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Medfoot Weblog

Morton’s Neuroma

What Is a Neuroma?

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot).Neuromas may also occur in other locations in the foot. The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.

 

Symptoms of a Morton’s Neuroma


If you have a Morton’s neuroma, you will probably have one or more of these symptoms where the nerve damage in occurring:

  • Tingling, burning, or numbness
  • Pain
  • A feeling that something is inside the ball of the foot, or that there’s a rise in the shoe or a sock is bunched up.

The progression of a Morton’s neuroma often follows this pattern:

  • The symptoms begin gradually.At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.
  •   The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.
  • Over time the symptoms progressively worsen and may persist for several days or weeks.
  • The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

What Causes a Neuroma?

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box. People with certain foot deformities- bunions, hammertoes, flatfeet, or more flexible feet-are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma.

Diagnosis

To arrive at a diagnosis, the podiatric foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests may be performed. The best time to see your podiatric surgeon is early in the development of symptoms. Early diagnosis of a Morton’s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.

Treatment


In developing a treatment plan, your podiatric surgeon will first determine how long you’ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem. For mild to moderate cases of neuroma, treatment options include:
Padding – Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
Icing – Placing an icepack on the affected area helps reduce swelling.
Orthotic devices – Custom orthotic devices provided by your podiatric surgeon provide the support needed to reduce pressure and compression on the nerve.
Activity modifications – Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
Changes in shoewear – It’s important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
 Medications – Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
Injection therapy – If there is no significant improvement after initial treatment, injection therapy may be tried.

When Is Surgery Needed?

Surgery may be considered in patients who have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma- the affected nerve is either removed or released. Your podiatric surgeon will determine which approach is best for your condition. The length of the recovery period will vary, depending on the procedure or procedures performed. Regardless of whether you’ve undergone surgical or nonsurgical treatment, your podiatric surgeon will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities that cause repetitive pressure on the foot.

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons.Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards.
Copyright © 2004, American College of Foot and Ankle Surgeons . www.acfas.org

Heel Pain-Plantar Fasciitis

Heel pain is most often caused by plantar fasciitis-a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst. Because there are several potential causes, it is important to have heel pain properly diagnosed.A podiatric foot and ankle surgeon is best trained to distinguish between all the possibilities and determine the underlying source of your heel pain.

What Is Plantar Fasciitis?

Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed-resulting in heel pain. The symptoms of plantar fasciitis are:

  • Pain on the bottom of the heel
  • Pain that is usually worse upon arising
  • Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time.After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet. Heel pain can occur to both Children and Adults.

Causes of Plantar Fasciitis

The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches- either overly flat feet or high-arched feet-are more prone to developing plantar fasciitis. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when a person’s job requires long hours on their feet. Obesity also contributes to plantar fasciitis.

Diagnosis

To arrive at a diagnosis, the podiatric foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays, a bone scan, or magnetic resonance imaging (MRI) may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Treatment Options

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
Stretching exercises -Exercises that stretch out the calf muscles help ease pain and assist with recovery.
Avoid going barefoot – When you walk without shoes, you put undue strain and stress on your plantar fascia.
Ice – Putting an ice pack on your heel for 10 minutes several times a day helps reduce inflammation.
Limit activities – Cut down on extended physical activities to give your heel a rest.
Shoe modifications – Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Your shoes should provide a comfortable environment for the foot.
Medications – Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce pain and inflammation.
 Lose weight – Extra pounds put extra stress on your plantar fascia. If you still have pain after several weeks, see your podiatric surgeon, who may add one or more of these approaches:
 Padding and strapping – Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
Orthotic devices – Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
Injection therapy– In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
Removable walking cast – A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
Night splint – Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
Physical therapy – Exercises and other physical therapy measures may be used to help provide relief.

Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your Podiatrist will discuss the surgical options with you and determine which approach would be most beneficial for you.

Long-term Care

No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. If you are overweight, it is important to reach and maintain an ideal weight. For all patients, wearing supportive shoes and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons.Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards.
Copyright © 2004, American College of Foot and Ankle Surgeons . www.acfas.org

Flexible Flatfoot

What Is Flatfoot?

Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common-partial or total collapse (loss) of the arch. Other characteristics shared by most types of flatfoot include:

  • “Toe drift,where the toes and front part of the foot point outward
  •  The heel tilts toward the outside and the ankle appears to turn in.
  •   Ashort Achilles endon, which causes the heel to lift off the ground earlier when walking and may act as a deforming force

Bunions and hammertoes may occur in some people with flatfeet. Health problems such as rheumatoid arthritis or diabetes sometimes increase the risk of developing flatfoot. In addition, adults who are overweight frequently have flatfoot.

