Advanced Foot and Ankle Center Blog

Many people come in the office experiencing pain along the outside of the foot and ankle.  This pain that patients describe could have started after an injury or it could be chronic and slowly getting worse.  Many times, this pain is due to inflammation from tendons on the outside of your leg called the peroneal tendons.

The anatomy of the tendons are important to understand why you could be experiencing  your symptoms.  The peroneal tendons start on the outside of the leg, just below the knee.  They course together down the leg, behind the back of the ankle bone and along the outside of the foot.  One of the tendons, called the peroneus brevis then attaches to the base of the 5th metatarsal (that bump you can see on the outside middle portion of your foot) and the other courses along the bottom of your foot in the deep arch and attaches to the bottom inside of your foot.  These tendons work together with every step to help your foot evert, or turn the foot out during gait. 

If you sprain your ankle or foot, the majority of the time the ankle and foot turn inside relative to the body.  When this happens, these tendons are forcibly stretched and can form small tears within the tendon.  These tears may not heal correctly so they fill in with scar tissue and become chronically painful.   For people who have pain but have not had an injury, it is usually do to the biomechanics of your feet.  Your foot may naturally be slightly inverted or turned to the inside and so this puts a gentle strain on these tendons.  Now imagine those tendons getting over stretched with every step, thousands and thousands of steps every day.  This then accumulates and causes pathology in the tendon.

Treatment begins with a thorough history and physical exam by one of the podiatrist at Advanced Foot and Ankle.  We will usually take X-rays to ensure that there is no bony problem as well.   After you have been diagnosed with peroneal pathology, there are many ways to improve your pain and symptoms beginning conservatively.  Some people will still have pain after conservative options and may need to have the tendon repaired surgically. 

At Advanced Foot and Ankle our providers have experience dealing with these issues and are here to help you.  If you have questions about this or any other foot/ankle issue, please call us at 972-542-2155 to be evaluated. 

Have a Wonderful Day,


Dr. Witt

December 07, 2018
Category: Foot Conditions
Tags: Sesamoid   Sesamoiditis  

What is Sesamoiditis?

Sesamoids are small bones that are only connected to tendons or surrounded in muscle. This only appears in a few places in the body, one of which is the foot. Two very tiny sesamoids are found in the underside of the foot near the big toe. One is on the outer side of the foot and the other bone is close to the middle of the foot. This structure provides a smooth surface for the tendons to slide over, which helps the tendons move muscles. They help with weight bearing and also help to elevate the bones of the big toe. So now that you know what sesamoids are, you might be wondering what sesamoiditis is and what its symptoms are.


Just like any other bone, sesamoids can unfortunately fracture. The tendons surrounding the sesamoids may also become irritated or inflamed and this is what sesamoiditis is. Sesamoiditis is also a form of tendonitis and is a common condition among ballerinas, runners, and baseball catchers due to the pressure that is constantly placed on their feet.

Symptoms of Sesamoiditis

Symptoms of Sesamoiditis may include:

  • Pain under the big toe or ball of the foot
  • Swelling and/or bruising
  • Difficulty in bending and straightening the big toe

Treating Sesamoiditis

Treatments include:

  • Resting and stopping any activity that could be causing pain and inflammation
  • Anti-inflammatories, such as ibuprofen and aspirin only after consulting your physician
  • Icing the sole of the foot
  • Wearing soft-soled and low-heeled shoes
  • Cushioning inserts in the shoes

If symptoms persist after treatments, you may need to wear a removable brace for 4-6 weeks to help the bones heal. Call your podiatrist today to ask any questions about sesamoiditis and get on your way to pain-free feet once again!

Rheumatoid arthritis (RA) is an autoimmune disorder which means your body is attacking itself.  More than 90% of patients with RA will develop some type of symptom from the disease in the joints of the foot and ankle.  This occurs because the cartilage and the soft tissue lining surrounding the joints becomes thickened and inflamed.   After time, this can then alter the joint and cause the bones to be deformed around the joint.   In the foot this can manifest itself by causing a deformity such as hammertoes, bunions, overlapping toes, bone spurs, calluses, collapsing of your arch and of course pain.  You can also begin to develop soft tissue masses called rheumatoid nodules.  These are hard, rubbery lumps that usually develop near a pressure point. 

There is no cure for RA but with the right team approach, the disease is manageable.  This includes help from your primary care physician, your rheumatologist and of course your podiatrist.    Treatment of foot and ankle complications from RA usually begins conservative with anti-inflammatory medications, shoe gear changes, custom orthotics, custom braces, physical therapy and cortisone injections.  In the later stage of the disease, these options are not always appropriate and surgery may be needed to help reduce a deformity that RA has caused.

At Advanced Foot & Ankle Center, our providers have experience with both conservative and surgical treatment of RA in the foot and ankle.  If you have a question about this or any other foot/ankle disorder, please call us at 972-542-2155 to be evaluated. 

Have a wonderful day,

Dr. Witt

  1. Check your feet every day.  If you cannot see the bottoms of your feet, use a mirror or have someone else check your feet.
  2. Do not walk barefoot or only in socks.  There are all kinds of things on your floors and carpet that may have fallen that you could step on and cut yourself with.  This is especially important for diabetics with nerve damage (neuropathy) and may not feel the pain from the object.
  3. Keep good control of your blood sugars.  This will help prevent or slow the progression of your neuropathy and help you heal faster if you do have a wound. 
  4. Be sure to trim your toenails straight across and leave them just a little longer.  This will usually prevent ingrown toenails. 
  5. Wear supportive shoes that aren’t worn out.
  6. If you notice any changes to your skin, including a sore, increased redness, swelling, pain, warmth or other worsening conditions, it is important to see your podiatrist or seek medical attention to be evaluated. 
  7. See your podiatrist regularly for check ups to prevent foot issues. 
November 20, 2018
Category: Foot Care
Tags: ingrown toenail  

Ingrown toenails may begin mildly but can quickly go from bad to worse. This frustrating and painful condition can affect anyone and cause significant issues. Unlike other foot-related conditions, which are often due to genetics or underlying conditions, ingrown toenails are almost always preventable and often come from lifestyle choices like the type of shoes you wear or the way you trim your toenails.

Do I have an ingrown toenail?

Ingrown toenails are easy to spot if you know what to look for. The nail begins to grow inward, curling in on one or both sides of the toenail and digging into the skin. An ingrown nail may begin with mild pain and discomfort and end up advancing quickly, producing symptoms like severe pain, difficulty walking, or even infection — which produces its own set of symptoms such as pus drainage or fever.

How can I prevent an ingrown toenail?

Preventing an ingrown toenail often boils down to the way you trim your nails and care for your feet. Always cut the nail straight across the top and never round off the corners to ensure that the nail grows straight. Wearing too-tight or narrow shoes which place pressure onto the toe can also contribute an ingrown toenail. Additionally, always keep your feet dry and clean and wear fresh socks daily.

Treating Ingrown Toenails

There are home remedies that may help stop the pain caused by ingrown toenails, such as soaking the foot in a warm foot bath and wearing better fitting footwear. Your podiatrist may be able to prescribe antibiotics to help avoid infection. In some cases, surgery by your podiatrist may be necessary. It's important to consult your doctor to see which method is best for you.

If you think you have an ingrown toenail or need help learning to better prevent them, a podiatrist can help you determine the best plan to healthier feet. Consulting with your foot doctor at regular foot examinations can help ensure that your feet stay healthy and pain-free for years to come.

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