More than 50 million people suffer from allergies in the United States each year. An allergy is an abnormal immune response to certain things in the environment, which are generally harmless to most people. These things are called allergens. Allergens are defined as any substance that triggers an allergic response. When allergies affect the ears, nose, and throat, the symptoms are referred to as otolaryngic allergies.

Symptoms

Allergy symptoms include a wide range of physiological responses. Symptoms may present themselves either suddenly or gradually, and the presence and severity of each symptom may vary from person to person. Symptoms related to ear, nose and throat allergens include:

• Runny nose
• Nasal congestion
• Constant sneezing
• Itching sensation in the eyes, nose and throat
• Reduced ability to smell or taste
• Frequent ear infections and sinus infections
• Frequent, unexplained nosebleeds
• Experiencing cold-like symptoms for more than 10 days
• Constantly feeling fatigued
• Symptoms that recur at the same time every year

If left untreated, allergies may cause complications such as chronic cough, head congestion, recurring infection in the ears and sinus, hearing loss, and may even lead to asthma.

Diagnosis

Healthcare providers who specialize in the diagnosis and treatment of ear, nose, and throat conditions are called Otolaryngologists, and allergies are among the most common problems which they diagnose and treat. Diagnosing an allergy is typically performed by first analyzing your medical history and performing a physical examination. Your doctor will want to track any symptoms you’ve had in the past that could be related to the allergy as well as the timing of the symptoms. For example, you will be asked if you experience symptoms seasonally or year-round or if symptoms occur occasionally, perhaps as a result of exposure to irritants such as mold, animals or dust mites.

Your doctor will also want to perform a physical examination that evaluates the head and neck for signs of allergies. He/she will also be looking for alternative explanations for your symptoms in addition to conditions that may interfere with treatment, such as a deviated septum.

The only way to firmly diagnose an allergy is to perform an allergy test. The most common allergy testing method is a skin test, because it is quick and reliable. During a skin test, your doctor will expose your skin to possible allergens and track how your body responds. There are three types of skin tests: skin prick test, intradermal test, and patch test. In some cases, a blood test may be preferable to confirm an allergy diagnosis. Talk to your doctor regarding specific instructions before conducting allergy testing.

Treatments

Your Ear, Nose, and Throat (ENT) Allergist may recommend the following treatments depending on your specific diagnosis. When reasonable, your doctor will recommend that you avoid or remove the identified allergen from your environment. Additionally, allergy medication has proved to be very effective for patients diagnosed with allergies. Some examples of allergy medications include:

• Nasal sprays, including steroid or antihistamine sprays
• Oral antihistamines
• Decongestants
• Leukotriene inhibitors

Immunotherapy

If avoidance of the allergen or allergy medications do not ease symptoms, your Otolaryngic Allergist may recommend a treatment option called immunotherapy. The practice of immunotherapy to treat allergies attempts to alter the body’s response to an identified allergen through small, regular doses of the allergen. Doses are given either through injection or, in some cases, by placing the allergen under the tongue. Over time, the body may change the way it responds to these allergens, alleviating symptoms and reducing the need for medication. Immunotherapy is the only method of treatment which has potential to alter the underlying disease- all other methods seek to reduce or eliminate symptoms.

Resources

Learn about the cause, diagnosis and treatment of allergies from The American Academy of Otolaryngic Allergy (AAOA).
Recommended therapies and practices for modern clinical care from The American Academy of Otolarngic Allergy (AAOA).
Guidelines on when a patient should seek a specialist from The American Academy of Otolarngic Allergy (AAOA).
Leukotrine inhibitors as an allergy treatment option from Healthline Media.
For general information about allergies provided by the Centers for Disease Control and Prevention (CDC).
Using leukotrine modifiers to treat asthma and potential side effects from WebMD.

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Arthritis, or inflammation of the joints, is a condition that can affect a variety of joints in the body. Because there are over 30 joints in the foot and ankle alone, and because they get a lot of wear over the years, this area is susceptible to foot and ankle arthritis. If left untreated, foot and ankle arthritis can lead to pain and deformity that may limit your ability to walk.

The primary types of arthritis that affect the foot and ankle are osteoarthritis, which occurs in a specific joint, and rheumatoid arthritis, which affects multiple joints throughout the body.

Symptoms of Foot and Ankle Arthritis

You may notice the following symptoms in the affected foot or ankle joint:

• Inflammation
• Redness
• Swelling
• Pain

In the case of rheumatoid arthritis, patients usually begin to experience foot and ankle arthritis symptoms at the front of the foot, followed by the back of the foot, and the ankle.

Foot and ankle arthritis may also cause secondary podiatric conditions, including hammertoe and flatfeet.

Causes of Foot and Ankle Arthritis

Foot and ankle arthritis most often occurs at an advanced age. Osteoarthritis and rheumatoid arthritis have different root causes:

Osteoarthritis can be caused by:

• Years of wear on a joint that causes damage to the joint cartilage
• A previous joint-related injury like a break, sprain, or ligament tear

Rheumatoid arthritis is an autoimmune condition where the immune system attacks the membranes around the joints, called the synovium. It affects multiple areas of the body and progresses to the feet or ankles in 90 percent of cases.

What to Expect at Your Appointment

During your appointment, your doctor will first examine your foot and ankle and ask you about your medical history, including past injuries to the foot and ankle, and whether you have had a prior rheumatoid arthritis diagnosis. In order to diagnose foot and ankle arthritis and determine the extent of the arthritis damage, your doctor will order an X-ray or other imaging test. You may also have a blood test to look for indicators of inflammation or rheumatoid arthritis.

Non-surgical Treatments for Foot and Ankle Arthritis

Your podiatric surgeonwill determine which treatment options are best for you depending on your age, the severity of symptoms, conclusions drawn from an x-ray exam, and other factors.

If symptoms are mild, your doctor may recommend non-invasive treatment options such as:

• Oral anti-inflammatory medication
• Corticosteroid injections to reduce inflammation and stiffness
• Physical therapy to maintain motion in the foot and ankle
• Orthotics, or custom inserts used in your shoes
• Weight loss, to reduce pressure on the affected foot or ankle

If you suffer from rheumatoid arthritis, you will also need be treated by a rheumatologist.

Surgical Treatment for Foot and Ankle Arthritis

Different levels of surgical treatment are available, and your doctor will recommend the best options given the location of your foot or ankle arthritis and how much it has advanced. Possible surgical recommendations include:

• Arthroscopic debridement, a surgery that cleans inflamed tissue out of the joint.
• Arthrodesis, or joint fusion, involves removing the ends of the bones that form the joint and fusing them together. It’s important to note that while it relieves pain, this operation causes a loss of motion in the joint.
• Arthroplasty, or artificial joint replacement.

Recovery from foot or ankle arthritis surgery maytake several months, but it varies by surgical procedure. Your doctor may give you a special shoe or boot to wear to protect your toe as well as require that you rest your foot during this time. Be sure to assess recovery times when you work with your doctor to choose the best treatment for you.

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Plantar fasciitis is a foot condition that causes heel pain due to inflammation of the plantar fascia, a band of tissue that runs along the length of your foot. This condition is notably common in runners and people who are overweight. In the U.S., about 2 million patients each year receive plantar fasciitis treatment.

The time when plantar fasciitis is most likely to develop is between 40 and 60 years of age. Left untreated, plantar fasciitis can lead to increased pain, decreased mobility, and complications due to changes in the way you walk.

Symptoms of Plantar Fasciitis

You may notice the following symptoms of plantar fasciitis, which may intensify over time:  

• Pain in the heel of your foot, especially after getting up in the morning or after a long period of sitting
• Pain in the heel that is stronger after exercise than during exercise
• Heel pain beginning as a stabbing pain and lessening after some time 

Causes of Plantar Fasciitis

There are several factors that may put you at a higher risk of developing plantar fasciitis:

• Being a runner
• Being overweight
• Having flatfeet or high arch feet, or tight calf muscles
• Working a job that involves a lot of time on your feet

What to Expect at Your Appointment

To diagnose plantar fasciitis, the podiatrist will examine your heel and foot to check on your arch, the mobility of your ankle, and to determine the point where you feel pain or tenderness.  Imaging tests usually are not necessary, but an x-ray or MRI may be ordered to rule out other causes of pain.

Non-surgical Treatments for Plantar Fasciitis

 The best treatment for plantar fasciitis is simple stretching. Your podiatric surgeon can recommend a number of stretching techniques that help you to get at the right muscles. Depending on the severity of your condition, treatments may include:  

• Stretches
• Resting your foot
• Icing your foot
• Oral anti-inflammatory medication 
• Orthotic shoe inserts for arch support
• Night splints that stretch the plantar fascia
• Physical therapy
• Corticosteroid injections

Surgical Treatment for Plantar Fasciitis and Post-treatment

Surgery is a last resort for plantar fascia treatment, when non-surgical treatment has not produced success for a year. In this case, a podiatric surgeon may suggest different surgical options including Platelet Rich Plasma injections or plantar fascia release.

Plantar fascia surgery may require a 6-10 week recovery time.

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Bunions are common foot deformities that can form at any age. They are the result of misaligned bones in the foot.

Sometimes, an individual’s big toe moves inward or toward the other toes. When this happens, a bunion can form at the base of the big toe joint, on the outer edge of the foot. This joint, called the metatarsophalangeal (MTP) joint, supports most of the body’s weight when we walk. For this reason, a bunion can be very painful and can even make wearing shoes extremely uncomfortable.

It’s also possible for a lump to develop on the outer, smallest toe. In this case, the bump is referred to as a “tailor’s bunion” or “bunionette.”

Symptoms of Bunions

• Redness, swelling, and/or pain of the big toe joint or smallest toe joint
• A lump at the base of the big toe or on the smallest toe, on the outer edge of the foot
• Limited movement of the big toe
• Pain when moving the big toe
• Irritation that may lead to corns or calluses, due to the big toe overlapping the second toe

If symptoms persist and your pain gets worse, make an appointment with a podiatric surgeon. Bunions are progressive, and if not treated early, they may require surgical intervention to be corrected.

Causes of Bunions

• Inherited foot type and structure
• Injuries to the foot
• Structural abnormalities of the foot

What to Expect at Your Appointment

During your appointment, your doctor will first examine your foot for symptoms of a bunion. If symptoms of a bunion are present, you may be asked to get an X-ray image of your foot to uncover any abnormalities in the bone structure and to confirm the diagnosis.

Non-surgical Treatments for Bunions

Your podiatrist will determine which treatment is best for you depending on your age, the severity of symptoms, the results from an x-ray exam, and other factors.

If symptoms are mild, your doctor may recommend conservative treatment options to relieve symptoms such as: Wearing more comfortable, wider shoes Placing a pad or a shield on the bunion to reduce friction Orthotics that correct the malformation of the foot Anti-inflammatory medication to help reduce pain and swelling

Surgical Treatment for Bunions and Post-treatment

If symptoms are severe and pain persists, surgical correction of the bunion may be necessary. Bunion surgery is used to straighten the bones that are causing the bunion, remove the bunion, reduce pain, and increase the toe’s mobility and function.

Recovery from bunion surgery can take up to several weeks. During this time, your doctor may recommend that you rest your foot and use a special shoe or boot to protect the operated area. At first, you may need crutches before you can start to gradually put weight on your foot.

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There’s not a lot of room inside our feet and ankles, so it’s easy for one condition to cause other problems. In this case, the narrow nerve passage in the ankle becomes compressed as the result of an adjacent condition (e.g., a varicose vein, bone spur, or swollen tendon), or a foot issue such as high arches or flat feet. The result is tingling or shooting pain, burning, or even numbness that can spread to other parts of the foot.

Treatment can range from rest and over-the-counter medication to ankle supports, shoe inserts, and carticosteroid injections. Surgery is sometimes necessary to decompress the nerve.

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Hallux Limitus and Hallux Rigidus are types of foot arthritis that affects the big toe joint. Typically, this condition first occurs between 30 and 60 years of age.

In the case of hallux limitus, you may experience a limited ability to move your big toe upward or downward. If the condition progresses to hallux rigidus, you may lose the ability to move your big toe and it can become painful.