Flexible Flatfoot

Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and generally progresses in severity throughout the adult years.As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed. The term “flexible” means that while the foot is flat when standing (weight-bearing), the arch returns when not standing. In the early stages of flexible flatfoot arthritis is not restricting motion of the arch and foot, but in the later stages arthritis may develop to such a point that the arch and foot become stiff. Symptoms, which may occur in some persons with flexible flatfoot, include:

  • Pain in the heel, arch, ankle, or along the outside of the foot
  • “Turned-in” ankle
  • Pain associated with a shin splint
  •  General weakness/fatigue in the foot or leg

Diagnosis of Flexible Flatfoot

In diagnosing flatfoot, the podiatric foot and ankle surgeon examines the foot and observes how it looks when you stand and sit. X-rays are usually taken to determine the severity of the disorder. If you are diagnosed with flexible flatfoot but you don’t have any symptoms, your podiatric surgeon will explain what you might expect in the future.

Treatment Options


If you experience symptoms with flexible flatfoot, the podiatric surgeon may recommend various treatment options, including:

  • Activity modifications – Cut down on activities that bring you pain and avoid prolonged walking and standing to give your arches a rest.
  •  Weight loss – If you are overweight, try to lose weight. Putting too much weight on your arches may aggravate your symptoms.
  •  Orthotic devices – Your podiatric surgeon can provide you with custom orthotic devices for your shoes to give more support to the arches.
  •  Immobilization – In some cases, it may be necessary to use a walking cast or to completely avoid weight-bearing.
  •  Medications – Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
  • Physical therapy – Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
  • Shoe modifications – Wearing shoes that support the arches is important for anyone who has flatfoot.
  •  Surgery – In some patients whose pain is not adequately relieved by other treatments, surgery may be considered.

Flatfoot Surgery A variety of surgical techniques is available to correct flexible flatfoot. Your case may require one procedure or a combination of procedures.All of these surgical techniques are aimed at relieving the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, joint fusions, or insertion of implant devices.

In selecting the procedure or combination of procedures for your particular case, the podiatric surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons.Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards.
Copyright © 2004, American College of Foot and Ankle Surgeons . www.acfas.org

Tailor’s Bunion

What Is a Tailor’s Bunion?

Tailor’s bunion , also called a bunionette, is an enlargement of the fifth metatarsal bone at the base of the little toe. The metatarsals are the five long bones of the foot. The enlargement that characterizes a tailor’s bunion occurs at the metatarsal “head,” located at the far end of the bone where it meets the toe. Tailor’s bunions are not as common as bunions, which occur on the inside of the foot, but both are similar in symptoms and causes.

 

Symptoms of a Tailor’s Bunion

The symptoms of tailor’s bunions include redness, swelling, and pain at the site of the enlargement. These symptoms occur when wearing shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation. Why do we call it “tailor’s bunion”?

The deformity received its name centuries ago, when tailors sat cross-legged all day with the outside edge of their feet rubbing on the ground. This constant rubbing led to a painful bump at the base of the little toe.

Causes of a Tailor’s Bunion

Often a tailor’s bunion is caused by an inherited faulty mechanical structure of the foot. In these cases, changes occur in the foot’s bony framework that results in the development of an enlargement. The fifth metatarsal bone starts to protrude outward while the little toe moves inward. This shift creates a bump on the outside of the foot that becomes irritated whenever a shoe presses against it.

Sometimes a tailor’s bunion is actually a bony spur (an outgrowth of bone) on the side of the fifth metatarsal head. Heredity is the main reason that these spurs develop. Regardless of the cause, the symptoms of a tailor’s bunion are usually aggravated by wearing shoes that are too narrow in the toe, producing constant rubbing and pressure. In fact, wearing shoes with a tight toe box can make the deformity get progressively worse.

Diagnosis

Tailor’s bunion is easily diagnosed because the protrusion is visually apparent. X-rays may be ordered to help the foot and ankle surgeon determine the cause and extent of the deformity.

Treatment: Non-surgical Options

Treatment for tailor’s bunion typically begins with non-surgical therapies. Your foot and ankle surgeon may select one or more of the following options:

  • Shoe modificationsWearing the right kind of shoes is critical. Choose shoes that have a wide toe box, and avoid those with pointed toes or high heels.
  •  Oral medicationsNonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
  •   Injection therapy Injections of corticosteroid are commonly used to treat the inflamed tissue around the joint.
  •   Padding Bunionette pads placed over the area may help reduce pain. These pads are available from your foot and ankle surgeon or at a drug store.
  •   Icing An ice pack may be applied to reduce pain and inflammation. Wrap the pack in a thin towel rather than placing ice directly on your skin.

When Is Surgery Needed?

