Nerves play a critical role in how we experience pain, balance, and movement. Nerves are two-way messaging electrical conduits that carry signals for motor function from the brain to the periphery, and sensory input, carrying information from the periphery to the brain. When there is a disturbance either mechanically or chemically in the signal pathway, symptoms can emerge.

Systemic conditions such as diabetes and autoimmune disorders can lead to nerve dysfunction, or peripheral neuropathy. Symptoms of neuropathy may include burning, stinging, compressive pressure, pins and needles, or even combinations of symptoms. Often the presentation will be insidious, developing slowly over time. However the symptoms can become profound and persistent, affecting quality of life. Treatment begins with identifying the underlying cause and if possible treating that condition, with nerve symptoms resolving when the underlying disorder is reversed. In some cases, such as with diabetic neuropathy, there is no reversal as the nerve damage becomes permanent.

Mechanical compression is another common cause of nerve pain in the foot. Morton's neuroma and tarsal tunnel syndrome are two examples of this. Electrical shock, tingling, and abnormal sensations hallmark these conditions. Generally, pressure relief has beneficial effects. Occasionally the pressure needs to be relieved with surgical means. This involves decompressive surgery.

In season 2, we will dive deeper into surgical management of nerve conditions and many others. This episode will touch on symptoms and workup.

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.

In this episode of BIPEDAL, we explore one of the most common deformities of the forefoot—hammertoes. These toe deformities affect millions of people and often develop gradually due to biomechanical imbalance in the foot.

A hammertoe occurs when one of the lesser toes—most commonly the second, third, or fourth toe—becomes bent at the middle joint, creating a characteristic hammer-like appearance. Early in the condition the toe may remain flexible, but over time the deformity can become rigid and painful.

We discuss the different types of digital deformities, including:

• Hammertoe, where the proximal interphalangeal (PIP) joint bends upward
• Mallet toe, which involves bending at the distal joint near the tip of the toe
• Claw toe, where multiple joints bend and the toe curls more dramatically

The episode explains how these deformities develop, focusing on the role of muscle imbalance between the intrinsic and extrinsic muscles of the foot, as well as contributing biomechanical factors such as long second toes, joint instability, structural foot types, and restrictive footwear.

Common symptoms include:

• Pain or irritation in shoes
• Corns and calluses from pressure points
• Difficulty finding comfortable footwear
• Progressive deformity of the toe

We also review treatment options, beginning with conservative approaches such as footwear modifications, padding, orthotics, and activity changes. These strategies aim to relieve pressure and slow progression of the deformity.

When symptoms persist or the deformity becomes rigid, surgical correction may be considered. Surgical procedures typically focus on realigning the toe, releasing tight tendons, or stabilizing the joint to restore function and relieve pain.

Finally, we discuss recovery and patient expectations following hammertoe surgery. Most patients are able to walk immediately in a protective surgical shoe, with gradual return to normal footwear over several weeks. Swelling can persist for a few months, but long-term outcomes are generally very favorable when the deformity is appropriately corrected.

This episode provides a clear overview of hammertoes—from how they develop to the treatments available—helping listeners better understand a condition that affects a large portion of the population.

Key Takeaways

• Hammertoes are a common deformity affecting the lesser toes.
• They often develop due to muscle imbalance and biomechanical factors.
• Early treatment focuses on pressure relief and supportive footwear.
• Surgery may be recommended when deformities become rigid or painful.
• Recovery typically allows early walking with gradual return to activity.

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.

Beginning with early primates more than 50 million years ago, the episode examines how primitive feet functioned primarily as grasping tools for arboreal life, featuring a divergent big toe, long toes, and a flexible midfoot. As environmental changes pushed early hominins toward life on the ground, the foot gradually adapted to support bipedal locomotion.

Key fossil discoveries—including Ardipithecus, Australopithecus, and the famous 3.6-million-year-old Laetoli footprints—provide critical evidence of how early humans began walking upright. Later species such as Homo erectus show the emergence of many modern features of the human foot, including shorter toes, a larger heel bone, and the development of the longitudinal arch.