Symptoms of Hallux Limitus/Rigidus

You may notice the following symptoms of hallux limitus/rigidus, which can intensify over time:

• Pain in the big toe when performing physical activity or walking
• Swelling of the big toe joint
• Stiffness in the big toe joint
• Bump, or bone spur, developing on top of the big toe

Causes of Hallux Limitus/Rigidus

Hallux limitus or hallux rigidus may occur as a result of damage to the bone surface that leads to wear in the joint. There are several risk factors that may make you more likely to develop this condition:

• Longer than normal metatarsal, the bone along the inner side of the foot
• Metatarsal that is elevated
• Previous injury of the big toe
• Family history of hallux limitus/rigidus

What to Expect at Your Appointment

At your appointment, your doctor will examine your big toe joint and check the range of motion that you have in your big toe without pain. He or she may also analyze your gait to determine how much the condition affects your walking -- a shift in gait may lead to other problems, so it’s an important factor to consider as you work together to choose your treatment plan. Your doctor may also order an X-ray or MRI to visualize the extent of the damage to the toe joint and how the bone spur has formed.

Non-surgical Treatments for Hallux Limitus/Rigidus

Your podiatric surgeon will determine which treatment options are best for you depending on your age, the severity of symptoms, conclusions drawn from an X-ray exam, and other factors.  

For mild to moderate hallux limitus, your doctor may recommend non-invasive treatment options such as:

• Ice or heat packs to alleviate pain
• Oral anti-inflammatory medication
• Physical therapy
• Corticosteroid injections to reduce inflammation and stiffness
• Changing the kinds of shoes you wear
• Orthotics, or custom inserts used in your shoes

Surgical Treatment for Condition and Post-treatment

In more severe cases, and where your condition has progressed to hallux rigidus, your podiatric surgeonmay recommend surgery. Surgical procedures that are most commonly used include:

• Cheilectomy, or shaving the bone spur that has formed on top of the joint.
• Arthrodesis, or bone fusion, which involves removing the ends of the bones that form the joint and fusing them together. After this operation, pain is eliminated, but you lose motion in the joint.
• Osteotomy, where some of the bone around the joint is shifted to increase joint space and motion.

Recovery time after hallux rigidus surgery depends on the surgical procedure.. Your doctor may give you a special shoe or boot to wear to protect your toe as well as require that you rest your foot during this time. Be sure to assess recovery times when you work with your doctor to choose the best treatment for you.

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Foot structure can vary from person to person. One way in which the feet can differ between individuals is with the shape of the arch. The arch is located on the bottom of the foot, the area from the base of the toes to the heel. It is responsible for helping the foot to support the weight of the body.

In some cases, the arch of the foot is abnormally shaped. Flatfeet appear to have an arch that has fallen - the entire bottom of the foot may even touch the ground. On the contrary, high arch feet are when the arch is raised more than usual, causing more weight to be distributed on the heel and the ball of the foot.

Symptoms of Flatfeet and High Arch Feet

Symptoms associated with flatfeet include:

• For children, pain in the foot, ankle, or lower leg, sometimes only during or after physical activity
• In adults, feet that ache after standing for long periods of time or after physical activity
• An ankle that rolls in (both adults and children)

Symptoms associated with high arch feet include:

• Pain while walking, standing, and running
• Calluses
• Difficulty finding shoes that fit
• A foot that is unstable

Causes of Flatfeet and High Arch Feet

Flatfeet are common in children between the ages of two and three years old. This is because the tissues and muscles that form the arch have not yet developed and are loose. However, in some children, the arch never develops, even when they grow to be adults. Additionally, some adults who have already formed arches can experience an injury that causes the foot to flatten, or the arch can fall with age.

High arch feet are often caused by a nerve condition or an inherited structural bone abnormality.

What to Expect at Your Appointment

During your appointment, your doctor will examine your feet for signs of flatfeet or high arches. Additionally, your doctor will check to see if the arch is still flexible or if it is rigid.

In order to further understand any structural abnormalities, your doctor may want to see images of the bone and muscular structure of the foot. These can be obtained through the following imaging techniques:

• X-ray
• MRI scan
• CT scan

Non-surgical Treatments for Flatfeet and High Arch Feet

When the arch is flexible, non-surgical treatment options typically help relieve pain for both flatfeet and high arch feet.

For individuals with high arch feet, options may include:

• Investing in orthotic shoe inserts to support the arch
• Buying shoes that support the ankle
• Using a brace that supports and stabilizes the foot and ankle

For individuals with flatfoot, the following conservative treatments can help relieve pain:

• Reducing the amount of activity that causes pain
• Investing in orthotic shoe inserts to support the arch
• Anti-inflammatory medication to reduce swelling and pain
• Stretching exercises and, in some cases, physical therapy

Surgical Treatment for Flatfoot and High Arch Feet and Post-treatment

If the pain is not relieved using non-surgical treatments, your doctor may present you with a surgical treatment option to stabilize the structure of the foot.

Your doctor will choose the procedure or combination of procedures that is best for your diagnosis based on the results from your imaging test results, your age, the amount of activity you do, and a variety of other factors.

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The Achilles tendon is located in the lower leg, just above the heel. It is the strongest tendon in the body and connects the calf muscles to the back of the heel bone. This structure is responsible for allowing you to point your foot downward and stand on your toes. It is also essential for proper walking mechanics, as this tendon allows us to push off when walking.

Sometimes, physical activity and overuse can cause repeated stress to the Achilles tendon, causing it to become inflamed and painful. When this happens, this is referred to as Achilles tendonitis. Additionally, if overstretched, the Achilles tendon can tear, resulting in a partial or whole rupture.

Symptoms of Achilles Tendonitis/Rupture

If you are experiencing the following symptoms in the area of the Achilles tendon, at the lower portion of the back of the leg or just above the heel, talk to your doctor. These may be signs of Achilles tendonitis:

• Stiffness in the morning
• Aching and a burning sensation
• Pain that gets worse with physical activity
• Swelling that increases with physical activity
• Bone spur, or bump, on the bone

If the Achilles tendon is ruptured, you may experience:

• Pain and swelling close to the heel
• The inability to stand on your toes
• The inability to point your foot downward

If you feel a snapping or a popping sensation in your heel, call your doctor immediately. This could indicate a rupture in the Achilles tendon.

Causes of Achilles Tendonitis/Rupture

Part of the Achilles tendon receives less blood circulation compared to other tendons, placing it at a higher risk of injury. Additionally, as we age, the Achilles tendon can weaken and become more susceptible to injury.

Achilles tendonitis and/or rupture can be caused by increasing the amount and/or intensity of exercise abruptly, especially activities that involve jumping and repeated impact such as running. An Achilles rupture can also be caused by sudden events such as falling or stepping into a hole unexpectedly.

What to Expect at Your Appointment

At your appointment, you will be asked to describe what you are feeling. Your doctor will then examine your foot for signs of tendinitis or a rupture. Your doctor may also ask you questions regarding the pain, such as if the pain goes away when you rest or if you have recently changed your exercise routine.

If clarification is needed to understand the severity of the rupture, your doctor may ask you to get an ultrasound or an MRI scan in order to obtain an image of the Achilles tendon and surrounding tissues.

Non-surgical Treatments for Achilles Tendonitis/Rupture

Often times, Achilles tendinitis can be treated conservatively using the following treatments:

• Rest and/or reducing the amount of exercise
• Anti-inflammatory medications
• Light stretching and/or physical therapy
• Icing the affected area after physical activity Wearing a shoe insert to lift the heel and relieve strain on the tendon

In the case of an Achilles rupture, if the tendon is partially torn, you may choose to wear a cast or boot that that will elevate the heel and relieve strain on the tendon, allowing it to heal. If the tendon is completely torn, surgery is often recommended.

Surgical Treatment for Achilles Tendonitis/Rupture and Post-treatment

If pain associated with Achilles tendonitis does not subside after six months, your doctor may present you with the option of a surgical procedure.

Rehabilitation after surgery for both Achilles tendonitis and rupture will be necessary in order to restore mobility in the lower leg, ankle, and foot. Individuals typically return to normal activities four to six months from the time of surgery.

Your doctor will present you with treatment options that best meet your needs based on the severity of the injury, your age, your activity level, and other factors.

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