We are preferred providers for a large number of insurance companies. If you are not certain regarding insurance coverage, our billing staff can help you find out.

Regional Employers

We are preferred providers for the majority of companies within the Puget Sound area.

The largest employers include:

• Boeing
• Microsoft
• Retail Clerks
• School District Employees (Including teachers, teaching assistants, administrative staff and custodians)

Insurance Companies:

• Aetna
• Amerihealth
• Azuris Northwest Health
• Benefit MD
• Blue Cross Blue Shield Boeing
• Carpenters Trust
• CIGNA
• Ethix
• Federal Blue Cross and Blue Shield
• First Choice
• Great West
• Guardian Life
• Hotel and Restaurant Employees Union
• Labor and Industries (L&I)
• LifeWise Health Plan (of Washington and Oregon)
• Metropolitan Life
• Mutual of Omaha
• National Association for Self-Employed
• North Star Administrators
• Northwest Iron Workers
• Northwest Laborers Employees Trust
• Operating Engineers (Local 302 and 612)
• Principal Insurance
• PacifiCare
• PHCS -- Private Health Care Systems
• Premera Blue Cross (all plans including Heritage Plus)
• Premera Blue Cross Microsoft Division
• Premera Blue Cross School District Division
• Providence Health Plans
• Puget Sound Electrical Workers (PSEW)
• Regence Blue Shield (Selections, Regence Northwest Health, RegenceCare)
• Regence / Uniform Medical
• Regence Federal Employees
• Retail Drug Employees Trust
• Sound Health and Wellness
• Tri West health Care
• United Healthcare
• WPAS (welfare pension and administration services administrative)
• Washington Employers Trust
• Washington Teamsters Trust
• Wausau Benefits
• Zenith Administrators

Infection can be caused by a number of different agents. Athlete's foot is an infection of the skin caused by a fungus. Warts are caused by a viral infection of the skin. When most people think about infections they are thinking about infection caused by bacteria. There are numerous types of bacterial infection. Infection generally requires a break in the skin from a cut, abrasion, puncture wound or ulceration. The most common infection is caused two bacteria, Staphylococcus and Streptococcus. Both of these infections cause progressive tissue damage of varying degrees. People with diabetes can develop infections by several bacteria at the same time.

Infection that occurs in the skin is called cellulitis. Deep infections that develop puss pockets are called abscesses. The most common bacterium that causes cellulitis is Streptococcus. These infections can become very serious and even life threatening. Cellulitis is characterized by spreading redness in the area with an increase in the temperature of the skin, often accompanied by fever and chills. People who suffer from venous stasis, chronic swelling in the legs, are prone to these infections. Cellulitis is also commonly seen in associated with athlete foot conditions. The athlete's foot causes small breaks in the skin, which can become infected, by the Streptococcus bacteria. Soft corns, particularly between the fourth and fifth toes can also become infected and cause cellulitis and or an abscess. Puncture wounds are very likely to become infected. This can result in a very dangerous deep abscess that can also infect the bone. A doctor should evaluate all deep puncture wounds as soon as possible. Simply cleaning the outside of the puncture wound is not enough to prevent infection. Oral antibiotics should be prescribed and the wound watched carefully. If there is any sign of infection, surgical cleaning of the wound should be preformed.

People with diabetes are at particular risk of infection. In fact, people with diabetes spend more time in the hospital for foot infections than for any other reason. Corns and calluses on the feet of people with diabetes can break down and allow bacterial invasion of the tissue. In people with long standing open ulceration the underlying bone can become infected. Bone infections, called osteomyelitis, generally require surgery to remove the infected bone. These infections are very difficult to cure with oral or intra-venous antibiotics without also removing the infected bone. The presence of bone infection can be diagnosed with special tests such as bone scans, CT scans and MRI. These test are not 100% accurate however and the experience of the treating doctor becomes very important in making the correct determination as to the presence of bone infection.

Gout, which is caused by an elevated blood uric acid level, can be confused with infection. This condition can cause sudden onset of pain, redness, and swelling of a joint or in the soft tissues. It is important to rule out an infection, particularly if it is in a joint. Rare instances of infection can occur without evidence of a break in the skin. The infection is carried to the site by the blood stream. Close examination of the patient may reveal an abscessed tooth that likely is the source of the infection. In other instances no source of the infection can be found.

People who have joint replacements, heart valve replacements or who have a pacemaker must be very cautious regarding infections. They are at risk of an infection spreading from another site to the area of their joint replacement, heart valve replacement or pacemaker. Also, people who have mitral valve prolapsed must be cautious if they have infections because the infection can spread to the heart.

What is ESWT?

Extracorporeal shockwave treatment, also known as ESWT, is a non-invasive, non-surgical treatment option for the intense, persistent heel pain associated with chronic plantar fasciitis and achilles tendonitis. "Extracorporeal" means "outside the body." Shockwaves, also known as pressure or sound waves, are generated from a special ESWT device and focused onto the targeted tissue. The shockwaves are delivered outside the body to trigger an individual's own repair mechanisms. The concept behind shockwave therapy in orthopedic disorders is that the shockwave stimulates and reactivates healing to encourage revascularization and other elements necessary to advance normal tissue healing. Additionally, shockwaves help to over-stimulate pain transmission nerves, which can lead to a reduction in sensitivity and pain.