The episode also explores the biomechanics that make the human foot so efficient, including the windlass mechanism, elastic energy storage within the arch and plantar fascia, and the role of the big toe in propulsion. Together, these adaptations transformed the foot into a structure capable of supporting long-distance walking and endurance running.

Finally, the discussion connects evolutionary design to modern foot pathology, highlighting how conditions such as plantar fasciitis, bunions, and arch dysfunction may represent trade-offs of our specialized bipedal anatomy.

I named the podcast 'Bipedal' since the story of structure origin is fundamental to understanding what can structurally go wrong.

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.

In this episode of BIPEDAL, we take a comprehensive look at arthritis of the foot and ankle, a common condition that can significantly affect mobility and quality of life. Foot arthritis is actually quite common, particularly in adults over the age of 50, while ankle arthritis is less frequent but often more debilitating when it occurs.

Osteoarthritis is the most common joint disease worldwide, affecting hundreds of millions of people. In the foot alone, imaging studies suggest that roughly one in five adults over 50 show signs of arthritis, although not all cases produce symptoms. Ankle arthritis affects approximately 1% of the population, and unlike hip or knee arthritis, the majority of ankle arthritis cases are post-traumatic, meaning they develop after an injury such as an ankle fracture or severe sprain.

Arthritis typically begins with breakdown of the protective cartilage inside the joint, which normally allows smooth, pain-free movement. As cartilage deteriorates, the joint space narrows and the bones begin to experience increased mechanical stress. Over time this can lead to bone spurs, stiffness, loss of motion, and chronic pain.

There are different causes of arthritis, including:

• Primary osteoarthritis, related to age and long-term wear
• Post-traumatic arthritis, often following fractures or ligament injuries
• Inflammatory arthritis, such as rheumatoid arthritis or psoriatic arthritis
• Biomechanical causes, including deformities or abnormal foot structure

Common symptoms of foot and ankle arthritis include:

• Pain during walking or standing
• Stiffness in the affected joint
• Swelling and inflammation
• Loss of joint motion
• Progressive deformity in advanced cases

Treatment generally begins with conservative management aimed at reducing pain and improving function. These strategies may include activity modification, supportive footwear, custom orthotics, bracing, anti-inflammatory medications, and occasionally injections to reduce inflammation. When symptoms become severe or conservative treatments fail, surgical options may be considered. These procedures can include joint debridement, realignment procedures, joint fusion, or in certain cases joint replacement, particularly for the ankle.

The episode emphasizes that treatment decisions are individualized and depend on the severity of arthritis, the joints involved, and the patient’s activity level and goals.

Key Takeaways

• The foot contains 33 joints, making arthritis a common source of foot pain.
• Approximately 20% of adults over 50 show signs of foot arthritis on imaging.
• Around 70–80% of ankle arthritis develops after trauma, such as fractures or severe sprains.
• Symptoms typically include pain, stiffness, swelling, and decreased mobility.
• Conservative treatments often provide relief, but surgical options exist for advanced cases.

This episode provides listeners with a clear overview of how arthritis develops in the foot and ankle and the wide range of treatment options available to maintain mobility and quality of life.

For more discussions about foot and ankle health, stay tuned to BIPEDAL.

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.

Approximately 10% of all fractures in the human body occur in the foot and ankle. It is a load bearing, highly stressed region of the body whereby forces are continuously being applied. Move the foot suddenly in the wrong direction, and these forces can overwhelm the ability of the bones to stay intact. However, all injuries resulting in fractures do not have to be the result of sudden movement or significant force. Repeated cyclic stress such as when training or carrying heavy loads may result in a type of fracture pattern as well.

Understanding the mechanism of injury is crucial in fracture evaluation and management. Because fractures follow patterns, skilled clinical evaluation can determine whether straightforward conservative management is appropriate, or more intensive surgical repair is required. Factors such as patient age, activity level, biologic capacity for healing, and even adequate blood flow all become part of a clinical picture that dictates methods of treatment.

