Bunions (Hallux Valgus)
A bunion is a common term for a medical condition known as Hallux Valgus. Hallux Valgus is the tilting of toe away from the mid-line of the body. It is usually characterized by a lump or bump that is red, swollen and/or painful on the inside of the foot in and around the big toe joint. There are many causes of bunions, but the primary one is tight, ill-fitting shoes, shoes that constrict the forefoot over a long period of time. High heels and constricting forefoot shoe gear are the primary causes of Hallux Valgus. There are many things that you can do to lessen the pain associate with this condition:
1. A good, well-supported, wide toe box shoe, along with good insole
2. Anti-inflammatory medications
3. Cold compresses, such as the Dura Kold Ice Wraps
4. Soaking the foot in Epsom salts, Johnson and Johnson foot soaks, or Dome-Boro type solutions, massage, therapy, and pads are also good palliative measures. |
Of course, if you have diabetes, vascular insufficiency, arthritis or a neuropathy (where the sensation to the foot is diminished) immediate care of a podiatrist is recommended. Doctors specializing in the care and treatment of the foot (Podiatrist) usually will recommend x-rays to determine the exact cause and treatment of this condition. Although cortisone injections and orthotics are helpful for this condition, it is usually a surgical procedure (bunion surgery) that eradicates the pain.
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Heel Spur / Plantar Fascitis
Heel spur/ plantar fascitis affects men and women equally. It is a condition in which the bottom of the heel is extremely painful. A heel spur is a bony overgrowth on the bottom of your heel bone. The heel spur is usually a result of an inflamed ligament (plantar fascia) on the bottom of the foot that attaches to the heel bone. Constant abnormal pulling of this ligament irritates the heel bone and the body lays down a bone spur as a protective mechanism. The patient usually complains of pain with the first step in the morning, some relief following activity, but returning after extended amounts of time standing or walking.
This condition is a constellation of many causes; overweight, ill fitting shoes, bio-mechanical problems (Malalignment of the heel), gout, pronation (a complex motion including outward rotation of the heel and inward rotation of the ankle) and rheumatoid arthritis are some of the causes of heel pain.
If you have pain in the bottom of your foot and you do not have diabetes or a vascular problem, some of the over-the-counter anti-inflammatory products are helpful in eradicating the pain. Ice compresses, stretching exercises and massage of the back of the leg, and traction of the leg muscles along with padding are also things that you can do at home.
But the most important aspect of heel pain or any painful condition of the foot is wearing good shoe gear. Good shoe gear usually consists of a sturdy, solid shoe. Heel pain is not relieved by a soft, ill supported shoe. Shoes such as Nike, K-Swiss, and Avia are the best shoes for this condition.
Your doctor, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. Orthotics are the number one treatment modality for this condition. An easy over-the-counter device such as the Heel Aid is a good first start in determining if you need an orthotic. If the pain is relieved with this device, most likely an orthotic will offer a permanent solution. Physical therapy is another modality that physicians use in the treatment of this condition. Ice packs, muscle stimulation, ultra sound, Therabath, and the new Plantar Fascitis Night Splint are also helpful.
If all these conservative measures fail to relieve the pain, then surgery is indicated. The newer minimal incision surgeries such as the Endoscopic plantar fasciotomy surgery is extremely beneficial for this condition, and for earlier ambulation, the use of the newer Cast Walking Boot is recommended.
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Orthotics
Orthotics are devices that are used to control abnormal foot function. When the foot is not functioning correctly, it will produce painful areas. The signs and symptoms of altered biomechanics of the foot are usually registered as pain. An orthotic can relieve that pain by supporting the ligaments and the osseous (bone) structures of the feet.
Orthotics come in many different forms. They are made from rigid materials, metal, plastic, carbon-type materials, and can be covered or not covered. But they must be made accurately.
There are several ways to construct an orthotic. One is to take a plaster impression of the foot. The newer, more advanced way is to take an optical impression of the foot. Some people use a foam based impression. But in any event the form of the foot must be captured accurately and the form is then sent to an orthotic laboratory, to be transferred into a mold of the patient's foot. Corrections are made to that mold and orthotic is made from that corrected mold.