What is plantar fasciitis?

The plantar fascia is a band of connective tissue on the plantar surface of the heel that plays a large role in maintaining the normal architecture of one's foot. Plantar fasciitis is a common clinical condition caused by overuse or injury of the plantar fascia and is defined as traction degeneration of the plantar fascial band at its origin on the medial tubercle of the calcaneus. Inflammation, fibrosis and decreased vascularization of the fascia occur, causing symptoms of heel pain. Other symptoms that may occur include burning in the sole of the foot, recurring foot pain that is especially aching in the morning or after sitting or heel pain after beginning a new exercise routine.

What causes plantar fasciitis?

There are a number of predisposing factors, including foot pronation, obesity, poor fitting shoes, minor trauma, occupational risks and change in exercise program. Although everyone is at risk, plantar fasciitis is most commonly found in athletes, runners, overweight individuals or those who are required to stand on hard surfaces for prolonged periods of time. Although approximately 2,000,000 Americans suffer from plantar fasciitis, ESWT is an appropriate treatment option in approximately 5 to 10% of those cases, as the remainder of the cases can be adequately addressed with more conservative therapies.

Who should receive ESWT for plantar fasciitis?

Prior to undergoing ESWT treatment, the patient must have been diagnosed with chronic plantar fasciitis for at least six months. Only after the patient's symptoms fail to respond to three conservative treatments should ESWT be administered. Conservative treatments include rest, physical therapy, heel cushions, non-steroidal anti-inflammatory drugs (ibuprofen, acetaminophen, etc.), cortisone injections, taping, orthotics, shoe modifications, night splinting and casting. In years past, surgical intervention for chronic plantar fasciitis was required when these other treatments had failed. Today, ESWT is available as an alternative, non-invasive treatment option.

Who should not receive ESWT treatment for plantar fasciitis?

Your health history should be reviewed with your doctor to see if this treatment is appropriate for you. ESWT is not recommended for patients with certain conditions. Patients with pacemakers and patients taking medications that may prolong or interfere with blood clotting (coumadin) are not candidates for ESWT. Also, children or pregnant women are not considered appropriate candidates for ESWT. ESWT is not appropriate for individuals suffering from acute plantar fasciitis.

What are the side effects of ESWT?

Compared to surgery, ESWT has fewer side effects and a much shorter recovery time. The most common patient complaint is some minor pain or discomfort during and after treatment. Other side effects might include minor skin bruising, reddening or swelling of the treated area. However, these possible occurrences usually resolve within a few days. The risks associated with surgery and general anesthesia are eliminated.

Fissuring or cracking of the skin of the heels can be a painful and annoying condition. The fissures can become deep enough to cause bleeding. Thick callusing and fissuring of the skin is a result of excessive and abnormal friction on the heel while walking. Frequently this occurs in people who wear open-backed sandals or shoes, as these shoes allow more slippage around the heel while walking. The skin thickens as a result of the friction. Skin lotions can help with reducing the dryness associated with the condition. Avoiding open-backed shoes is also helpful. There is a very good prescription medication for reducing the callused area called Whitfields Ointment. This is an old time remedy that many pharmacies no longer carry. With a prescription, some pharmacists will make up the medication for you. The medication contains mild acid compounds that reduce the thick callus. Care should be used with this medication and it should only be used under the supervision of a doctor.

Hammertoes Treatment in Issaquah, WA

Hammertoes are a contracture of the toes as a result of a muscle imbalance between the tendons on the top and the tendons on the bottom of the toe. They can be flexible or rigid in nature. When they are rigid, it is not possible to straighten the toe out by manipulating it. Frequently, they develop corns on the top of the toe as a result of rubbing on the shoe. They may also cause a bothersome callous on the ball of the foot. This occurs as a result of the toe pressing downward on the bone behind the toe. This area then becomes prominent and the pressure of the bone against the ground causes a callous to form. (Corns and Calluses)

They tend to slowly get worse with time and frequently flexible deformities become rigid. Treatment can be preventative, symptomatic or curative. (For information on hammertoe of the big toe see Hallux hammertoe)

Preventative treatment of hammertoe is directed toward the cause of the deformity. A functional orthotic is a special insert that can be prescribed by your podiatrist to address the abnormal functioning of the foot that causes the hammertoe. Functional orthotics can be thought of as contact lenses for your feet. They correct a number of foot problems that are caused by an abnormally functioning foot. Our feet, much like our eyes, change with time. Functional orthotics slow down or halt this gradual change in the foot. Often when orthotics are used for flexible hammertoes, the toes will overtime straighten out and correct themselves. Calf stretching exercises are also helpful. Calf stretching can help to overcome part of the muscle imbalance that causes the hammertoe.

Symptomatic treatment of hammertoes consists of such things as open toed shoes or hammertoe pads. There are over the counter corn removers for temporally reducing the painful callus often seen with the hammertoe. These medications must be used with caution. They are a mild acid that burns the callus off. These medications should never be used for corns or calluses between the toes. Persons with diabetes or bad circulation should never use these products.

