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Our Services


Many common foot complaints like heel pain, arch pain, and ball of foot pain can be attributed to faulty foot mechanics. What this means is that even a tiny flaw in the complex arrangement of 26 bones, 33 joints, and intricate framework of muscles, tendons, and ligaments that make up each of the feet can cause issues such as gait abnormalities, foot instability, and areas of atypical or excessive pressure. Over time this can lead to foot pain and dysfunction including problems such as plantar fasciitis, heel spurs, Achilles tendon problems and flat feet. Faulty foot mechanics can also lead to uncomfortable symptoms in other parts of the body including the knees, hips and back.        

The good news is that foot problems of this nature can often be treated with custom shoe inserts called orthotics. Custom made orthotics can be specifically designed to correct an abnormal or irregular walking pattern, provide the foot with improved support, correct or prevent worsening foot deformity, relieve areas of pressure, and help reduce discomfort. By promoting the proper alignment of the structures in the feet, and by working like shock absorbers, orthotics can improve foot function, restore balance, enhance sports performance while also alleviating foot pain as well as knee, hip and back discomfort.

Our office is skilled and experienced in treating all types of structural and functional foot problems and will thoroughly evaluate all issues and concerns related to your condition. If our podiatrist determines that an orthotic is needed, the appropriate records and impressions will be taken to design and fabricate the most effective one to address your specific needs.



Ankle And Foot Fractures

An ankle or foot fracture is a painful and debilitating injury that impairs mobility and disrupts normal daily activities. Occurring as either an isolated injury or in conjunction with other trauma, the severity of an ankle or foot fracture depends upon its location, the degree and type of fracture, and the damage to the surrounding tissues. When not treated promptly these fractures can have dangerous complications and result in long-lasting impairment.

Symptoms of a broken ankle or foot may include:

  • Pain
  • Difficulty bearing weight/limping
  • Swelling
  • Bruising
  • Tenderness
  • Deformity

If any injury to any associated nerves or blood vessels has occurred, additional symptoms including paleness, numbness, or an inability to move the ankle, the foot, or the toes may be present. The treatment of a foot or ankle fracture depends upon the type and severity of the injury, which bone in the foot is broken, what part of the bone is broken, as well as where this bone is located in the foot. Foot or ankle fracture treatment can range from buddy taping an uncomplicated toe fracture to immobilization with a splint or cast as well as complex surgical procedures designed to restore bone integrity and function. 

Ingrown Toenails

An ingrown toenail occurs when the edge of the toenail grows into and penetrates the underlying skin at the end of or side of the toe. While an ingrown toenail may not initially cause symptoms as it continues digging into the skin, it can produce increasing irritation, inflammation, redness and pain. An ingrown toenail can become so uncomfortable that wearing any shoes, other than ones with a wide, open toe may be impossible. With an ingrown toenail, extra skin, as well as other tissue, can begin to grow around the impinging portion of the nail.  Furthermore, once the ingrown toenail penetrates the skin, an infection may develop with pus and worsening symptoms.

Common causes of ingrown toenails may include:

•    Over-trimming the Toenails

•    Heredity

•    Trauma

•    Improper Footwear

•    Nail Disorders

•    Faulty Foot Mechanics

If you are suffering from an ingrown toenail, the safest approach is to see your podiatrist for professional guidance, diagnosis, and care. This advice holds true for everyone and is especially important if an infection is present, if you suffer from diabetes, have nerve damage in your feet, suffer from poor circulation, or have a compromised immune system.

The good news is that fixing most ingrown toenails and relieving the associated symptoms can be accomplished with a minor in-office procedure. The extent of the procedure depends upon the severity of the case, whether or not your ingrown toenail is a chronic problem, and if there are other contributing medical factors.