Surgery is often considered when pain continues despite the above approaches. Surgery is highly successful in the treatment of tailor’s bunions. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

 

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons.Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards.
Copyright © 2004, American College of Foot and Ankle Surgeons . www.acfas.org

Posterior Tibial Tendon Dysfunction

What Is Posterior Tibial Tendon Dysfunction?

Posterior tibial tendon dysfunction (PTTD) is an inflammation and/or overstretching of the posterior tibial tendon in the foot.An important function of the posterior tibial tendon is to help support the arch. But in Posterior Tibial Tendon Dysfunction, the tendon’s ability to perform that job is impaired, often resulting in a flattening of the foot. The posterior tibial tendon is a fibrous cord that extends from a muscle in the leg. It descends the leg and runs along the inside of the ankle, down the side of the foot, and into the arch. This tendon serves as one of the major supporting structures of the foot and helps the foot to function while walking.

Posterior Tibial Tendon Dysfunction is often called “adultacquired flatfoot” because it is the most common type of flatfoot developed during adulthood.Although this condition typically occurs in only one foot, some people may develop it in both feet. Posterior Tibial Tendon Dysfunction is usually progressive, which means it will keep getting worse – especially if it isn’t treated early.

Symptoms of Posterior Tibial Tendon Dysfunction


The symptoms of Posterior Tibial Tendon Dysfunction may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle.As the condition progresses, the symptoms will change. For example:

  • When Posterior Tibial Tendon Dysfunction initially develops, typically there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen.
  •  Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward.
  • As Posterior Tibial Tendon Dysfunction becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.

What Causes Posterior Tibial Tendon Dysfunction?

Overuse of the posterior tibial tendon is frequently the cause of Posterior Tibial Tendon Dysfunction. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Treatment: Non-surgical Approaches for Posterior Tibial Tendon Dysfunction

Because of the progressive nature of Posterior Tibial Tendon Dysfunction, it’s best to see your foot doctor as soon as possible. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated Posterior Tibial Tendon Dysfunction could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases of Posterior Tibial Tendon, treatment can begin with non-surgical approaches that may include:

  •   Orthotic devices or bracing – To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle stirrup brace or a custom orthotic device that fits into the shoe.
  •   Immobilization – Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weightbearing for a while.
  • Physical therapy – Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
  • Medications – Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Shoe modifications -Your foot and ankle surgeon may advise you on changes to make with your shoes and may provide special inserts designed to improve arch support.

When Is Surgery Needed?

In cases of Posterior Tibial Tendon that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgical treatment may include repairing the tendon, realigning the bones of the foot, or both. Your foot and ankle surgeon will determine the best approach for your specific case.

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons.Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards.

Copyright © 2004, American College of Foot and Ankle Surgeons . www.acfas.org

Gout

What Is Gout?

Gout is a disorder that results from the build-up of uric acid in the tissues or a joint-most often the joint of the big toe.
An attack of gout can be miserable, marked by the following symptoms:

    • Intense pain that comes on suddenly-often in the middle of the night or upon arising
    •   Redness, swelling, and warmth over the joint-all of which are signs of inflammation

What Causes Gout?

Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid. Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes.At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is furthest from the heart, it’s also the coolest part of the body and, thus, the most likely target of gout. However, gout can affect any joint in the body.

The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body’s ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications (“water pills”), and the vitamin niacin (also called nicotinic acid).While gout is more common in men aged 40 to 60 years, it can occur in younger men and also occurs in women. Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding the following foods and beverages: shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.

Diagnosis

In diagnosing gout, the foot and ankle surgeon will take your personal and family history and examine the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.

Treatment

Initial treatment of an attack of gout typically includes the following:

      • Medications – Prescription medications or injections are used to treat the pain, swelling, and inflammation.
      •  Dietary restrictions – Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid.
      •   Fluids – Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
      •   Immobilize and elevate the foot – Avoid standing and walking to give your foot a rest.Also, elevate your foot (level with or slightly above the heart) to help reduce the swelling. The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint.

When Is Surgery Needed?

In some cases of gout, surgery is required to remove the uric acid crystals and repair the joint.Your ankle surgeon will determine the foot care procedure that would be most beneficial in your case.

 

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons.Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards.
Copyright © 2004, American College of Foot and Ankle Surgeons . www.acfas.org

Hammertoe

Hammertoes Treatment

Hammertoe is a contracture— or bending—of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.