Curative treatment of hammertoes varies depending upon the severity of the deformity. When the hammertoe is flexible, a simple tendon release in the toe works well. The recovery is rapid often requiring nothing more that a single stitch and a Band-Aid. Of course if several toes are done at the same time, the recovery make take a bit longer. For the surgical correction of a rigid hammertoe, the surgical procedure consists of removing the damaged skin where the corn is located. Then a small section of bone is removed at the level of the rigid joint. The sutures remain in place for approximately ten days. During this period of time it is important to keep the area dry. Most surgeons perfer to leave the bandage in place until the patient's follow-up visit, so there is no need for the patient to change the bandages at home. The patient is returned to a stiff-soled walking shoe in about two weeks. It is important to try and stay off the foot as much as possible during this time. Excessive swelling of the toe is the most common patient complaint. In severe cases of hammertoe deformity a pin may be required to hold the toe in place and the surgeon may elect to fuse the bones in the toe. This requires several weeks of recovery.

Complications associated with the surgery are infection, excessive swelling leading to delays in healing and potential deviation of the toe. If excessive bone is removed during the surgery, the toe may be a bit floppy. The toe always has a floppy feeling for several weeks following the surgery. This is normal and generally not permanent.

If pinning the toe is not required during the procedure, then the surgery could be performed in the doctor's office under a local anesthesia. Some patients perfer the comfort of sedation during the surgery and if this is the case or if a pin must be placed, then the surgery could be performed in an outpatient surgery center.

For a proper diagnosis and recommended treatment plan, we suggest you consult with a podiatrist for professional help and care.

Hallux varus is a condition in which the great toe is pointing away from the 2nd toe. This can be considered the opposite of a hallux valgus or bunion deformity. In contrast to a bunion, however, the 1st metatarsal remains in its anatomical position while the great toe is deviated towards the middle of the body.

Hallux varus most commonly occurs as a complication from bunion surgery. However, other causes can lead to this condition. These include: congenital deformity, tight or short abductor hallucis tendon, trauma, absence or surgical removal of the fibular sesamoid.

The presenting symptom is most commonly pain. This can occur from the toe rubbing against the side of the shoe. Occasionally, this deformity can also lead to problems with ingrown nails as the nail fold is pushed into the nail border by the shoe.

Diagnosis

The diagnosis of hallux varus is fairly simple as the great toe can be seen to be deviated away from the 2nd toe. A careful history will often assist in determining the cause of the hallux varus.

This is a condition that is not uncommon in children. A congenital deformity is most commonly the result of a tight or short abductor hallucis tendon. This tendon attaches to the side of the great toe. It opposes the pull of the adductor hallucis tendon that is on the opposite side of the great toe. By working together, these tendons assist in keeping the great toe straight. However, when the abductor tendon is tight, it will overpower the adductor tendon and pull the toe toward the midline of the body. The diagnosis can be made by attempting to reduce this deformity manually and feeling the tightness of the tendon.

Trauma should also be considered as a possible cause of this condition. Injury to the great toe, which disrupts the mechanical balance of the tendons, can lead to this abnormal deviation of the toe. A careful history and clinical examination will often lead the physician to the correct cause.

The fibular sesamoid is key structure in the development of a hallux varus. Because the adductor hallucis tendon attaches to this structure, any disruption of the fibular sesamoid can lead to a hallux varus. This can result from a condition referred to as agenesis of the fibular sesamoid. In this condition, the fibular sesamoid fails to develop from birth. Therefore the normal attachment of the adductor tendon is absent, causing the abductor tendon to pull the toe medially. Trauma to the sesamoid which disrupts this attachment can also lead to a hallux varus (see sesamoiditis). One of the more common etiologies however is when a fractured fibular sesamoid needs to be removed due to non-union and chronic pain. Surgically the attachment of the adductor tendon is disrupted when the fibular sesamoid is removed.

The most common cause of a hallux varus, however, is following a bunionectomy. This fortunately is not a common complication of bunion surgery. This most commonly develops as a result of: 1) aggressive removal of the "bump" on the side of the great toe; 2) removal of the fibular sesamoid; 3) over tightening of the soft tissues medially as one corrects the deviation of the toe.

Treatment

Treatment of this condition is dependent on the cause. In children with a tight adductor tendon, treatment should be focused on stretching this tendon. This can be done with stretching exercises, splinting of the toe and straight or reversed last shoes. If conservative care fails to correct the deformity, surgery may be necessary. This is performed by selective sectioning of the tendon with a small incision on the side of the toe. The toe is then splinted in a neutral or straight position.

When hallux varus develops as a complication from bunion surgery, additional corrective surgery is often necessary. The extent of the surgery will depend on the degree of the deformity and the length of time the hallux varus has been present. The earlier the hallux varus is discovered and treated, the less complicated the corrective surgery.

