Problems & Treatments Bunion Deformities and Treatment What to Do about a Bunion A bunion is a protuberance of bone or tissue around the joint. The enlargement occurs either at the base of the great toe or on the outside of the foot, at the base of the little toe where it is called a "bunionette" or "tailor's bunion." Bunions at the base of the great toe usually begin when the big toe starts moving toward the smaller toes. Women are more frequently affected with bunions because of tight, pointed, confining or high-heeled shoes. Older people are also vulnerable to bunions because of the higher incidence of arthritis affecting the big toe joint. Symptoms Pain from a bunion can be mild, moderate or severe, making it difficult to walk in normal shoes, especially high-heeled shoes. The other toes can be affected by a bunion, as a result of pressure from the great toe pushing inward toward the lesser toes. Treatments Treatments vary depending on the severity of pain and deformity. Left untreated, bunions tend to get larger and usually more painful. The main goal of early treatment is to relieve pressure on the bunion and smaller toes, and to diminish the progression of joint deformities. Surgical Treatment When conservative treatment does not provide satisfactory relief from symptoms, or when the condition interferes with your activities, surgery may be necessary. Types of Surgery The general guidelines for types of surgery are: Mild Bunion, Moderate Bunion, Severe Bunion, and Arthritic Bunion or big toe joint. Postoperative Care After the foot has healed, and if the bunion was the result of improper foot function or foot type, the cause of the problem should be addressed. Toe Problems / Digital Disorders Common Deformities The most common digital deformities are hammer-toes, claw toes, mallet toes, bone spurs, overlapping and underlapping toes, and curled toes. Corns and calluses - a buildup of skin on the affected joint, often associated with bursitis (inflammation of small pouches, called bursas, which lie above the joint between the tendon and skin) - are perhaps the most noticeable and bothersome symptoms. Hammertoes A hammertoe may be flexible or rigid, and may occur on any of the lesser toes. Ligaments and tendons that have tightened cause the toe's joints to buckle, cocking the toe upward. Mallet Toes and Claw Toes Mallet toes and claw toes are similar in appearance to hammertoes, but joints at different locations on the toe are affected. Bone Spur A bone spur is an overgrowth of bone that may occur alone or along with a hammertoe. Overlapping and Underlapping Toes Any one of the toes can overlap or underlap, pushing on adjacent toes and causing irritation. Treatments for Toe Deformities Any toe problems that cause pain or discomfort while walking should be given prompt attention by a podiatric surgeon. Ignoring the symptoms can aggravate the condition, and over time may lead to an infection, a breakdown of tissue or ulceration. Conservative Treatments For people who have minor discomfort, less advanced conditions or are unable to undergo surgery, the symptoms may be treated conservatively (without surgery). This usually involves: Trimming or padding corns and calluses. Wearing supportive orthotics (individually fitted plastic or leather inserts) in shoes. This helps relieve pressure on toe deformities and allows the toes and major joints of the foot to function more appropriately. Splints or small straps to realign the toe. Wearing shoes with a wider toe box. Intermetatarsal Neuromas and Treatments What Is An Intermetatarsal Neuroma? An intermetatarsal neuroma (IMN) is any irritative process of the common digital nerve branch that supplies the plantar (bottom) of adjacent toes. It most frequently involves the nerve that supplies sensation to adjacent sides of the third and fourth toes, but can also affect other toes of the foot. A neuroma is not cancerous and is not a true tumor but a reactive, degenerative process such as a scar. Symptoms Besides pain, you may also experience numbness and burning of your foot. Symptoms are aggravated by walking in shoes and relieved by removing shoes, resting and massaging the foot. Pain that occurs at rest may suggest that the neuroma is worsening. Causes Intermetatarsal neuroma occurs in all adult age groups and is most prevalent among females. Although the exact etiology of IMN is unclear, several factors contribute to its occurrence. High-heeled shoes, trauma, inflammatory conditions such as arthritis, and repetitive trauma from stresses incurred in occupational and recreational activities are several of these factors. Any condition that causes constriction or irritation of the nerve can lead to the development of an intermetatarsal neuroma. Diagnosis Diagnosis is made by a podiatric surgeon and is based on a thorough history of symptoms, physical examination and diagnostic procedures. Classic symptoms include pain with walking. This pain may manifest itself as burning, shooting, stabbing or radiating. Relief of pain by removing the shoes and massaging the area is another typical symptom. A thorough physical examination of the lower extremity is performed. Special attention is directed to the sensory portion of the neurological exam. The patient's description of symptoms provided can often be reproduced upon physical examination. A painful, movable mass perceptible to touch that replicates the pain is a strong sign of a neuroma. Treatment The goal of treatment is to reduce or eliminate symptoms, so that you can maintain your normal lifestyle. Although some patients may not receive complete relief, it is expected that the vast majority will gain significant improvement from therapy. Conservative treatment for an intermetatarsal neuroma usually includes modifying shoes, orthoses or arch supports. These conservative therapies may provide complete, partial or no relief of symptoms. Conclusion The management of intermetatarsal neuroma includes many treatment options. Your podiatric surgeon may consider conservative therapy before surgical intervention and