Orthotics are used for many conditions, from childhood to adulthood. In children, orthotics are used to realign the arch structure, realign in-toeing and out-toeing gait problems, or to accommodate knee and hip problems. In the very active age group, such as runners or sports related activities, specially constructed orthotics are accommodated to the specific sporting event. Most professional athletes and weekend athletes use orthotics to help increase their performance. In the older age group, orthotics are also used as an accommodative device for diseased areas of the foot. Diabetic ulcers, hallux valgus (bunions), heel spurs, plantar fascitis, and a host of osseous (bone) or arthritic types of problems can be helped by an orthotic.
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Neuroma
Neuroma: pinched nerve, nerve tumor, or swollen nerve are some common terms for a rather painful condition. A neuroma is usually situated between the third and fourth toes. They are characterized by a sharp, lancinating type pain, usually when the patient is wearing shoes. The patient feels that they may need to remove their shoe and rub their foot for relief. The reason for this patient activity is that the nerve between the toes is pinched by constricting shoe gear. When the pain becomes more frequent and lasts over a longer period of time, the nerve becomes enlarged.
Early treatment for the patient consists of a thick soled shoe, a wide toe box, and certainly avoidance of high heels. Over-the-counter remedies include, but are not limited to, inserts, such as Sof Soles, Johnsons foot soaks/Paraffin Baths, massage and ice.
A professional, such as a podiatrist, can offer many treatments for this condition. Usually an x-ray is indicated, and a complete exam and history is taken. The first line of treatment is usually injections of cortisone into the neuroma mixed with a local anesthetic. This is usually carried out to a maximum of three injections. Anti-inflammatory medications are also used in the treatment of this condition. A third line of defense is biomechanical. Prescription orthotics, made from a cast of the foot are also beneficial in relieving pain of the neuroma.
But if all these conservative measures fail then surgical excision is indicated. Usually this surgery can be done under a local block (xylocaine) anesthetic, and is done on an out-patient basis. The recovery time for this procedure is usually less than three weeks and return to normal shoe gear is very rapid.
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Ingrown Nails/Fungus Nails
An ingrown toenail is a condition in which the nail is cutting into the flesh. This condition is usually very painful and is usually associated with infection of the toe. A nail is ingrown when one or both corners or sides of the nail grow into the skin of the toe. Irritation, redness, uncomfortable sensation of warmth, as well as swelling, pain and infection can result from an ingrown toenail.
This condition is not to be taken lightly. A toenail infection in the presence of diabetes or vascular problems can lead to loss of limb.
If you think you have a systemic condition (a condition which can be life threatening) you should see your physician/podiatrist immediately.
If the toenail is discolored and thickened, then you may have a mychotic (fungus) infection. This is most readily treated by the new oral medications such as Sporanox and Lamasil.
But again, an ingrown toenail is a serious condition for people with impaired circulation, diabetes or other systemic diseases, and care and treatment of this condition should be sought from a podiatrist or family doctor.
Soaks, topical ointments such as Neosporin, and correct filing of the nail (cut toenails straight across, and leave slightly longer than the end of the toe, then file straight across) are also beneficial. If surgery is indicated, in that conservative measures have failed, then a phenol (a chemical technique) is usually the procedure of choice. Most foot doctors (Podiatrists) employ this ingrown toenail surgery procedure on an outpatient basis.
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Hammertoes/Bone Spurs
Hammertoes, exostosis (bonespurs) could also be grouped under arthritis. Hammertoes, bonespurs, and exostosis are all a result of an imbalance of the muscle structures of the toes, when the toes become crooked, bent, or buckle under causing joints to protrude. These are all descriptions of a biomechanical imbalance.
Although heredity can be a factor in the formation of these conditions, usually it is ill-fitting shoes that precipitate these conditions. In diabetics, or people with poor circulation, hammertoes can be a serious condition. Infections can ensue and the hammertoes can become the source of loss of limb. If a corn develops over a hammertoe, it is usually a result of the pressure between the toe and the shoe.
First aid remedies that can be tried at home; make sure the shoe is fitting adequately, massage, soaks/paraffin baths, pads, creams. But if the redness or infection are present the care of a podiatrist, is recommended. If the deformity is permanent and causing constant pain, surgical correction utilizing a tenotomy, capsulotomy or arthroplasty (realigning the bone) is the next stage of treatment.
Usually hammertoes can be repaired without using pins or wires, but sometimes this is necessary. In some extremely deformed toes your doctor will recommend an implant to be placed inside the joint to help maintain alignment. Earlier ambulation is encouraged with the use of a post-operative shoe.
