Bunion Deformities
What to Do about a Bunion?
In the front of the foot, the joint at the base of the great toe is the most complex. Here the bones, tendons and ligaments work together to transmit and distribute the body's weight, especially during movement. Should this joint become abnormally stressed over an extended period of time, a bunion deformity may result. A bunion (from the Latin "bunio," meaning enlargement) 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 when tight, pointed shoes are worn. This crowding puts pressure on the joint, pushing it outward. The movement of the joint in this outward direction starts the formation of a bunion. A common deformity of the big toe joint, a bunion occurs mostly among people who wear shoes. Women are more frequently affected with bunions because of tight, pointed, confining or high-heeled shoes. Wearing high heels is especially stressful on the joints of the foot because all of the body's weight rests there. The foot is then forced into a narrow, pointed "toe box", compounding the problem. Older people are also vulnerable to bunions because of the higher incidence of arthritis affecting the big toe joint.
Treatments
- Padding
- Medications
- Physical Therapy
- Orthothics
- Surgical Treatment
Hammertoes
The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, overlapping and under lapping toes, and curled toes.
These deformities may or may not be painful. 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. If deformities are left untreated, the toe's mobility may become limited, and more serious problems, such as skin ulceration and infection, may develop.
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. Shoes then rub on the prominent portion of the toe, leading to inflammation or bursitis. Corns and calluses soon form. During the early stages, a hammertoe remains flexible, meaning it will straighten when pressure is applied to the buckled area. As time passes, the toe can become permanently buckled or rigid, requiring surgery for correction. Painful calluses on the bottom of the foot may accompany rigid hammertoes because of pressure generated on the joint.
Mallet Toes and Claw Toes
Mallet toes and clew toes are similar in appearance to hammertoes, but joints at different locations on the toe are affected. The joint at the end of the toe buckles in a mallet toe, while a claw toe involves abnormal positions of all three joints of the toe.
Bone Spur
A bone spur is an overgrowth of bone that may occur alone or along with a hammertoe. Pain, corns and calluses are the major symptoms. Left untreated, a bone spur may eventually be accompanied by bursitis or small skin ulceration.
Recommended treatments will vary depending upon the severity of the condition.
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.
Surgical Treatments
When the deformity is painful or permanent, surgical correction is recommended to relieve pain, correct the problem, and provide a stable, functional toe.
Arthritic Disorders
Joint stiffness, pain or tenderness, swelling and/or redness that persist for more than two weeks-all may signal arthritis. Any of 100 forms of arthritis can damage our bodies, especially the joints, gradually wearing away protective cartilage where the bones meet to make a joint. The force our body weight generates on the toe and ankle joints makes them particularly susceptible to arthritis. As cartilage erodes and bone rubs against bone, the joint becomes painful. Movement may become limited as bone ends erode or thicken, sometimes developing painful outgrowths, or spurs. If left untreated, damage to cartilage can seriously weaken the joints, often leading to pain and deformities. There are both surgical and non-surgical treatments for some arthritic patients.
Diabetic Foot Problems
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. Expenditures related to diabetic foot problems total hundreds of millions of dollars annually. It is estimated that 15% of all diabetics will develop a serious foot condition at some time in their lives. Common problems include infection, ulceration, or gangrene that may lead, in severe cases, to amputation of a toe, foot or leg. Most of these problems are preventable through proper care and regular visits to your podiatric surgeon. This physician can provide information on foot inspection and care, proper footwear, and early recognition and treatment of foot conditions.
Causes
Foot problems in persons with diabetes are usually the result of three primary factors: neuropathy, poor circulation, and decreased resistance to infection. Also, foot deformities and trauma play major roles in causing ulcerations and infections in the presence of neuropathy or poor circulation.
Neuropathy (Nerve Damage)
Your ability to detect sensations or vibration may be diminished. Neuropathy allows injuries to remain unnoticed and untreated for lengthy periods of time. It may cause burning or sharp pains in feet and interfere with your sleep. Ironically, painful neuropathy may occur in combination with a loss of sensation. 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. The symptoms can progress to severe cramping or pain at rest, with associated color and temperature changes (the feet may turn bright red when hanging down and constantly feel cold). Also, the skin may become shiny, thinned and easily damaged. A reduction in hair growth and a thickening of the toenails might also be present. Poor circulation, resulting in reduced blood flow to the feet, restricts delivery of oxygen and nutrients that are required for normal maintenance and repair. Healing of foot injuries, infection or ulceration is affected. Peripheral vascular bypass operations may avert lower extremity amputation.