A
abductor (muscle)
achillobursitis
aclasis – pathological continuity of structure
acrodermatitis enteropathica
acrokeratosis paraneoplastica – Bazex syndrome
adductor (muscle)
adiposis dolorosa – Dercum disease
aDWF – ankle Doppler wave form
AFO – ankle-foot orthosis
alligator skin – ichthyosis congenita
allylamines – e.g. Naftin (naftifine)
angle, DMMA – distal metatarsal articular, Engel, Fowler-Philip, Kite, talo-first, Taygar
ankylosis
anserinoplasty
antalgic gait
AOFS hindfoot ankle score
apophysitis
aPVR – ankle pulse volume recording
atavistic tarsometatarsal joint
athlete’s foot – tinea pedis, ringworm of the feet
atavism

PROPER NOUNS:
Abrikosoff tumor
Alizarin sweat test
Allen maneuver
Apelqvist grades 1 through 4
Ashurst-Bromer classification of ankle fracture
Atasoy flap for nail injury repair
Austin – bunionectomy, screw, wire

B
ball-and-ring device
basal cell nevus syndrome
basic fuchsin (in fungicides)
BB – blunted and bowed
bipivotal hinge
bivalve of cast
BK amputation/case – below-the-knee
blebs
bowing of bone
bowleg; bowlegged – genu valgum
brachymetatarsia
bubble patch
bunion (see proper names in second alpha section)
bunionectomy
bunionette
bursitis – inflammation of the bursa of a joint
bursotomy
butenafine hydrochloride – Mentax (antifungal)

PROPER NOUNS:
Banks-Laufman incision
Bannon-Klein implant
Bardenheuer bifurcation procedure
Bart-Phumphery syndrome
Bazex syndrome – acrokeratosis paraneoplastica
Beau lines
Bechtol arthroplasty
Bednar tumor
Berman-Gartland procedure
Betadine scrub
Bier amputation
Blair arthrodesis
Blajwas-Schwartz-Marcinko irrigation/drainage system
Bledsoe cast brace
Blex contractile force curve
Blount, brace, disease, staples
Blucher opening
Bodsky ischemia classification
Boots: Acme, Denis Browne, Dingo, Gibney, 9-West, Red Dog, SACH, Sorel, Stride Rite,
Technica, TheraBoot, Unna Gelcast/gelatin, Unna paste, Vasque
Brace, dropfoot, (AFO), ischial weightbearing, Knight, Lyman-Smith, Milwaukee,
Stabheilizer (for footdrop), Taylor, toe drop, weightbearing
Brewster triple arthrodesis
Brockman incision
Brostrom procedure
Bunion – hallux abductovalgus, last, tailor’s,
Bunionectomy:
Akin
Austin
Joplin
Keller
Kreuscher
Lapidus
Logriscino
McBride
Mitchell
Reverdin
scarf osteotomy
Silver
Stone
tricorrectional
Wu
Z
Brunnstrom stage I-V
Bunnell, anvil, drill, needle, operation, probe
Burns-Haney incision
Burow triangle

C
calcaneal – pertaining to the calcaneus bone
calcaneitis
calcaneoapohysitis
calcaneoastragaloid
calcaneocavus
calcaneocuboid
calcanodynia
calcaneofibular
calcaneonavicular
calcaneoplantar
calcaneoscaphoid
calcaneotibial
calcaneovalgocavus
calcaneus bone
calcar, femorale, pedis
calcarine
calf-corset weightbearing
calf-lacing, double-upright brace
callosity – pertaining to a callus
callus; calluses
capillary refill (time)
capsulitis
cast brace/boot
castaway orthotic
CCE – clubbing, cyanosis, edema
cellulitis
cetylpyridinium Cl
cheiropodalgia
chemical matricectomy
chevron osteotomy
chloroxylenol
chondroma – tumor of the chondral tissue
clam, clamshell walker
claudication
clavus, clavi: corn, heloma, duras, hystericus, interdigital, mollis, secalinus
clawfoot
clawtoe(s)
cleft foot
clonus; ankle, toe
clubfoot – see talipes
coalition
cookie; metatarsal c.
coralline hydroxyapatite
corn – clavus, hard, interdigital, kissing, soft
counter of shoe
coax, valga/varum
crescentic osteotomy
CRPS – chronic regional pain syndrome

PROPER NOUNS:
Calandruccio fixation device
Cam Walker walking brace
Can-Am brace
Carville sandal
Cam Walker CBWO screw
Chambers osteotomy
Chang-Miltner incision
Charcot, arthrosis, foot, joint, restraint, procedure disease
C. restraint orthosis walker
Charcot-Marie-Tooth disease – CMT
Charnley, arthrodesis, fixator
Charnley-Mueller; arthroplasty/prosthesis
Chopart amputation
Chrisman-Snook ankle reconstruction
Cincinnati incision
Clayton procedure
Clearz – a fungicide
Coban dressing
Cobbies shoewear
Codman triangle
Cole osteotomy for midfoot deformity
Coleman block test
Colonna-Ralston incision
Comf-Orthotic insoles
Converse athletic shoewear
Comed footgear
Compound W
Cook walking brace
Corfan shoe
Cotrel-Dubousset brace
Count’R-Force arch brace
Couvelaire incision
Crego elevator
CROW brace
CRPS – chronic regional pain syndrome
Cryo Cuff
Curtain incision
Cutter implant
Cymeline

D
danglefoot, aka dropfoot
DCCT – Diabetes Control and Complications Trial
decubitus ulcer
dendritic synovitis
desquamates
DFO – dorsiflexion osteotomy
dial-in cut osteotomy
diabetic toe(s)-(foot or feet) – see ULCER
diaphysis
DIP joint; DIPJ – distal interphalangeal joint
disk disease
DMMA – distal metatarsal articular angle
dorsomedial
duckfooted – flatfooted
duckwalk
duck waddle

