Achilles Tendonitis

Achilles tendonitis is an irritation or inflammation of the large tendon in the back of the lower calf that attaches to the back of the heel. It is a common condition typically associated with overuse (specifically in running and jumping exercises), and is often caused by lack of flexibility and overpronation (excessive rotation of the foot).

Most cases of Achilles tendonitis can be treated with conservative methods, such as ice and OTC anti-inflammatory medicines, resting, and reducing or stopping high-impact activities until the inflammation subsides. Stretching and orthotics can also help. In extreme cases, surgery is warranted.

At the High Performance Foot + Ankle, your case will be expertly diagnosed and handled. If conservative methods will not suffice to restore your foot and ankle health, Dr. Paukovitz will advise the best next steps, including the latest, minimally invasive surgical treatments. Additionally, we will instruct on how to prevent future occurrences of this condition.


An ankle sprain is a soft tissue injury. Most often, a sprain occurs when an injury pulls, stretches, or tears the ligaments that connect bone to bone. A fracture is actually a break in the bone. Injuries are the most common causes of foot and ankle sprains and fractures, with many occurring during sports. Tripping or stumbling on uneven ground is another common cause of ankle sprains and fractures. Pain, swelling, bruising, and difficulty walking on the affected foot or ankle are the most common symptoms of a sprained or fractured foot or ankle.

If you've hurt your foot or ankle, it's best to err on the side of caution. The acronym RICE can help you remember what to do: Rest—Rest the affected area. Stay off the injured foot or ankle until it can be fully evaluated. Walking, running, or playing sports on an injured foot or ankle may make the injury worse. Ice —Apply ice to the affected area as soon as possible, and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation. Compression —Wrap an elastic bandage (such as an Ace® wrap) around the affected foot or ankle. The wrapping should be snug, but not so tight as to cut off circulation. Elevation —Elevate the affected extremity on a couple of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

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Arthritis, in general terms, is inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis has multiple causes, and joint inflammation and arthritis are associated with many different illnesses. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims.

There are several forms of arthritis:

Osteoarthritis : Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or “wear and tear” arthritis. Although it can be brought on suddenly by an injury, its onset is generally gradual; aging brings on a breakdown in cartilage, and pain gets progressively more severe.

Rheumatoid arthritis (RA): RA is a complex, chronic inflammatory system of diseases, often affecting more than a dozen smaller joints during the course of the disease, frequently in a symmetrical pattern. It is often accompanied by signs and symptoms—lengthy morning stiffness, fatigue, and weight loss—and it may affect various systems of the body, such as the eyes, lungs, heart, and nervous system. It is characterized by alternating periods of remission. Serious joint deformity and loss of motion frequently result from acute RA..

Gout (gouty arthritis): Gout is a condition caused by a buildup of the salts of uric acid—a normal byproduct of the diet—in the joints. A single big toe joint is commonly the affected area, possibly because

Athlete’s Foot (tinea pedis) is a skin disease caused by a fungus, usually occurring between the toes. The fungus most commonly attacks the feet because shoes create a warm, dark and humid environment that encourages fungus growth. Signs of Athlete's Foot include dry skin; itching and burning, which may increase as the infection spreads; scaling; inflammation and blisters, which often lead to cracking of the skin. Athlete's Foot may spread to the soles of the feet and to the toenails, as well as to other parts of the body, notably the groin and underarms

Good foot hygiene and avoiding walking barefoot can help reduce the spread of the fungus. Feet should be washed daily with soap and water and dried thoroughly. Usually, Athlete’s Foot can be treated with OTC medicated powders, creams, sprays, or lotions that are specifically formulated to fight the athlete’s foot fungus. In moderate cases, a prescription topical medication may be required; more severe cases may require prescription oral medication. In the most severe cases nail removal followed by oral and topical medication may be used to treat this problem.

If an apparent fungus condition does not respond to proper foot hygiene and there is no improvement within two weeks, schedule an appointment with our office. At the High Performance Foot + Ankle, we will assess the degree of fungal infection, and design a specific treatment plan according to your needs.

A bunion is a “bump” on the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing a lump of bone on the foot. Because this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated. The symptoms of a bunion include the development of a firm bump on the outside edge of the foot, at the base of the big toe; redness, swelling, or pain at or near the MTP joint; corns or other irritations caused by the overlap of the first and second toe; and restricted or painful motion of the big toe.

Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type. Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor, as is wearing shoes that are too tight or cause the toes to be squeezed together.

For short-term relief, bunion sufferers can use commercial, non-medicated bunion pad around the bony prominence; wear shoes with a wide and deep toe box; avoid shoes with high heels; and apply ice to the bunion if it becomes inflamed and painful. More severe cases require medical intervention. Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. In addition to padding and taping bunions, anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammation caused by joint deformities. Physical therapy and ultrasound therapy can also be used to treat bunions, as can orthotics (shoe inserts), which may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity. When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint.