discuss all aspects of care with you. Diabetic Foot Problems and Treatments INTRODUCTION Foot problems are a leading cause of hospitalization for the eight million persons in the United States who have been identified as having diabetes mellitus. It is estimated that 15% of all diabetics will develop a serious foot condition at some time in their lives. Most of these problems are preventable through proper care and regular visits to your podiatric surgeon. Causes Foot problems in persons with diabetes are usually the result of three primary factors: neuropathy, poor circulation, and decreased resistance to infection. Neuropathy (Nerve Damage) - Neuropathy allows injuries to remain unnoticed and untreated for lengthy periods of time. Neuropathy can also affect the nerves that supply the muscles in your feet and legs. This 'motor neuropathy' can cause muscle weakness or loss of tone in the thighs, legs, and feet, and the development of hammertoes, bunions, and other foot deformities. Poor Circulation - Persons with diabetes often have circulation disorders (peripheral vascular disease) that can cause cramping in the calf or buttocks when walking. Poor circulation, resulting in reduced blood flow to the feet, restricts delivery of oxygen and nutrients that are required for normal maintenance and repair. Infection - Persons with diabetes are generally more prone to infections than non-diabetic people. Due to deficiencies in the ability of white blood cells to defend against invading bacteria, diabetics have more difficulty in dealing with and mounting an immune response to the infection. Foot Deformities Foot deformities such as hammertoes, bunions, and metatarsal disorders have special significance in the diabetic population. Neuropathy places the foot at increased risk for developing corns, calluses, blisters and ulcerations. If these are left untreated, serious infections may result. Ulcers of the Foot An ulceration or ulcer is usually a painless sore at the bottom of the foot or top of the toes, resulting from excessive pressure at that site. Ulcers frequently underlie a pre-existing corn or callus that was allowed to build up too thickly. Footcare Guidelines Inspect your feet daily for blisters, bleeding, and lesions between your toes. Use a mirror to see the bottom of your foot and heel. Do not soak your feet unless the temperature of the water is lukewarm, not as hot as you can stand it. (95°-100° Fahrenheit). Avoid temperature extremes - do not use hot water bottles or heating pads on your feet. Wash your feet daily with warm, soapy water and dry them well, especially between the toes. Use a moisturizing cream or lotion daily, but avoid getting it between the toes. Do not use acids or chemical corn removers. Do not perform "bathroom surgery" on corns, calluses, or ingrown toenails. Trim your toenails carefully and file them gently. Have a podiatrist treat you regularly if you cannot trim them yourself without difficulty. Contact your podiatric surgeon immediately if your foot becomes swollen or is painful, or if redness occurs. Do not smoke. Learn all you can about diabetes and how it can affect your feet. Have regular foot examinations by your podiatric surgeon. Heel Disorders and Treatments Relief for Painful, Inflamed Heels Sharp pain, aching or stiffness on the bottom of one or both heels is a very common ailment. The pain is often at its worst upon awakening in the morning (or after sitting down for an extended period and then resuming activity), causing hobbling or limping for a few minutes before a comfortable stride can be resumed. Causes of Heel Pain Heel pain originates deep within the foot, directly on the heel bone or within the foot's connective tissues, called the fascia. Several layers of fatty tissue surround the heel bone, softening the impact or walking and running and protecting the bones and muscles of the foot. Beneath this padding, a fibrous band of connective tissue (the fascia) extends from the heel bone, supports the arch and reaches across to the toes. Pain can result when these tissues become irritated or inflamed, or when small spurs grow on the heel bone. Inflammation Most cases of heel pain are characterized by inflammation. First, the fascia begins to pull on the bone and the tissues become irritated, then inflamed. Inflammation of the fascia is called fascitis. Heel Spurs A projection or growth of bone may be called a spur, and can grow where the muscles of the foot attach to bone. While some heel spurs are painless, others that are determined to be the cause of chronic heel pain may require medical treatment or surgical removal (see "Surgical Treatments for Heel Pain"). Other Causes While injury, overuse or other temporary, mechanical causes can bring on discomfort in the heel, a painful heel may also accompany a more serious condition, such as: Gout Arthritis Psoriasis Collagen disorders Nerve injuries Heel bone abnormalities Tumors Self-Care Several steps can be taken to care for a painful heel at home. Take medications that contain ibuprofen or aspirin daily as directed, for as long as symptoms persist, to help reduce tissue inflammation. Follow dosage directions carefully. As with any medication, be aware of potential allergic responses and discontinue use if any adverse reaction occurs, or if pain is not relieved after several days' use. Soak the heel in ice water to relieve pain and inflammation. This works best by placing the foot in a basin filled with tap water, high enough to cover the heel. Allow the foot to adjust to this temperature. Then add ice cubes (two or three at a time) every five or six minutes over a 30-minute period. Soak the foot in ice water three times daily and immediately after any activity. Heat may also be recommended, but ice is usually preferable. Avoid sports and other vigorous activities while healing. Wear higher heeled shoes and choose shoes with heels made from soft rubber instead of leather. Running shoes are often the most comfortable. • Stretch the calf muscles daily.

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