PROPER NOUNS:
Danis-Weber classification of ankle injury
DarcoGel ankle brace
Darier sign
De Guglielmo disease – erythemic myelosis
De Morgan spots
Dejerine-Sottas disease
Denis Browne, bar, boot, splint, shoe
Dercum disease
DesignLine orthotic
Diab-A-Thotics
Di Guglielmo disease – erythemic myelosis
Dias-Tachdjian classification of physeal injury
Dickinson approach
Diebold-Bejjani osteotomy
Di Guglielmo disease
Donjoy RocketSoc ankle brace
Downey-McGlamry procedure
Dressflex orthotic
Dr. Scholl’s foot products
Dubreuilh melanosis circumscripta
Dunn triple arthrodesis
DuoFilm products
Dupuytren, contracture, exostosis
DuVries incision/repair
Dwyer osteotomy
Dynafo ankle-foot orthosis (or D. AFO)
Dynasplint orthotics
DynaStep

E
epiphysis, epiphyseal

PROPER NOUNS:
Eastersohn osteotomy for tailor’s bunion
Easy Spirit shoewear
Eaton-Lambert syndrome
Eckert-Davis classification of peroneal tendon subluxation
Eichenholtz stage
Elastomull
Elmslie procedure
Engel angle
Esmarch bandage/tourniquet
Essex-Lopresti fracture
Etonic shoes
Evans calcaneal osteotomy
Evazote

F
flaccid
flatfoot
flexion/extension
fractures – (see list in Surgical Compendium)
fungus

PROPER NOUNS:
Famolare shoes
Farber disease
Felty syndrome
Flex Foot products
Floam cushion
Florsheim shoes
Footmaxx orthotics
Foot Medic products
Forestier disease
Fosnaugh nail biopsy
Fowler-Philip angle
Freer elevation
Freiberg infraction (not infarction)
Friedreich
Forst H-block
Fungus products: Fungatin, Fungi Clear, Fungi-Nail – sorcinol, salicylic acid

G
GAIT, antalgic, ataxic, gegenhalten, halting, spastic, scissor, three-point, Trendelenburg, two-point
ganglion cyst
gastrocnemius
gastrocsoleus
GENU – knee, recurvatum, varum – bowleg, valgus/valgum – knock knee
gout – podagra; tophaceous. gouty arthropathy
gun-barrel sign
guttate keratoses

PROPER NOUNS:
Ganley splint
Gowers sign

H
hammertoe(s)
hamstring muscle/tendon
HALLUX, dolorosa, flexus, limitus (limitans), malleus, rigidus, valgus, interphalangeus –HBO – hyperbaric oxygen therapy (baro chamber)
healing sandal
heloma
helosis
helotomy
hemi-implant
hindfoot

PROPER NOUNS:
Hawkins classification of talar fractures
Homan sign/test

I
intoeing gait
iontophoresis
IPJ – interphalangeal joint; DIPJ, PIPJ

J
JERK, Achilles, ankle, quadriceps, triceps, surae

PROPER NOUNS:
Jahss classification of MTPJ dislocation

K
keratoderma
keratoma
keratosis
knock-knee – genu varum
koilonychia – spoon nail

L
leg-length discrepancy

PROPER NOUNS:
Lachman sign/test
Langer arch, lines
Lauge-Hansen classification of ankle fracture
Leser-Trelat sign
Lhermitte sign/symptom
Litecast
Low Dye strap/tape
Luir-Torre syndrome

M
matrix; matrices
metatarsalgia
metatarsocunieform
mortise

PROPER NOUNS:
Mediplast plaster – salicylic acid
Mees lines
Mephisto orthotic shoes
Morton neuroma
Mulder sign

N
NAIL, nailbed, matrix, parrot beak, reedy, spoon, turtleback, watch-crystal
neoprene ankle support/brace
neuralgia
neuritis, peripheral
nonweightbearing

O
onychia
orthotic device; orthotics
orthotist
os, calcis
osteochondroma
osteotomy

PROPER NOUNS:
Ogden classification of epiphyseal fractures
Ohashiatsu foot massage, shiatsu

P
paronychia, perionychia – herpetic, tendinosa
pemphigus
PES, (pedes), abductus, adductus, anserinus, arcuatus, calcaneus, carinatum, cavus, equinovalgus, equinovarus, equines, febricitans, gigas, planovalgus, planus, pronatus, supinatus
PFMT osteotomy
phalanx; phalanges
pilon (tibial)
PIP joint – proximal interphalangeal joint
piriformis
plafond – tibial pilon
planovalgus
PLANTAR, callosities, fasciitis, fibroma, tyloma, warts – verruca plantaris/verruca pedis
plantaris – plantar; sole
plantigrade
PNP – peroneal nerve palsy (footdrop)
podagra – gout
podalgia
popliteus
pouce flottant – ray defect
PPG – photoplethysmography
pronation/supination
prop-and-press device
proximal interphalangeal joint – PIPJ
psoriasis
pterygia of nails (singular – pterygium)

PROPER NOUNS:
PLA screws – polyactide absorbable screws

Q
quick – (the flesh at the leading edge of a fingernail or toenail)

