Foot Conditions

Bunions – although they may develop on the fifth (little) toe, bunions usually occur at the base of the big toe.  A bunion is one of the most common big toe problems that are often caused by incorrect foot mechanics and can be hereditary.  Because the big toe is so critical to movement, any problem with it can make walking or even standing painful.  A bunion changes the shape of your foot, making it harder to find shoes that fit or are comfortable.  The foot may flatten too much, forcing the toe joint to move beyond normal range.  In some cases joint damage may occur and the need for a joint implant may be necessary.  To determine the best treatment for your problem your doctor may ask if and when your bunion causes pain.  X-rays may be taken of the area to show the position of the big toe joint and the angle of the other foot bones for a treatment plan.  If a bunion is not painful with daily activities your doctor may recommend that you wear a different style of shoes and/or orthotic devices for your shoes.  For painful or severe bunions, outpatient surgery may be recommended.  There are many different types of bunion surgical procedures.  It would be necessary to evaluate the bone structures and angles of deformity for which procedure would be best to correct your bunion deformity.   The procedures may range from shaving off the bone prominence to shifting the bone to reducing the angle between the first and second toes with the use of a surgical shoe for after care.  A more severe bunion may require a piece of bone to be removed for repositioning the angle of the foot with the use of stabilizing pins and/or screws to hold the bones together.  Usually this type of bunion procedure would require a non-walking cast. Depending on the extent of the repair, healing may take several months.   Most procedures do require the patient to use, or continue to use, supportive shoe inserts (orthotics) to control the foot mechanics in aftercare.  Bunion surgery can both reduce pain and improve the appearance of your feet.

Children’s Feet – having strong, health feet allows your child to walk, run and play. If your child’s feet form correctly, certain types of back and leg pain can be avoided later in life.  Exam of the feet and ankles ensure that your child’s bones are growing correctly.   Both the size and shape of your child’s feet change quickly during the first year of life.  Because a baby’s feet are flexible, too much pressure or strain can affect the shape of the foot.  To help ensure normal growth, allow your baby to kick and stretch his or her feet.  Make sure the shoes and socks are not to tight or squeeze the toes.  If you have concerns with your baby’s feet talk to your podiatrist.  Many infants have feet that appear to turn in.  This may worry you, but an evaluation will help with a diagnosis if needed.  A toddler will walk when he or she is ready.  Watch you child’s gait once he or she does begin to walk, try not to force the issue.  If your toddler’s feet are fat, flat and floppy, do not worry, this is usually normal.  If you have questions with your toddler’s feet a foot exam of watching your toddler walk would be indicated.   To help with severe flat feet, special shoes or custom made orthotics may be prescribed.  To correct mild in-toeing, your toddler may need to do exercises and correct shoegear.  If your child’s feet turn in or out a lot, corrective shoes, orthotics, splints or castings may be prescribed.  The bone structure of your child’s feet are pretty well formed by the time he or she reaches 7 or 8.  If a growth plate (the area where bone growth begins) is injured, the damaged plate may cause the bone to grow oddly.  With proper care the risk of future bone problems is reduced.  If your child keeps complaining of pain after an injury have this checked by a podiatrist.  Call anytime an injury causes serious swelling, localized tenderness, limping, ongoing night pains or you do not feel comfortable with your child’s condition. If a bone or growth plate is damaged, your child may need to use crutches to take weight off the injury as it heals.  In the case of fracture, a cast, splint or brace may be needed for the healing process.  Make sure you pay attention to your child’s feet and the shoes you put them in.  The shape of the foot changes as your child grows.

Hammer toes – one or more toes curl or bend abnormally and cause pain when walking and may cause further problems as corns and spurs.  This can be caused by an inherited muscle problem an abnormal bone length or poof foot mechanics.  When hammer toes are flexible, you can straighten the buckled joints.  Flexible hammer toes may become rigid over time causing corns irritation and pain.  The treatment for this type may be a release of tendons which allows you to walk in a surgical shoe and the use of bandages.  A curled digit is most often inherited.  When the toe curls inward (most often the fifth toe) it moves under the next toe.  Then the nail of the curled toe starts to face outward.  This can cause corns and painful nails.  The treatment plan most often for this curled condition would be to remove a wedge of skin and a section of bone to help straighten (derotate) the toe.  You can walk on your foot with a surgical shoe, but most cases require the use of a stabilizing pin to hold your toe as it heals for an approximate four to six weeks.  Rigid hammer toes are fixed (not flexible).  You can not straighten the buckled joints.  Corns, pain and loss of function may be more severe with rigid hammer toes and with flexible ones.  The treatment plan is very similar to the treatment of a curled toe.  A part of the joint may be removed and the toe is straightened.  In some cases an entire joint may be replaced with an implant.  Again as with the curled toe you would most likely use stabilizing pins and surgical shoe for a few weeks.  A bone spur may occur alone or with hammer toes.  Most times if it is just the spur that is causing pain a simple removal of the spur may be all that is needed.  The recovery time is much shorter with this procedure. 

Ingrown Toenails – are very common and usually involve the big toe.  Improper nail trimming or injury to the nail is the most common reason for ingrown toenails.  It is important to trim the toenails straight across and not to short.  Do not dig or carve into the borders of the nails. Also ingrown nails may occur if the growth plate of the nail is damaged or has a fungal growth in the nail that makes the nail thick.  Nail borders that become infected with drainage may require the physician to remove part of or the total nail to clear the infection. This type of procedure may be done in the physician's office under local anesthesia.  If this is a recurring problem the physician may recommend a permanent removal of the nail border or total nail by treating the nail growth site to stop regrowth.

Neuroma – a painful growth of tissue entrapping or compressing nerve tissue in the foot most often seems to occur between the third and fourth toe bones.  It is described as occurring when bones in the feet press together and irritate a nerve but actually the nerve tissue is more commonly irritated as it passes next to a support ligament.  This may be caused by wearing tight or poorly fitting shoes, by repeated stress on the foot or by an irregular walking pattern.  Symptoms of a neuroma include sharp burning pain in the ball of the foot, especially when walking. Tingling or numbness between the toes and the ball of the foot or a feeling of a stone in your shoe also commonly present. Possible treatment plans may include shoe changes and the use of orthotic devices, physical therapy or medications to reduce the swelling in the tissues surrounding the nerve by steroid injection therapy.  At times surgical removal of the nerve may be necessary.

Tarsal Tunnel Syndrome – occurs when the nerve running behind your ankle bone, within the tarsal tunnel, is pinched by inflamed tissue. When a nerve is pinched some or all of the signals cannot travel their complete route. This is comparable to carpal tunnel in the wrist area.  You may feel burning or stabbing pains in your heel and may also shoot into the front of your foot or up the leg as a referred pain. Treatments of conservative nature may include supportive shoe gear, orthotic devices, physical therapy or injection therapy of an anti-inflammatory medication.  If these treatments do not help in reducing the symptoms it may become necessary to have a surgical procedure to release the tight structures that are causing the compression in hopes of reducing the pain.