Fungal Infections

Fungal nail infections are very common in adults and account for nearly half of all nail disorders. Technically known as onychomycosis, fungal nail infections can affect both your fingernails and toenails, but are most frequently seen in the toes. While the infection is a slow-growing one, a nail fungus can eventually cause the overlying nail to discolor, thicken, change texture, become increasingly brittle, break and even detach from the nail bed.

Left untreated an increasingly disfigured toenail can cause discomfort and irritation, especially while wearing shoes or walking. Not only that, fungal nail infections can spread to the other nails. If a diseased toenail breaks, it can also pierce the skin thereby allowing bacteria to enter, which can lead to a more serious type of infection. This is especially dangerous for individuals who have diabetes or a compromised immune system.

For all of these reasons, it is a good idea to give our office a call at the first sign of any discoloration, thickening or deformity of your toenails. Although a fungal nail infection can often be identified by its appearance, other conditions can produce a similar look, and an accurate diagnosis is essential for proper care. One thing is for certain; you can rest assured that our office will consider every aspect of your case in determining the best approach to care. Furthermore, we offer the most effective methods of care including the latest generations of topically applied medications, oral antifungal drugs, laser and surgical procedures.


One of the most common foot problems seen by podiatrists is a bunion. Typically recognized as an unsightly bump at the base of the big toe, a bunion is actually a deformity of the framework of the foot. It develops when the joint at the base of the big toe becomes unstable, causing both the bone and soft tissues to move out of place. The bunion’s characteristic bony knob appears on the foot just behind the big toe and angles outward as the big toe angles inward toward the smaller toes. Occasionally, a bunion may develop at the base of the little toe on the outside of the foot. This is known as a tailor’s bunion or bunionette.

 Foot mechanics that put too much pressure on the big toe joint may be the reason behind the development of bunions. Factors such as gait, inherited foot type, wearing ill-fitting or poorly designed footwear, as well as having an occupation that puts a lot of stress on the feet can increase the risk that a bunion will form. Individuals affected by injuries to foot alignment, neuromuscular disorders, congenital deformities, or joint conditions are also more likely to develop bunions.

Without the appropriate podiatric care, a bunion can widen the foot, make wearing shoes more difficult and impair daily function. A shifting big toe can put so much pressure on the smaller toes, that they too develop abnormalities. Moreover, the toe joint damage associated with a bunion can cause stiffness, bursitis, or arthritis and give rise to additional complications.

Our podiatrist will evaluate your bunion and develop an appropriate treatment plan. If non-surgical, conservative methods of care fail to provide relief, and the bunion is interfering with your daily life, our podiatrist may recommend a surgical procedure.


Flat Feet

The purpose of arches in the feet is to add springiness and flexibility to the midfoot. Arches in the feet help to generate the strength to push off with movement, distribute body weight, absorb the shock of contacting the ground, and assist with balance. In addition to these functions, the arch of each foot acts as an energy store to support activities like walking, running, or jumping.

One of the most common and well-known deformities of the lower extremities is flat feet. They occur when the arches of the feet (the insteps) are either partially or completely collapsed. This deformity puts the soles of the feet, the plantar surface, in complete or near complete contact with the ground. When flat feet, which are also known as fallen arches, are present, the alignment of the legs may also be slightly altered. In some cases this can lead to pain and other problems in the feet, ankles, legs, knees, hips, and the lower back.

If you or your child has foot pain, it is a good idea to see our podiatrist for a thorough evaluation and treatment. This is the best way to prevent any additional and potentially debilitating complications from developing. Our podiatrist can provide the most suitable and therapeutic treatment options to stabilize the causes of flat feet, help restore and improve foot function, and alleviate any associated symptoms.


One of the most common toe deformities seen by our office is a hammertoe. Most often attributed to wearing ill-fitting, tight footwear or high-heeled shoes that squish the toes into a bent position, a hammertoe can also be influenced by genetic factors, the result of a bunion, or caused by arthritis in the toe joint.

Just as the name implies, a hammertoe resembles a “hammer” with the toe bending at the middle joint into a claw-like deformity. Hammertoes can develop in any of the small toes of the foot, but most often affect the second and third toes. Hammertoes usually affect women, but men can develop them as well.

Hammertoes can cause you discomfort while walking or when you simply try to move or stretch your toes. You may also develop corns or calluses on the top of the toe and the ball of the foot and have difficulty fitting into your shoes.

While in the early stages of a hammertoe, the joint may still be flexible and conservative therapy will provide sufficient relief, left untreated your toe will become more rigid and less responsive to these methods of care.

Our podiatrist will develop an appropriate plan to treat your hammertoe, taking into consideration the severity of the toe deformity, existing medical conditions, your level of activity as well as any other factors that may influence your care. A non-surgical, conservative approach may include strategically placed foot padding, wearing shoes with a roomy toe box, custom orthotics, splinting and taking anti-inflammatory medication as needed to reduce pain and inflammation. In severe cases, surgery may be required to straighten the joint. A combination of procedures may be recommended when a hammertoe is accompanied by other foot deformities.

Diabetic Foot Care

For people with diabetes even the smallest blister, sore, or cut on the foot can pose tremendous risks. Something as minor as an irritation from a small pebble in a shoe can quickly progress from a wound that doesn’t heal to a dangerous infection that can lead to an amputation and even a life-threatening situation. The statistics are alarming. Foot infections and their complications are the leading cause of hospitalization for diabetics. More than 60% of non-traumatic lower limb amputations occur in people with diabetes.

The keys to avoiding the foot related complications of the disease are the prevention and early detection of problems. If someone has diabetes it is extremely important that in addition to maintaining a healthy blood sugar level and healthy lifestyle, they practice a daily foot care regimen at home, and see a podiatrist for a thorough examination on a regular basis.

Our podiatrist will screen for the presence of diabetic neuropathy and vascular damage as well as check the foot and nearby structures for redness, swelling and non-healing wounds. Furthermore, our podiatrist will provide guidance and care to prevent foot ulcerations or injury. In cases of an existing cut or ulceration, our podiatrist will perform the most appropriate wound care as well as prescribe strategies to protect the foot from infection and accelerate the healing process.

Heel Pain

One of the most common complaints heard by podiatrists is that of heel pain. As the largest of the 26 bones in the foot, the heel is designed to perform many tasks. While the heel is equipped to handle heavy loads, too much stress can lead to problems.

Symptoms of heel pain may be felt in the front, back, or bottom of the heel. Pain that is felt under the heel is most frequently associated with a condition known as, plantar fasciitis. The plantar fascia is a band of connective tissue that runs along the bottom of the foot from the heel to the base of the toes. Overuse or prolonged wear and tear on the heel can strain this band causing damage, inflammation, and pain. Other sources of heel discomfort may include, stress fractures, tendonitis, arthritis, nerve irritation or cysts.

As plantar fasciitis can be a slow-healing and chronic condition, early diagnosis and intervention are important. Most individuals will experience improvements with conservative therapy alone. However, if symptoms are disabling and persistent even after an extended course of conservative treatment, then other approaches to care, including surgery, will be considered.

Since heel pain can occur for a variety of reasons, it is important when symptoms arise to contact our office for a thorough evaluation and care.

Corns and Calluses

Corns and calluses are thick and hardened layers of skin that develop as part of the body’s protective response to continuing pressure and friction. While they can form anywhere on the body, they most often develop on the hands or feet.

Typically seen on the feet, corns, and calluses can be distinguished from each other in several ways. Calluses are rough, hard patches of skin that appear slightly yellowish and are usually seen on the ball of your foot or on the heel. Varying in size and shape and lacking well-defined edges, they are not usually painful. Corns, on the other hand, are commonly found on non-weight bearing areas of the feet such as the on the tops and sides of the toes and between the toes. Small cone-shaped bumps of skin with a core that points inward, corns can be painful.