R
ray – digit, toe/finger
rearfoot
retrocalcaneobursitis (or retrocalcaneal bursitis)
rockerbottom foot
rubor

PROPER NOUNS:
Rosenthal classification of nail injuries

S
sartorius
sciatica
scleroderma
Seattle foot
semimembranosus
semitendinosus
sesamoid bones
sesamoiditis
spur, calcaneal s.
STOCKING, dysesthesia, TED hose
subtalar joint
subtarsal
supination/pronation
suture – (see list in Surgical Compendium)
syndactyly
syndesmosis tibiofibularis
synovial cyst

PROPER NOUNS:
Salter-Harris classification of epiphyseal fractures
Supp Hose
Sudeck a.SD3 stirrup brace
SWMF – Semmes-Weinstein 10-gm monofilament

T
talipes, clubfoot
talus, talar
tarsonavicular bone
tarsal tunnel syndrome
tenalgia
tendo (pl: tendines)
tendo calcaneus
tendo Achillis (Achilles tendon)
tendon – see MUSCLES AND TENDONS
tendon enthesis (junction of tendon and bone)
tendon of Hector
tendon washer
tendinitis
tendinoplasty
tendinous
tensor fasciae latae
tenodesis
tenolysis
tenosynovitis
TENS unit (Transcutaneous Electrostimulator)
tibia vara – Blount disease
tibial pilon – plafond
tibial torsion
tibialis anticus (anterior)
tibialis posticus (posterior)
TINEA, athlete’s foot (pedis), cruris, manus, transversalis
TRIANGLE, Burow t., Odman, Kager
triceps surae (sural muscle)
triple arthrodesis
tyloma – callus, (corn), tyloma mollum, tylosis plantaris, tylotic, tyroid (cheesy)

PROPER NOUNS:
Taygar angle
Taylor brace/splint
TBI – toe:brachial index
TBSA – total body surface area
TcPO2 (or) TcpO2, etc. – transcutaneous partial pressure oxygen
TED – thromboembolic disease
TED hose/stockings
Thurston Holland flag sign
Tscherne-Gotzen classification of tibial fractures

U
ULCER, decubitus, diabetic (toe/s, foot/feet), full-thickness, ischemic, partial-thickness, pressure, venous stasis
ungual tuft, unguis, ungues, unguis incarnates, unguis matrix

PROPER NOUNS:
UNNA (Unna), flex compression dressing, Gelcast, gelatin boot, wrap

V
VAE – venous air embolism
valgus, valga, valgum, coax, genu, talpies, valgus rotation
vallum unguis
varicosity
varix
varus, varum, same as valgus
vastus – intermedius, lateralis, medialis (internus)
VEGF – vascular endothelial growth factor
VERRUCA, verrucae (wart), acuminate, condyloma acuminatum, digitata, filiformis
necrogenica, peruana, peruviana, plana, plana juvenilis, plantaris – plantar wart,
seborrheica – seborrheic keratosis
verrucose
verrucosis
verrucous

PROPER NOUNS:
Velcro
Verocay bodies

W
wart – verruca
web space
weightbearing; nonweightbearing

PROPER NOUNS:
WIRE, Kirschner AKA K-wire, Kerrison, titanium
Wolff law (regarding bone structure)

X – NO REFERENCES

Y – NO REFERENCES

Z

PROPER NOUNS
Zymderm collagen implant

This tumor was once thought to be a cancer of a tendon sheath. It is now known to be a benign non-cancerous tumor of a tendon sheath. These masses are generally found on the toes, top of the foot or sides of the foot. They are always closely associated with a tendon sheath. They can also occur deep inside the foot. They slowly enlarge but never grow any larger than 4cm in size. They are firm irregular masses that are commonly painful. The pain seems to be a result of the tumor pressing firmly on the surrounding tissues and due to the interference with the function of the tendon that the mass is growing from. As the tendon grows it can press so firmly on the bone it lays next to, that it can cause erosion of the bone. It is because of this erosion of bone that the tumor was once thought to be cancerous. Cancerous tumors can have the characteristic of invading bone through aggressive and destructive means. The erosion of the bone associated with giant cell tumors is due to pressure on the bone and not due to the invasion of the bone by the tumor. Other common soft tissues masses that may occur in the foot are ganglions, fibromas.

Diagnosis

The diagnosis of a giant cell tumor is generally made by a pathologist following removal of the mass. Clinical history of the mass may give the surgeon an idea of what they might expect when removing the mass. X-rays may show the shadow of the mass, and in 10-20% of the cases, may demonstrate bone erosion. The mass is firm and nodular, and always connected to a tendon. A MRI may be useful in determining the extent or size of the mass.

Treatment

Treatment of giant cell tumors is the excision of the tumor. Some physicians may attempt to inject the mass with cortisone in an attempt to shrink the mass.

The Procedure

The surgical excision of giant cell tumors is generally performed in an out patient surgery center. Depending on the location of the mass the surgery may be performed under a local anesthesia, with intravenous sedation or general anesthesia. Following administration of the anesthesia an incision is placed over the mass. The mass is then carefully dissected free from the surrounding soft tissues. Following the closure of the surgical site a gauze compressive dressing is applied. Depending upon the location of the mass the surgeon may apply a splint or below the knee cast. In some instances the surgeon may perfer that the patient use crutches for a few days or for as long as three weeks.

Recovery Period

The recovery period depends upon the location of the mass and the extent of the soft tissue dissection necessary to remove the mass. The sutures are left in place for 10 to 14 days. During this period of time the patient should limit their activities and keep the foot elevated above their heart. It is also important to keep the bandage in place and keep the surgical site dry. If the patient has been instructed to wear a removable cast or use crutches it is important that they follow the surgeons instructions. Time off from work will depend upon the level of activity required of the job and the shoes necessary for work. Generally a minimum of one week off from work is necessary. If the patient can return to work while wearing a cast and they are allowed to perform light duty then they may be able to return to work after one week.

Possible Complications

The surgery is generally successful and without complications. However, as with any surgical procedure there are potential complications. Possible complications include, infection, excessive swelling, delays in healing, tendon or nerve injury. Because the mass is a growth from a tendon, removal of the mass may require the excision of a portion of healthy tendon. This can weaken the tendon or cause scaring of the tendon. Additionally there may be small skin nerves in the area of the tumor that may have to be sacrificed when removing the mass. If this occurs there may be small areas of patchy numbness on the skin following the procedure. This is generally not a significant problem. On occasion a nerve may get bound down in scar tissue and cause pain following the surgery. Recurrence of the mass is also possible but generally not considered a complication of the procedure.

Gangrene of the skin is associated with the loss of blood supply of a particular area. In some instances, it is caused by bacterial infection of an open sore or ulceration. The most common form of gangrene develops in the feet of people with diabetes who also have associated loss of circulation in the feet and toes. Any person with poor circulation can develop gangrene. A sudden onset of pain in the feet or legs associated with a decrease in skin temperature, and color changes to the skin of the feet is a strong indication that there has been a sudden blockage of blood flow to the legs. This condition needs immediate medical attention. People who have diabetes may not experience pain associated with such an event because of a condition called diabetic neuropathy. Diabetic neuropathy affects the nerves of the feet and legs causing a diminished ability to perceive pain, excessive heat, cold, vibration, or excessive pressure. This condition places people who have diabetes at greater risk of injury from any source without their being aware of it. For instance, a patient with diabetes can develop an ingrown toenail, and if they also have diabetic neuropathy, they may not experience the same level of pain as someone without the neuropathy. As a consequence the ingrown toenail can worsen, and become infected without providing the warning signs of pain. If the person with diabetes also has poor circulation, the infection can lead to gangrene of the toe. This situation can ultimately lead to the amputation of the toe, foot, or leg, depending upon how bad the circulation is in the leg.

Treatment

Treatment consists of surgical removal of the gangrene, surgery to improve the circulation (by-pass surgery), hyperbaric oxygen treatment and IV antibiotics.

Severe infections can also cause gangrene. The flesh-eating bacterium called Hemolytic Streptococcus is a rapidly spreading infection. Intense local heat, redness, swelling, fever, and weakness characterize this rapidly developing infection. The infection can start with a small abrasion or injury. This condition requires immediate medical treatment. It can result in amputation and/or death. Treatment consists of surgical removal of the infected tissue and IV antibiotics and supportive care as needed for any failing body functions.

A prescription foot orthosis is an in-shoe brace which is designed to correct for abnormal foot and lower extremity function (the lower extremity includes the foot, ankle, leg, knee, thigh and hip). In correcting abnormal foot and lower extremity function, the prescription foot orthosis reduces the strain on injured structures in the foot and lower extremity, allowing them to heal and become non-painful. In addition, prescription foot orthoses help prevent future problems from occurring in the foot and lower extremity by reducing abnormal or pathological forces acting on the foot and lower extremity. A prescription foot orthosis is more commonly known by the public as a "foot orthotic".

Podiatrists prescribe two main types of prescription foot orthoses for their patients, accommodative orthoses and functional foot orthoses. Both types of prescription foot orthoses are used to correct the foot plant of the patient so that the pain in their foot or lower extremity will improve so that normal activities can be resumed without pain. However, accommodative and functional foot orthoses are generally made using different materials and may not look or feel the same. Both types of prescription foot orthoses are nearly always prescribed as a pair to allow more normal function of both feet [similar to having both the left and right wheels of a car realigned in a front end alignment].

Accommodative Foot Orthoses

Accommodative foot orthoses are used to cushion, pad or relieve pressure from a painful or injured area on the bottom of the foot. They may also be designed to try to control abnormal function of the foot. Accommodative orthoses may be made of a wide range of materials such as cork, leather, plastic foams, and rubber materials. They are generally more flexible and soft than functional foot orthoses. Accommodative orthoses are fabricated from a three dimensional model of the foot which may be made by taking a plaster mold of the foot, stepping into a box of compressible foam, or scanning the foot with a mechanical or optical scanner.

Accommodative orthoses are useful in the treatment of painful calluses on the bottom of the foot, diabetic foot ulcerations, sore bones on the bottom of the foot and other types of foot pathology. The advantages of accommodative orthoses are that they are relatively soft and forgiving and are generally easy to adjust in shape after they are dispensed to the patient to improve comfort. The disadvantages of accommodative orthoses are that they are relatively bulky, have relatively poor durability, and often need frequent adjustments to allow them to continue working properly.