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. Infections often worsen and may go undetected, especially in the presence of diabetic neuropathy or vascular disease. Often, the only sign of a developing infection is unexplained high blood sugar, even without fever. The combination of fever and high blood sugar often warns of a severe infection requiring hospitalization. Lesser degrees of infection are often treated on an outpatient basis.
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. Traumas from heat, cold, shoe pressure, or penetration by a sharp object are also potential causes. Neuropathy allows the lesions to develop because the normal warning sense of pain has been lost and they go unrecognized. Continued pressure or walking on the injured skin creates even further damage and the ulcer will worsen. The open sore will frequently become infected and may even penetrate to bone. Treatment relies on early recognition of the ulceration by a podiatric surgeon, avoidance of weight bearing activities such as walking, avoidance of wearing "closed-in" shoes, and early intervention. Besides local wound care, dressings and antibiotics, other measures may be necessary to adequately relieve pressure on the area. When use of crutches, a wheelchair, or rest is not feasible, plaster casts, braces, healing sandals, or orthotics (special shoe inserts) can be used to protect the foot while it heals. If circulation is inadequate to allow healing, your podiatric surgeon may refer you to a vascular surgeon for appropriate evaluation and possible vascular reconstructive surgery. Once an ulcer has healed, it is important to continue to see your podiatric surgeon regularly. Special footwear and inserts may be recommended to protect your feet and prevent new or recurrent lesions from developing.
Gout
Gout is a form of arthritis that occurs as a result of the build-up of uric acid in the body and the joint fluid (hyperuricemia). This accumulation of uric acid typically occurs when the body has difficulty processing certain protein substances called purines (PURE-EENS) that are found naturally in our diets.
Symptoms
Gout usually starts with a sudden onset of intense pain in one or more joints, usually the big toe joint of the foot. The pain is accompanied by redness, swelling and warmth over the joint. Typically, the patient does not recall injuring the joint before the pain started. Many patients say they first noticed pain in the middle of the night or upon arising in the morning. While symptoms most commonly occur in the big toe joint, any joint may be involved. Other common sites are the instep of the foot, the ankle, or the knee. When the foot is involved, wearing shoes is difficult and painful, as are attempts to move the joint or stand on the foot.
Treatment
The treatment of gout starts with establishing the correct diagnosis. Oral anti-inflammatory medications are most often used to manage the acute attack. While over the counter drugs may reduce symptoms, they are rarely strong enough to treat the acute pain, swelling and inflammation. If the gout attack is in the toe, it will typically help to elevate the foot, avoid standing and walking, and wear only a loose slipper until the individual can be seen by a podiatric surgeon. Gout often can be controlled with proper medication, both when there is an attack and on a long-term basis. It is important that your doctor establish which of the two primary causes (producing too much uric acid or not eliminating it properly) is involved in order to treat the gout with the appropriate medication.
Nail Disorders
Ingrown Nail
Painful ingrown nails may be congenital, caused by an over curvature of the nail, or an imbalance between the width of the nail plate and the nail bed. Toe injuries that change the nail's contour also can lead to an ingrown toenail. Toe deformities (such as a bunion that forces the big toe to lean toward the second toe), high-heeled or narrow, pointed shoes can put pressure between the nail and soft tissues, eventually forcing the nail to grow into the skin.
Fungal Infections
Various types of fungi are present everywhere in the environment. The dark, moist surroundings created by shoes and stockings make the feet especially susceptible to fungal infection. Most fungi are harmless until they penetrate the skin. A fungus can invade through minor cuts, or after injury or repeated irritation to the toes have caused the nail to separate from the bed. Fungal infections of the nail plate and nail matrix are quite common especially in sunny tropical Florida.
Ankle Sprains
Ankle Sprains are common injuries that occur when ligaments are stretched or torn.
Treatments
Initial treatment includes rest, ice, compression and elevation (RICE). The "RICE" method promotes healing, decreases pain, and reduces swelling around the ankle joint. In more severe cases, non-weight-bearing activities are encouraged and crutches may be recommended. Compression may be achieved with an elastic bandage, splint, short leg cast or brace, depending on severity. Compression eliminates motion around the ankle joint. The ability to walk or participate in other weight-bearing activities during the healing process depends on the severity or type of ankle sprain.
Custom Orthotics
Orthotics are custom made supports that are worn inside the shoes. They are different from “old-fashioned arch supports” in that they are specially made for each individual patient problem. Orthotics support the foot and stop excessive strain in muscle, tendons, and ligaments.
A cast is taken of the patients feet and orthotics can be made to treat heel spur, metatarsal problems, plantar fasciatis, shin splints, and other related conditions. Orthotics can be made for dress shoes and work shoes. They can be especially helpful after foot surgery.