Foot corns and calluses often develop as a direct result of pressure due to:

•    Footwear that is tight or ill-fitting as well as high heels, bunched up socks or   going shoeless

•    Athletic events that put a lot of pressure on the feet or a lot of walking & running

•    Toe deformities that expose an area to increased pressure

•    Bony prominences

•    Incorrect foot alignment and gait abnormalities

It is always a good idea to consult with our podiatrist about any unusual bumps or lesions on your feet. This is especially important if you are having pain and discomfort that is interfering with your daily activities or if you have diabetes, poor circulation or other serious medical conditions.

Our podiatrist can safely pare down or trim corns and calluses as well as prescribe the appropriate medicated patches and instruct you in the right methods of home care. In some cases, besides well-fitting footwear or specially designed padding, custom-made orthotics may also be prescribed to prevent further irritation and recurrence of the corns and calluses. A cortisone injection can be given in situations where persistent pain is present. If conservative treatments are not effective, other procedures may be recommended. 

Athlete's Foot

Athlete’s foot is a common and contagious fungal infection that thrives in many warm and moist environments. It can be found in places like showers, around swimming pools and locker room floors. Absolutely anyone in direct contact with an infected person or a surface contaminated with the fungus can acquire athlete’s foot.

Athlete’s foot typically develops between the toes but can also occur on other parts of the feet. It can affect one, or both of the feet. Although the skin infection can vary from person to person, signs and symptoms may include:

  • Itching, stinging or burning discomfort
  • Dry, flaky, scaly, peeling, or cracking skin
  • Redness
  • Inflammation
  • Oozing or crusting blisters

When left untreated there is a risk that athlete’s foot can spread to the soles of the feet and to the toenails. Furthermore, other parts of the body can become infected by scratching the affected area, not washing the hands, and then touching the skin elsewhere. In the most severe cases of athlete’s foot there may be large, open cracks with exposed raw skin tissue. This particular situation is not only painful; it can lead to a serious secondary bacterial infection. 

It is always a good idea to make an appointment with our podiatrist when suffering a problematic foot condition. Often athlete’s foot can be diagnosed by simply examining the area. However, not all itchy and scaly feet necessarily mean athlete’s foot is present. Additional tests are sometimes required as there can be other conditions such as dermatitis, psoriasis, or a low-grade skin infection that produce similar symptoms. 

Once a definitive diagnosis of athlete’s foot has been made, our podiatrist will prescribe the appropriate antifungal medication and care. Used as directed, the medication in combination with daily foot hygiene and improved foot care practices, can help resolve the infection as well as prevent it from spreading.


Sinus Tarsi Implant Surgery

Sinus tarsi implant surgery is a minimally invasive procedure designed to address excessive pronation of the subtalar joint, which is the articulation between the talus bone (ankle bone) and the calcaneus (heel bone). By placing a small implant in the sinus tarsi (the canal between the two bones), excessive joint mobility and overpronation of the foot can be prevented, while a somewhat normal range of motion can be maintained. Functioning as a small, internal orthotic, the implant realigns not only the bones of the foot but can also help to restore the alignment to the rest of the body. A sinus tarsi implant surgery may be performed on children and adults for congenital or adult onset flatfoot disorders.

Sinus tarsi implant surgery offers significant benefits over other surgical approaches to care. In addition to being a minimally invasive and reversible procedure, the surgery does not require post-op casting and the recovery time as well as return to athletic activity is quicker. As opposed to long-term orthotic treatment, there is almost instantaneous gait improvement along with a decrease in pain and tiring of the feet and legs.

Our distinguished Foot & Ankle Surgeon, Dr. James Totten, is Triple Board certified in his specialty with over 25 years of experience in treating all types of foot and ankle disorders. Dr. Totten specializes in pediatric hypermobility flatfoot surgery and performs subtalar arthroeresis procedures using implants with established track records for safety and deformity correction including the HyProcure® and Subtalar MBA® Implants.

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