I am taking a broad look at this type of injury in Season 1 to lay the foundation for future discussions. Next season we will begin to explore more in depth surgical topics including specific fracture scenarios that we treat.

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.

The great toe joint is just that - it's great! Until it's not. Stiffness and immobility are very common conditions. Some studies show that over 60% of people will develop arthritis in this joint at some point in their life.

Patients will report initially with occasional pain with bending, or when performing certain activities such as jumping or stooping. As the condition progresses, limitation of motion becomes more pronounced, and bone spurs will become evident. In later stages, even walking may be painful.

Because arthritis is progressive degeneration, there is no easy "fix." We manage symptoms using shoe modifications and orthotic therapy, occasionally supplemented by medications and physical therapy. When these modalities fail, surgery may be indicated. The good news is that this is a slow process, often taking years for symptoms to rise to this level of care.

Surgery also has options. In early stages, joint salvage is preferred over joint destruction. This may include a simple clean up of the spurs and removal of loose cartilage. As the cartilage wear patterns continue and joint space narrows, decompression through osteotomy (cutting of the bone) may extend the life of the natural joint. In later stages of degeneration the joint may no longer be salvageable. At this stage we consider either replacement or fusion depending on activity level, radiographic parameters, and patient preference.

Joint fusion remains the mainstay for end stage arthritis. So there is always a definitive procedure for alleviating pain in this joint, but we work through many methods before choosing this option.

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.

Gout is a term we use to describe the intense inflammatory episode that occurs when elevated uric acid levels in the blood - a condition called hyperuricemia - cause crystal deposition in the joints. Very often this occurs in the foot since this is a cooler area of the body. Patients will remark that even the sheets touching the joint elicits intense pain.

Clinically, we often see the great toe joint involved. This is probably due to several factors, including that underlying arthritis is often present before a gout episode occurs. Additionally this is a relatively large joint in a cool area of the body.

Diet may play a role. Specifically, foods high in purines will contribute to hyperuricemia. Shellfish, dark flesh fish such as salmon and tuna, red meat and derivative products such as gravy, even beans and peas may elevate systemic uric acid levels. Additionally, dehydration may compound the elevated uric acid levels, such as with consumption of alcohol or when taking diuretic medication.

With blood tests we can determine the levels of uric acid and consider either diet modification for transient or slightly elevated uric acid or long term medication for very high levels. These medications will lower the uric acid and thus indirectly reduce or eliminate gout attacks.

Gout as an inflammatory condition is manageable, but clinical evaluation is essential. Each attack is not without consequence and multiple attacks over time can lead to severe debilitation, sometimes requiring surgical management.

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.

Ankle sprains are very common orthopedic injuries. A sprain is stretching or tearing of ligaments. Since there are multiple ligaments holding the ankle complex together, there is a myriad of injury patterns that can result from "rolling" your ankle.

On the outside of the ankle there is a ligament complex called the lateral collateral ligaments. These are the most commonly injured in a typical ankle sprain. On the inside of the ankle lies the deltoid ligament, and triangular shaped ligament complex that can secondarily become injured during a lateral sprain or primarily injured, such as when stepping in a hole and the foot is turned outwards. And in between the leg bones, the tibia and fibula, is a strong ligament complex called the syndesmosis that can also become torn in high ankle sprain patterns.

When I examine patients, I am taking inventory of the integrity of all of these structures, as well as the bones that they connect to. I pay special attention to the ability of the ligament to restrain motion. This can clue us in to whether a ligament has been simply stretched, partially, or fully torn.

An unstable ankle as a result of torn ligaments can be especially problematic long term. This is due to the aberrant motion allowed when ligaments are stretched or unstable. The result is premature wear of the cartilage lining the joint which can lead to early arthritis. Thus the reason we take even 'simple' sprains very seriously both in initial approach and with rehabilitation.

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.