Our practice provides in-office diagnostic ultrasound procedures. Ultrasound serves as the soft-tissue counterpart to what X-ray affords us in assessing bone trauma, allowing us to accurately view and monitor pathologies involving muscles, tendons, ligaments, and the like.

The Value of Podiatric Ultrasound

• Highly accurate examinations and measurements of the plantar fascia.  The ultrasound can clearly indicate areas of inflammation, rupture, or thickening.  It can also be used, in part, to definitively distinguish between plantar fasciitis and plantar fasciosis, a plantar fibroma, a heel spur, or other heel pad injuries (each of which requiring its own individual course of treatment).
• Clear examinations of the various tendons around the foot and ankle. (especially the Achilles and Posterior Tibial tendons)  It allows our Doctors to ascertain the extent of tears, ruptures and varying degrees of tendonitis.
• Critical differentiation between neuromas (pinched nerves) and capsulitis (inflamed joint). Both are very similar in location and symptomatic effects, but have distinctly different treatment protocols and they can be verifiable under ultrasound examination.
• Clear distinction between assorted soft tissue tumors.
• Unmistakable clarification of the presence of foreign bodies that are often missed entirely under MRI and can be invisible to X-ray. (Indeed, having the ability to avoid unnecessary MRI's is one of the foremost advantages of being able to offer ultrasound to our patients. Our doctors can ascertain the majority of soft-tissue pathologies right then and there, in the office, rather than having to refer you out, like most podiatrists, for a costly, time-consuming MRI.)
• Comprehensive evaluation of deep tissue trauma (as well as ulcers and lesions), where the trauma below the wound and any tunneling can be identified and carefully monitored.

Use of Diagnostic Ultrasound in Guided Injections and Aspirations

• difficult targeted injections of the plantar fascia,
• the targeting of stump neuromas, multiloculated cysts, and intra-articular     injections
• intra-lesional injections,
• biopsies of deep masses and abscesses,
• The aspiration of fluid-filled masses not fully palpable. 

Did you know that our office is the only Podiatry office in southeast Michigan that is accredited by the Joint Commission? (see http://www.jointcommission.org) This means that we have passed a rigorous inspection of over 150 details focused on patient safety, infection control, and staff training. This allows us to perform office based surgery with I.V. sedation at a level comparable (or even better) than a hospital.

All You Need to Know About Morton's Neuroma

Morton's Neuroma - it sounds serious enough -- but what is it? What causes it? And how is it treated?
A neuroma is an enlarged nerve and Morton's Neuroma is an enlarged nerve located in the interspace between the third and fourth toes. That area of the foot is particularly vulnerable because two nerves combine in that space and become larger in diameter than any of the other nerves going to other toes.
What causes this nerve enlargement? The leading cause seems to be compression on the nerve - compression and irritation. The condition is more common in women and it makes sense because many women wear shoes that force their toes into a very cramped toe space.
Other causes include activities that repeatedly irritate that part of the foot, such as basketball or jogging. We also see Morton's Neuroma in patients who have other foot conditions, including flat feet, bunions, and hammertoes. An accident or injury to the foot can also cause the neuroma.
The symptoms of Morton's Neuroma include:
- Pain
- A feeling that something is in your shoe, sock or foot
- Tingling or numbness in the toes
- Burning sensation in the ball of the foot
The condition starts out slowly, with intermittent pain. Left untreated, Morton's Neuroma results in permanent nerve damage to the foot. Early diagnosis is always best from a treatment standpoint.

How is this condition treated? It really depends on how advanced the neuroma is and the severity of the symptoms. Non-invasive/non-surgical solutions are always our first choice. These might include icing the area, wearing shoes that are wider in the toe area, refraining from repetitive sports activities, steroid injections, special padding techniques, custom biomechanical orthotics to reduce pressure on the nerve and medications to reduce inflammation and pain.
If a patient doesn't respond well to the more conservative treatments, surgery may be indicated. The surgery is minimally invasive and can be performed right here in our SurgiCare center. Recovery time is minimal and you may walk on the surgical foot right away.
After surgery it is best for patients to focus on quality, supportive shoe gear and wear prescription orthotics to properly support the feet and optimize their mechanical function.
Please let us know if you have any of the symptoms of Morton's Neuroma, so that we can conduct a thorough examination to arrive at a proper diagnosis.

Those All Too Common Corns and Calluses

Corns and calluses are one of the most common reasons for a visit to our office. In fact, we see quite a few cases each and every day!
A callus is a hardened area of skin on the foot that forms as the result of pressure or continuous rubbing from shoes or socks. It is usually raised and painless and appears on the bottom of the foot or heel.
A corn usually forms on the tops of toes, in between toes or on the tips of toes. Like a callus, a corn is a hardened area of skin, but it is smaller with a harder center that is surrounded by inflamed skin. Corns usually cause pain because they get pushed into the skin, affecting sensitive nerve endings.
Both corns and calluses form as a means for the foot to protect itself from ongoing pressure. The more persistent the pressure, the thicker the corn or callus!
What types of pressure or other types of foot conditions cause corns and calluses to develop?
- Shoes that are too tight, causing pressure on the foot, or too loose, causing the foot to move around within the shoe (can also cause blisters)
- Going sock-less or wearing socks that are too loose-fitting
- Hammertoes - the top of the bent toe is a likely area for increased pressure against a shoe
- Improper gait (manner of walking) that causes pressure on the bottom of the foot, making it easier for calluses to develop
- Pre-existing deformity of the foot or biomechanical problem, such as a bone spur

Although there are numerous over-the-counter (OTC) corn and callus remover products available, many of these products contain different types of acid that can burn the skin and may cause infection. For patients who are diabetic, elderly and unable to feel different sensations, these OTC preparations may prove especially dangerous.
The best (and safest) way to treat corns and calluses is to make an appointment for a complete foot and ankle examination. Treating corns and calluses on your own may provide temporary relief but it doesn't address the cause of the corn or callus.
"Bathroom surgery," using a razor or knife to "trim" or remove the corn or callus is dangerous and may lead to additional problems.
Some things like psychiatry, cardiology and podiatry are best left to professionals. Please give us a call if you are having a problem with corns or calluses and let us help - we know just what to do!