Painful burning, stinging, electrical shocks and possibly numbness in the plantar foot, especially with weight bearing and activity may be tarsal tunnel syndrome. This is an often misdiagnosed condition since the symptoms overlap with many other pathologies.

Diagnostic testing such as MRI, CT, ultrasound and EMG/NCV studies are not consistently diagnostic, leading to many alternate theories for pain in this region. Many practitioners will often overlook double crush situations where the peripheral nerves are already hypersensitive due to more proximal level compression. Systemic disorders such as diabetes and thyroid disease may also make peripheral nerves more susceptible to compression injuries.

Careful history and physical exam, and occasionally a diagnostic block are used to confirm the diagnosis and rule out others.

Treatments are also difficult because there is no consistency in response to any one method. Occasionally surgery is required for pain relief, although expectations for surgical outcome must be guarded. In advanced stages the post-operative prognosis worsens, and patients often will gain some but not complete relief. This is true even if space occupying lesions are the causative factor and can be removed.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Key diabetes statistics in the United States:

Total Prevalence: Approximately 40.1 million people (diagnosed or undiagnosed) have diabetes, about 12% of the US population.

• Diagnosed vs. Undiagnosed: Of the 40.1 million, roughly 29.1 million are diagnosed, while 11 million are undiagnosed.
• Prediabetes: An estimated 115.2 million American adults aged 18 and older have prediabetes.
• New Cases: Every year an estimated 1.5 million Americans are diagnosed with diabetes.

Economic and Health impact:

Cost: The total estimated cost of diagnosed diabetes in the United States in 2022 was over $412.9 billion.

• Mortality: Diabetes is a leading cause of death in the US.
• Complications: Uncontrolled diabetes can lead to heart disease, kidney damage, vision loss, and leg or foot amputations.

Diabetes affects all of the major organ systems in the lower extremity. The nervous system, circulatory system, musculoskeletal system, and even the skin. What we see in the foot is a window into what is happening to the body systemically. A diabetic foot wound is not a simple or isolated condition - it reflects advanced disease state, and can be a critical entry point, a big red flag, for more intensive treatment of the underlying condition.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Equinus, or a tight heel cord, is a major contributor to foot pathology. In some cases it is subtle and the body can compensate to the point where it is unnoticeable. However over years the compensatory motion that is "borrowed" from other joints becomes apparent as either pain in areas such as the Achilles insertion or the plantar fascia, or structural changes such as collapse of the arch or bunions.

Because it is such an influential force across the entire foot, the Achilles tendon is usually examined along with specific pathologies that may be the 'presenting complaint.' Patients are often unaware of the tightness in the heel cord. This is where careful and deliberate clinical evaluation is essential. Treatment of a specific pathology while ignoring the primary causative condition will lead to reoccurrence.

Calf stretching is part of comprehensive rehabilitation for many foot and ankle conditions. Stretching is best when performed with frequency, repetition and force. Gravity is one way to achieve stretch, but tensioned bands, belts, even a pillowcase can be more effective at helping stretch this strong structure. The benefits of stretching cannot be overemphasized. It is especially important as we age, become less active or mobile.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.