Functional Foot Orthoses

Functional foot orthoses are used to correct abnormal foot function and, in so doing, also correct for abnormal lower extremity function. Some types of functional foot orthoses may also be designed to accommodate painful areas on the bottoms of the foot, just like accommodative foot orthoses. Functional foot orthoses may be made of flexible, semi-rigid or rigid plastic or graphite materials. They are relatively thin and easily fit into most types of shoes. They are fabricated from a three dimensional model of the foot which may be made by taking a plaster mold of the foot, stepping into a box of compressible foam, or scanning the foot with a mechanical or optical scanner.

Functional foot orthoses are useful in the treatment of a very wide range of painful conditions of the foot and lower extremities. Big toe joint and lesser toe joint pain, arch and instep pain, ankle pain and heel pain are commonly treated with functional foot orthoses. Since abnormal foot function causes abnormal leg, knee and hip function, then functional foot orthoses are commonly also used to treat painful tendonitis and bursitis conditions in the ankle, knee and hip, in addition to shin splints in the legs. The advantages of functional foot orthoses are that they are relatively durable, infrequently require adjustments and more likely to fit into standard shoes. The disadvantages are that they are relatively difficult to adjust and relatively firm and less cushiony.

Foot and Lower Extremity Biomechanics

The study of the mechanical nature of the foot and lower extremity is called biomechanics. It is a specialized branch of science that uses the mechanical principles of physics to study the motions and forces on the human body. Podiatrists receive specialized, in-depth training during their four years of medical training on how the movements and forces in the foot affect the movements and forces in the rest of the lower extremity, and how the movements and forces in the lower extremity affect the movements and forces in the foot. No other medical specialty has this in-depth training, which is necessary to understand lower extremity pathology as it relates to the biomechanics of foot function. Therefore, the podiatrist is the most qualified medical specialist to diagnose and treat foot pathology.

Understanding the biomechanics of the foot and lower extremity is of critical importance when the mechanism of an injury must be determined to decide on a appropriate treatment plan for the patient. In addition, biomechanics plays an important part in the planning for corrective surgery for injuries, such as tendon ruptures or bone fractures, or for the surgical correction of deformities of the foot, such as hammertoes, bunions, or heel spurs. As a result of the podiatrist's training and expertise in biomechanics, they will often prescribe either functional or accommodative orthoses as part of their treatment plan. In many instances, an orthosis will be all that is required for the successful treatment of foot or lower extremity pathology. In most instances, however, an orthosis will be prescribed along with other therapies, such as stretching or strengthening exercises, oral or injectable medications, and specific types of shoes, in order to insure the fastest healing for the patient.

The Process of Prescribing Foot Orthoses

In order to design and fabricate a prescription foot orthosis, the podiatrist must perform a biomechanical examination of the foot and lower extremities. Angular measurements are taken of the toes, foot, ankle, knees and hip to determine the amount and level of any structural or functional deformities. This examination is done while the patient is on an examining table and also while standing. The podiatrist will also do a walking and/or running gait analysis of the patient to determine how their foot and lower extremity functions during these activities. Abnormalities from the biomechanical examination and gait examination are noted in the patient's chart for future consideration in the design and fabrication of the prescription foot orthosis.

The podiatrist then next must make a three dimensional model of the patient's feet in order to make a prescription foot orthosis. This is done by either applying plaster splints to the patient's foot, by having the patient step into a box of compressible foam, or having the foot scanned by a mechanical or optical scanner. The resultant three-dimensional model of the foot is then used along with a detailed orthosis prescription from the podiatrist to have the prescription foot orthoses made for the patient. Most podiatrists have a specialty podiatric orthosis laboratory make their orthoses while some podiatrists make their own prescription foot orthoses.

Advantages and Disadvantages of Prescription Foot Orthoses

The advantages of prescription foot orthoses are many. First of all, they are custom made for each foot of each patient, so that each foot orthosis will only fit one foot correctly. In addition, since they fit so exactly to the persons foot, they can be made with relatively rigid, durable materials with a minimal chance of discomfort or irritation to the patients foot. Prescription foot orthoses also have a much greater potential to effectively and permanently treat painful conditions, all the way from the toes to the lower back, since they are designed specifically for an individual’s biomechanical nature.

For example, in children, prescription foot orthoses are used to prevent abnormal development of the foot due to flatfoot or intoeing or outtoeing disorders. In athletes, prescription foot orthoses are used to allow the athlete to continue training and competing without pain. And in most adult patients, prescription foot orthoses are used to allow more normal daily activities without pain or disability.

One disadvantage to prescription foot orthoses is that they are relatively expensive when compared to store bought over-the-counter foot inserts. Even though the over-the-counter inserts do help some people with mild symptoms, they do not have the potential to correct the wide range of symptoms that prescription foot orthoses can since they are made to fit a person with an "average" foot shape.

In this fashion, prescription foot orthoses may be considered to be analogous to prescription eyeglasses. Over-the-counter eyeglasses may work for some people since they are made to correct for the average eye. However, over-the-counter eyeglasses will almost never work as well as prescription eyeglasses. Prescription foot orthoses, since they are custom made to each foot of a patient, are almost always more corrective and comfortable than over-the-counter foot inserts, even though over-the-counter inserts do work for some people.