resort, but it comes with the risk of nerve damage and infection and often does not stop the pain.

The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone. Running, jumping and walking all impact this tendon. Two common injuries to the Achilles tendon are tendonitis and a rupture of the tendon. Tendonitis is inflammation in the tendon often caused by an increase in the amount of stress placed on it. Non-surgical treatments include rest, ice or anti-inflammatory medication.  A rupture (tear) of the Achilles tendon can be treated by placing the lower leg in a cast for several weeks or with surgery. Many physicians feel surgery is the better option because it lowers the risk of re-ruptures. Both methods require 4 to 6 months of rehabilitation.

Ankle sprains are the most common sports related foot and ankle injury. A sprain occurs when the ligament holding the ankle bones and joint stretches beyond its normal range. It can be treated non-surgically with a combination of rest, ice wrapped around the joint for 30 minutes immediately after injury, compression by a bandage and elevating the ankle above the heart for 48 hours. This combination is referred to as RICE. Severe ankle sprains in which the ligaments are torn may require reconstructive surgery followed by rehabilitation.

Soccer players can sustain foot, ankle, and lower leg injuries that are either traumatic (collisions, knocks, falls, etc.) or due to repetitive strains on tissues, joints, and muscles. A common traumatic injury in soccer is an ankle sprain—where the ligament(s) in the ankle stretch excessively or tear. An Achilles tendon rupture is another acute injury where this tendon—which attaches the calf muscles to the heel—partially or fully tears. Also, when running or jumping, a soccer player’s lower leg muscle can sometimes pull away from the Achilles tendon. Examples of overuse injuries include plantar fasciitis, which is an inflammatory condition causing heel pain, Achilles tendonitis, and stress fractures—which are very common in soccer players. Warming up properly, wearing protective gear, healing properly even after a minor injury, training appropriately, and staying off of wet playing fields are all good ways to help avoid a soccer injury. See a podiatrist to receive treatment for these or any other soccer injury, and to learn more about how to prevent future injuries.

Sports related foot and ankle injuries require proper treatment before players can go back to their regular routines. For more information, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor can provide the care you need to keep you pain-free and on your feet.

Sports Related Foot and Ankle Injuries

Foot and ankle injuries are a common occurrence when it comes to athletes of any sport. While many athletes dismiss the initial aches and pains, the truth is that ignoring potential foot and ankle injuries can lead to serious problems. As athletes continue to place pressure and strain the area further, a mild injury can turn into something as serious as a rupture and may lead to a permanent disability. There are many factors that contribute to sports related foot and ankle injuries, which include failure to warm up properly, not providing support or wearing bad footwear. Common injuries and conditions athletes face, including:

  • Plantar Fasciitis
  • Plantar Fasciosis
  • Achilles Tendinitis
  • Achilles Tendon Rupture
  • Ankle Sprains

Sports related injuries are commonly treated using the RICE method. This includes rest, applying ice to the injured area, compression and elevating the ankle. More serious sprains and injuries may require surgery, which could include arthroscopic and reconstructive surgery. Rehabilitation and therapy may also be required in order to get any recovering athlete to become fully functional again. Any unusual aches and pains an athlete sustains must be evaluated by a licensed, reputable medical professional.

If you have any questions please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.

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Tuesday, 12 July 2022 00:00

What Are Plantar Warts?

Plantar warts are described as small growths that appear on the heels or other areas of the feet that bear a large amount of weight. The pressure in these areas causes plantar warts to hide behind thick layers of skin called calluses. In most cases, plantar warts are not a serious health issue, and they usually go away without treatment. However, it is still important be mindful of them.

Plantar warts are caused by infections with human papillomavirus (HPV) in the outer layer of skin on the soles of the feet. The plantar warts then develop when the virus enters the body through weak spots at the bottom of the feet, such as tiny cuts and breaks. Plantar warts are not guaranteed for all who encounter the virus. Everyone responds differently to the affects of HPV.

Plantar warts are most common in the following groups: children and teenagers, people with weakened immune systems, people with history of plantar warts, and people who walk barefoot. Exposure to HPV is common in environments such as locker rooms or pool areas.

One of early signs to look out for is a callus, since many plantar warts hide behind them. You can also locate these warts by looking for small, fleshy, rough, grainy growths near the base of the toes and the heel. Early signs of plantar warts are shown by black pinpoints, which are small, clotted blood vessels. Lesions that interrupt normal lines and ridges in the skin of your foot may also be a sign of plantar warts. Any feeling of pain while walking or standing can also be a symptom of plantar warts.

Although most cases are not serious, some conditions may require a visit to your podiatrist.  If you are uncertain that your lesion is a wart, if you have diabetes, or if you are experiencing bleeding, you may need to see a seek professional treatment. Your doctor may offer treatments such as prescribing stronger peeling medicine or using cryotherapy by applying liquid nitrogen to the wart. More serious cases may require minor surgery or laser treatment.

There are simple solutions available to help prevent plantar warts. One common task is to avoid walking barefoot in swimming pool areas and locker rooms, as this is where HPV is commonly present. Keeping your feet clean and dry, while changing shoes and socks daily can also help prevent future plantar warts. If you know someone who has plantar warts, it is important to avoid direct contact with their warts. You should also refrain from picking or scratching your wart if you happen to develop one.

Tuesday, 12 July 2022 00:00

When to Seek Help For Plantar Warts

Anyone who cares about maintaining the health of their feet should be aware of plantar warts, an unsightly and uncomfortable foot condition. Plantar warts are callous-like growths on the feet that typically appear on the bottoms, or soles, of the feet. These warts are caused by the person-to-person transmission of different types of human papillomavirus (HPV). Plantar warts can range significantly in size, from small to giant cases. Children ages 12-16 are typically the most affected by this condition. Although it is true that many cases of plantar warts are painless and will eventually resolve themselves, you may have to visit a podiatrist. You should consider seeking out care from a podiatrist for your plantar warts if they begin bleeding or spreading, especially beyond your feet. You should also consider consulting with a podiatrist if they do not react positively to any self-care treatment. Upon your visit, a podiatrist will determine the best way to treat the warts, which may include cryosurgery, electrocautery, or the application of certain acids. If you have any concerns about your plantar warts, it may be best to seek out the help of a professional.

Plantar warts can be very uncomfortable. If you need your feet checked, contact John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor will assist you with all of your foot and ankle needs.

About Plantar Warts

Plantar warts are the result of HPV, or human papillomavirus, getting into open wounds on the feet. They are mostly found on the heels or balls of the feet.

While plantar warts are generally harmless, those experiencing excessive pain or those suffering from diabetes or a compromised immune system require immediate medical care. Plantar warts are easily diagnosed, usually through scraping off a bit of rough skin or by getting a biopsy.

Symptoms

  • Lesions on the bottom of your feet, usually rough and grainy
  • Hard or thick callused spots
  • Wart seeds, which are small clotted blood vessels that look like little black spots
  • Pain, discomfort, or tenderness of your feet when walking or standing

Treatment

  • Freezing
  • Electric tool removal
  • Laser Treatment
  • Topical Creams (prescription only)
  • Over-the-counter medications

To help prevent developing plantar warts, avoid walking barefoot over abrasive surfaces that can cause cuts or wounds for HPV to get into. Avoiding direct contact with other warts, as well as not picking or rubbing existing warts, can help prevent the further spread of plantar warts. However, if you think you have developed plantar warts, speak to your podiatrist. He or she can diagnose the warts on your feet and recommend the appropriate treatment options.

If you have any questions please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.

Read more about What Are Plantar Warts?
Sunday, 10 July 2022 00:00

Do Your Child's Feet Hurt?

Have your child's feet been examined lately? Healthy feet are happy feet. If your child is complaining of foot pain, it may be a sign of underlying problems.

Tuesday, 05 July 2022 00:00

Sever's Disease

Sever’s disease, also known as calcaneal apophysitis is a common bone disorder that occurs during childhood. The disease is defined as an inflammation of the growth plate in the heel. When a child has a growth spurt, his heel bone grows faster than the muscles, tendons, and ligaments in his leg. This disease is a result of overuse. The people who are most likely to be affected by this disease are children who are in a growth spurt, especially boys who are from the ages of 5 to 13 years old. 60% of children with Sever’s disease have both heels involved.

Symptoms of this disease are heel pain that intensifies during running and jumping activities. The pain is typically localized to the posterior part of the heel. Symptoms may be severe, and they can easily interfere with daily activities. Children who play soccer, baseball, and basketball are more likely to develop Sever’s disease.

Your doctor will diagnose your child based on his or her symptoms, x-rays are generally not helpful in diagnosing this disease. Your doctor may examine both heels and ask your child questions about his or her activity level in sports. Your doctor may then use the squeeze test on your child’s heel to see if there is any pain. Nevertheless, some doctors might still use x-rays to rule out any other issues such as fractures, infections, and tumors.

Sever’s disease can be prevented by maintaining good flexibility while your child is growing. Another prevention method is to wear good-quality shoes that have firm support and a shock-absorbent sole. Sever’s disease can be treated by ceasing any activity that causes heel pain. You should apply ice to the injured heel for 20 minutes 3 times a day. Additionally, orthotics should be used for children who have high arches, flat feet, or bowed legs.

If you suspect your child has Sever’s disease, you should make an appointment with your podiatrist to have his or her foot examined. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen to relieve pain. In more severe cases, your child may need a cast to rest his or her heel. Fortunately, Sever’s disease does not cause long-term foot problems. After treatment, your child should start to feel better within two weeks to two months.

Engaging in a sport can be a rewarding and exciting way for children to spend their time. However, as a growing child engages in increased physical activity, they may be at a greater risk for Sever’s disease. This foot affliction occurs when the growth plate in one or both of a child’s heels becomes swollen. The resulting stress put on the heel can make the back of the foot red and inflamed. Children with Sever’s disease can experience pain and discomfort when putting weight on their heel. This condition occurs most often in children during puberty and growth spurts. Usually children are most affected by this condition during sports season. Although Sever’s disease can be painful, there are a number of steps that you can take to help your child mitigate the condition. For example, a child can stretch before engaging in physical activity, paying particular attention to the hamstrings and calf muscles. Also, you can help your child select a good pair of sneakers to make sure that they are getting the proper amount of support they need in their heels. Sever’s disease is certainly not pleasant for any growing child, so you might consult a podiatrist to help your child manage this condition.

Sever's disease often occurs in children and teens. If your child is experiencing foot or ankle pain, see John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor can treat your child’s foot and ankle needs.

Sever’s Disease

Sever’s disease is also known as calcaneal apophysitis, which is a medical condition that causes heel pain I none or both feet. The disease is known to affect children between the ages of 8 and 14.

Sever’s disease occurs when part of the child’s heel known as the growth plate (calcaneal epiphysis) is attached to the Achilles tendon. This area can suffer injury when the muscles and tendons of the growing foot do not keep pace with bone growth. Therefore, the constant pain which one experiences at the back of the heel will make the child unable to put any weight on the heel. The child is then forced to walk on their toes.

Symptoms

Acute pain – Pain associated with Sever’s disease is usually felt in the heel when the child engages in physical activity such as walking, jumping and or running.

Highly active – Children who are very active are among the most susceptible in experiencing Sever’s disease, because of the stress and tension placed on their feet.

If you have any questions, please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot and ankle injuries.

Read more about Sever's Disease
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