Persistent, painful bunions will require podiatric attention. Bunions tend to get larger and more painful if left untreated, making non-surgical treatment less of an option. Dr. Paukovitz is especially experienced in treating bunions, and can work with you to design a treatment plan tailored to your individual condition and specific needs.

Calluses and corns are areas of thickened skin that develop to protect that area from irritation. They occur when something rubs against the foot repeatedly or causes excess pressure against part of the foot. If the thickening of skin occurs on the bottom of the foot, it's called a callus. If it occurs on the top of the foot (or toe), it's called a corn. Corns and calluses are not contagious but may become painful if they get too thick. In people with diabetes or decreased circulation, they can lead to more serious foot problems. People with certain deformities of the foot, such as hammertoes, are prone to corns and calluses. Corns and calluses typically have a rough, dull appearance, may be raised or rounded, and they can be hard to differentiate from warts.

Mild corns and calluses may not require treatment, but if corns or calluses are causing pain and discomfort or inhibiting daily life in any way, medical intervention is advisable. Also, people with diabetes, poor circulation, or other serious illnesses should have their feet checked. For mild corns or calluses, a change of footwear or adding padding to shoes may suffice; larger corns and calluses are most effectively reduced (made smaller) with a surgical blade. The procedure is painless because the skin is already dead. Additional treatments may be needed if the corn or callus recurs.

At the High Performance Foot + Ankle, we will assess your calluses and corns and prescribe an appropriate treatment plan. We will also inspect your shoes and watch you walk, to provide advice about preventative measures.

Diabetes is the inability to manufacture or properly use insulin, and it impairs the body's ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) can lead to serious damage to the eyes, heart, kidney, nerves, and feet. Having diabetes increases the risk of developing a wide range of foot problems. Furthermore, with diabetes, small foot problems can turn into serious complications; even a small cut can produce serious consequences. Diabetes warning signs include skin color changes; swelling of the foot or ankle; numbness in the feet or toes; pain in the legs; open sores on the feet that are slow to heal; ingrown and fungal toenails; bleeding corns and calluses and dry cracks in the skin, especially around the heel.

Regular checkups by a podiatrist are the best way to ensure that a diabetic’s feet remain healthy. Foot-related complications, especially those that result in amputations, can be minimized with proper, proactive care. Including a podiatrist in diabetes care can reduce the risk of lower limb amputation up to 85 percent and lowers the risk of hospitalization by 24 percent.

Diabetes is a complex disease that demands a team approach to treatment. Dr. Paukovitz and her staff will work with you to ensure your feet and ankles receive the attention that is required, and design a treatment plan tailored to your individual condition and specific needs.

Flat feet is a common and usually painless condition in which the arch on the inside of the foot is flattened, allowing the entire sole of the foot to touch the floor when standing. Flat feet can occur when the arches do not develop during childhood. In other cases, flat feet may develop after an injury or from the simple wear-and-tear stresses of age. Occasionally, flat feet can contribute to problems in the ankles and knees.

If there is no pain in the foot and ankles, no treatment is required. If flat feet are causing pain, orthotic devices (arch supports), structurally supportive shoes and stretching exercises can help.

At the High Performance Foot + Ankle, we can determine if your flat feet are the cause of your foot pain, and treat accordingly.

Toenail fungus, or onychomycosis, is an infection underneath the surface of the nail caused by fungi. The nail often becomes darker in color and smells foul. The infection is capable of spreading to other toenails, the skin, or even the fingernails. The resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Fungal toenail infection can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate. The toenails are especially vulnerable around damp areas such as swimming pools, locker rooms, and showers. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions are especially prone to fungal nails. Other contributing factors may be a history of athlete's foot and excessive perspiration.

A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid antifungal agent. However, even the best over-the-counter treatments may not prevent a fungal infection from coming back. Signs of infection including discoloration, thickening, or deformity of your toenails require medical attention. Typical treatment options include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail. In some cases, surgical treatment may be required.

At the High Performance Foot + Ankle, we know the

A hammer toe is a contracture, or bending, of the toe at the first joint of the digit, called the proximal interphalangeal joint. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammer toes are more common in females than males. Symptoms of a hammer toe include pain at the top of the bent toe upon pressure from footwear; formation of corns on the top of the joint; redness and swelling at the joint contracture; restricted or painful motion of the toe joint; and pain in the ball of the foot at the base of the affected toe. An abnormal balance of the muscles in the toes, heredity and trauma can also lead to the formation of a hammer toe. Arthritis is another factor, because the balance around the toe in people with arthritis is disrupted. Wearing shoes that are too tight and cause the toes to squeeze can also cause a hammer toe to form.

Flexible Hammer Toes: These hammer toes are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammer toes because they are still moveable at the joint.

Rigid Hammer Toes: This variety is more developed and more serious than the flexible condition. Rigid hammer toes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammer toe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.

For short-term relief, hammer toe sufferers can use c

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel. Two common afflictions of the heel are heel spurs and plantar fasciitis.

A heel spur is a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome." Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Plantar fasciitis is an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and it can be quite painful. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Ingrown nails, the most common nail impairment, are nails whose corners or sides digpainfully into the soft tissue of nail grooves, often leading to irritation, redness, and swelling. The big toe is the most common location for this condition, but other toes can also become affected. Ingrown toenails may be caused by heredity, improperly trimmed nail, shoe pressure and repeated trauma to the feet from normal activities. Typically, ingrown toenails cause pain, redness and swelling, drainage, odor and prominent skin tissue.

Home remedies, such as warm salt-water soaks, can help alleviate the pain of an ingrown toenail temporarily, but if the infection persists, medical intervention is needed. People with diabetes, peripheral vascular disease, or other circulatory disorders must avoid any form of self-treatment and seek podiatric medical care as soon as possible. A podiatrist will remove the ingrown portion of the nail and may prescribe a topical or oral medication to treat the infection. If ingrown nails are a chronic problem, your podiatrist can perform a procedure to permanently prevent ingrown nails.

At the High Performance Foot + Ankle, we will assess the degree and cause of your ingrown toenail, and design a specific treatment plan according to your needs. We can also provide guidance that can help you prevent this condition from recurring.

Metatarsalgia is a general term used to describe pain and inflammation in the metatarsal region of the foot, more commonly referred to as the ball of the foot. This common condition can be caused by high-impact activities, the wearing of ill-fitting footwear, and some underlying conditions. While metatarsalgia is generally not serious, it is a painful condition that can cause sharp, aching or burning pain in the ball of the foot and tingling and numbness in the toes, making even normal activities difficult.

At-home treatments, such as ice and rest, often can relieve metatarsalgia symptoms. Proper footwear with shock-absorbing insoles or arch supports will also help prevent or minimize future problems with metatarsalgia. Medical attention should be sought if pain does not decrease after several days, even after rest and a change in footwear. Treatment options usually include icing, 24-hour rest, passive range of motion (ROM) and ultrasound. Orthotics can help, particularly in individuals with a high arch who experience pain from metatarsalgia. Generally, physical therapy can provide relief. In more severe cases, surgery may be necessary.

at the High Performance Foot + Ankle, we can determine what is causing your foot pain, and develop a course of treatment to address it. We can also provide personalized advice that will help you prevent these injuries in the future

A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth toes. Although the exact cause of neuromas is unclear, certain factors, such as biomechanical deformities (i.e., a high-arched or flat foot), trauma, improper footwear and repeated stress can contribute to their growth. Symptoms of a neuroma include pain in the forefoot and between the toes, tingling and numbness in the ball of the foot, swelling between the toes and pain in the ball of the foot when weight is placed on it. The vast majority of people who develop neuromas are women.

For short-term relief, sufferers of neuromas should wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment. Similarly, wearing shoes with thick, shock-absorbent soles, as well as proper insoles that are designed to keep excessive pressure off of the foot can help. Commercial, non-medicated shoe pads can relieve pressure on the afflicted area, and applying ice to the area on a daily basis can temporarily relieve pain. However, medical attention should be sought at the first sign of pain or discomfort, because if left untreated, neuromas tend to become worse. Treatment options vary depending on the type and severity of each neuroma. For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, additional treatment or surgery may be necessary to remove the tumor.

Also referred to as "tibial stress syndrome," shin splints refers to pain along the tibia, the large bone in the lower leg. Most commonly associated with runners, shin splints usually occur from overuse, and are experienced as a shooting pain felt near the front or sides of one or both tibia bones (the shins). Occasionally, shin splints will cause mild swelling of the lower leg. Pain usually stops with rest; however, eventually the pain may become continuous.

Shin splints can be treated immediately with ice and anti-inflammatory medications. Medical attention should be sought if these traditional methods do not bring relief, and if shin pain worsens. A podiatrist may recommend a physical therapy program, as well as testing to determine if prescription orthotic inserts could prevent further injury.

At the High Performance Foot + Ankle, we will evaluate the severity of your shin splints, and put you on a treatment plan that will speed recovery and help prevent future occurrences of this condition.

Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus and can appear anywhere on the skin. Those that appear on the sole of the foot are called plantar warts. Children, especially teenagers, tend to be more susceptible to warts than adults. The virus that causes warts generally invades the skin through small or invisible cuts and abrasions. The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments. When plantar warts develop on the weight-bearing areas of the foot they can be the source of sharp, burning pain.

Because warts are caused by a virus, if left untreated, they can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Therefore, it is advisable to be aware of any suspicious growths on the feet, and act promptly to stop their spread. Self-treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self-treatment with such medications should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. In-office treatment may involve the removal of warts by a simple surgical procedure, performed under local anesthetic. Also, lasers have become a common and effective treatment option.

If you are bothered by warts or have any type of suspicious, painful growth on your