Common symptoms of hammertoes include:

• Pain or irritation of the affected toe when wearing shoes.
• Corns (a buildup of skin) on the top, side, or end of the toe, or between two toes. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location.
• Calluses (another type of skin buildup) on the bottom of the toe or on the ball of the foot. Corns and calluses can be painful and make it difficult to find a comfortable shoe. But even without corns and calluses, hammertoes can cause pain because the joint itself may become dislocated. Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment. Corns are more likely to develop as time goes on—and corns never really go away, even after trimming. In more severe cases of hammertoe, open sores may form. Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.

What Causes Hammertoe?

The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people. Hammertoes are often aggravated by shoes that don’t fit properly—for example, shoes that crowd the toes. And in some cases, ill-fitting shoes can actually cause the contracture that defines hammertoe. For example, a hammertoe may develop if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is caused by some kind of trauma, such as a previously broken toe. In some people, hammertoes are inherited.

Treatment: Non-Surgical Approaches

There are a variety of treatment options for hammertoe. The treatment your podiatric foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors. A number of non-surgical measures can be undertaken:

Trimming corns and calluses: This should be done by a healthcare professional. Never attempt to do this yourself, because you run the risk of cuts and infection. Your podiatric surgeon knows the proper way to trim corns to bring you the greatest benefit.
Padding corns and calluses: Your podiatric surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your podiatric surgeon about this option.
Changes in shoewear: Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels—conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches.
Orthotic devices: A custom orthotic device placed in your shoe may help control the muscle/ tendon imbalance.
Injection therapy: Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often prescribed to reduce pain and inflammation.
Splinting/strapping: Splints or small straps may be applied by the podiatric surgeon to realign
the bent toe.

When Is Surgery Needed?

In some cases, usually when the hammertoe has become more rigid, surgery is needed to relieve the pain and discomfort caused by the deformity. Your podiatric surgeon will discuss the options and select a plan tailored to your needs. Among other concerns, he or she will take into consideration the type of shoes you want to wear, the number of toes involved, your activity level, your age, and the severity of the hammertoe. The most common surgical procedure performed to correct a hammertoe is called arthroplasty. In this procedure, the surgeon removes a small section of the bone from the affected joint. Another surgical option is arthrodesis, which is usually reserved for more rigid toes or severe cases, such as when there are multiple joints or toes involved. Arthrodesis is a procedure that involves a fusing of a small joint in the toe to straighten it. A pin or other small fixation device is typically used to hold the toe in position while the bones are healing. It is possible that a patient may require other procedures, as well— especially when the hammertoe condition is severe. Some of these procedures include skin wedging (the removal of wedges of skin), tendon/muscle rebalancing or lengthening, small tendon transfers, or relocation of surrounding joints. Often patients with hammertoe have bunions or other foot deformities corrected at the same time. The length of the recovery period will vary, depending on the procedure or procedures performed.

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons. Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards.
Copyright © 2004, American College of Foot and Ankle Surgeons • www.acfas.org

Bunions

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Symptoms, Causes, Precautions and Treatment of Bunion

Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment.

What Is a Bunion?

Bunions are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment— producing the bunion’s “bump.” Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Usually, the symptoms of bunions appear at later stages, although some people never have symptoms.

What Causes a Bunion?

Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won’t actually cause bunions in the first place, it sometimes makes the deformity get progressively worse. That means you may experience symptoms sooner.

Symptoms

Symptoms occur most often when wearing shoes that crowd the toes— shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions. Symptoms, which occur at the site of the bunion, may include:
• Pain or soreness
• Inflammation and redness
• A burning sensation
• Perhaps some numbness
Other conditions which may appear with bunions include calluses on the big toe, sores between the toes, ingrown toenail, and restricted motion of the toe.Diagnosis Bunions are readily apparent—you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the podiatric foot and ankle surgeon may take x-rays to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike—some bunions progress more rapidly than others. Once your podiatric surgeon has evaluated your particular case, a treatment plan can be developed that is suited to your needs.Treatment Sometimes observation of the bunion is all that’s needed. A periodic office evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself. These options include:

Changes in shoe wear: Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
Padding: Pads placed over the area of the bunion can help minimize pain. You can get bunion pads from your podiatric surgeon or purchase them at a drug store.
Activity modifications: Avoid activity that causes bunion pain, including standing for long periods of time.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.
Icing: Applying an ice pack several times a day helps reduce inflammation and pain.
Injection therapy: Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.
Orthotic devices: In some cases, custom orthotic devices may be provided by the podiatric surgeon.

When Is Surgery Needed?

When the pain of a bunion interferes with daily activities, it’s time to discuss surgical options with your podiatrist. Together you can decide if surgery is best for you. Recent advances in surgical techniques have led to a very high success rate in treating bunions. A variety of surgical procedures are performed to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may also have occurred. The goal of these corrections is the elimination of pain. In selecting the procedure or combination of procedures for your particular case, the podiatric surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons. Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards.