Four Common Foot Disorders
Your feet take a pounding every day from walking, standing, exercise, working and shoes. When you add a foot disorder to the equation, each painful step reminds you of how much stress your foot takes. A recent study by the American Podiatric Medical Association showed that there is a 75% chance of you having some type of foot aliment during your lifetime. While there are numerous foot conditions, some conditions are much more common than others.
Understanding these conditions and what you can do to help yourself can be the first step back towards a pain-free lifestyle.
- Heel Pain – Watch out for that first step in the morning.
Heel pain is the most common foot disorder; it is a combination of plantar fasciitis with or without a heel spur. Plantar fasciitis is an inflammatory condition of the arch ligament that runs from the heel to the ball of the foot and helps to maintain the arch structure.
With continued strain, this can lead to the development of a heel spur. It is a common misconception that a heel spur requires surgery or is a more serious condition; this is inaccurate.
There is a direct correlation to body mass index (being overweight) and the occurrence of heel pain. Other causes of heel pain include: Foot structure, high activity level or a change of activity level, shoe gear, the type of surfaces you stand on, injury, and arthritic conditions.
Symptoms usually include a bruised feeling of the heel, which is often worse in the morning or after sitting. This is due to contracture of the plantar fascia while off the foot and a resultant stretch when first getting back on your foot.
You can be actively involved in your treatment with a few simple steps. The first goal is to get the inflammation under control, followed by long-term prevention of recurrence:
- Start with stretching, appropriate shoe gear, RICE therapy, over-the-counter arch support and anti-inflammatory medication – see the article on “Five Tips to Fixing Your Aching Feet.”
- If you do not see a resolution of symptoms, consult a professional.
- Bunions – Why is my big toe crooked?
Bunions (Hallux Abducto Valgus) are a boney deformity of the big toe joint in which the great toe moves towards the second toe and a large bump develops on the joint. The joint subsequently does not move through a normal range of motion.
Bunions are most often related to foot structure and foot function. Shoes can play a factor in development of bunions, as can arthritis, injury, neuromuscular disorders, and congenital disorders.
Symptoms may include any of the following: Arthritis, pain and swelling, limitation of motion, redness, calluses or corns.
Treatment should be initiated with progression of the deformity or symptoms:
- Start by going to a wider shoe with good arch support.
- Consider an over-the-counter arch support.
- Take an anti-inflammatory medication per package instructions if you experience pain or swelling.
- If these measures do not alleviate your symptoms, consult a professional.
- Hammer Toes – Why is my toe rubbing on my shoe?
Hammer toes are contractures of the toe, usually the middle joint on the toe, but may also involve the end joint of the toe or the joint where the toe attaches to the foot. They are the result of a tendon imbalance due to foot mechanics or structure. Other causes include shoes, neuromuscular disorders, congenital disorders, and injury.
Hammer toes are progressive and become more rigid with time, which can result in corn formation and pain. With progression, this can lead to redness, swelling and sores.
There are few treatment options for this condition, but here are a few things you can try on your own to help:
- First try to get a wider toe box shoe.
- If you have corns or skin irritations, consider non-medicated padding.
- Over-the-counter orthotics can help with the mechanical or structural deformities.
- If symptoms or deformities progress, seek professional care.
- Morton’s Neuroma – Why are my toes burning and why does it feel like my sock is bunched up under my toes?
Morton’s neuroma is a pinched nerve that is typically located between the third and fourth toes.
The cause of this is unknown, but shoes are contributory, as are certain activities like running.
The symptoms can be varied, but normally they include burning, numbness, pain, and a full feeling in the ball of the foot. These symptoms are often made worse with dress shoes.
This is a difficult condition to treat on your own, but there are a few steps you can take:
- Start with a wider shoe and avoid dress shoes if possible; this helps stop the pinching effect of shoes.
- Try a cushioned over-the-counter arch support.
- Take an anti-inflammatory medication per package instructions.
- If symptoms do not resolve, consult professional care.
Call 317-660-2115 today to arrange for a consultation about your feet if any of these or other foot disorders are giving you pain. Or use the online appointment request option available 24/7 at Hoosier Foot and Ankle for your convenience.
References:
- Apma.org (American Podiatric Medical Association)
- Acfas.org (American College of Foot and Ankle Surgeons)
Hammer Toe | Relief is Possible
Arthropathy is a big word for a painful toe — deformed to have the shape of a hammer. Thus the name, Hammer Toe.
Hammer toe often goes together with bunions which have forced the toe into an unnatural position. Shoes that fit poorly, especially those that are too small or too tight around the toes can contribute to the issue. It is common for a callus to form on the bottom of the toe and a corn to occur on the top. Wearing some shoes can make this condition excruciatingly painful.
There are some conservative treatment methods that I would offer to a patient as well as surgery. Things like physical therapy and shoes with a larger, more roomy toe box. Your first appointment at Hoosier Foot and Ankle can give us a chance to discuss what treatment paths would work best for you.
When surgery is necessary, there are some very predictable implant options that will stabilize the toe and permit it to have a more normal appearance. Implanting a Smart Toe fixation is part of the treatment shown in this video.
Hammer toe answers
Hammer toes are a contracture of the toe at one or more of the toe joints. There are many causes of hammer toes, but typically a biomechanical abnormality that lead to a tendon imbalance is the primary cause. A contracture of the joint closest to the toenail is called a mallet toe. A hammer toe is a contracture of the second joint of the toe and is the most common digital deformity. A claw toe is a combination of a hammer toe and mallet toe. The metatarsal joint may be contracted with any of the above deformities. From a clinical and treatment standpoint, the most important factor is if the deformity is flexible or rigid.
Treatment options are really limited for hammer toes. If the deformity is flexible, you can treat the biomechanical abnormality that led to the deformity typically with a custom orthotic. If this is not a viable option, then a surgical procedure called a flexor tendon transfer is an excellent choice. This involves rerouting the long tendon on the bottom of the toe to the top of the toe. This changes this tendon from a deforming force to a corrective force. For a rigid deformity the options are surgical or live with the deformity (working around it with a wider, boxier shoe). Surgically the two choices are arthroplasty or arthrodesis. For completeness sakes, implant arthroplasty is also a possible treatment option for this deformity. I do not use implants for hammer toes unless there is a flail (floppy toe) deformity.
I have gone back and forth over my career between arthrodesis and arthroplasty, primarily because I have not been completely satisfied with either procedure. For mallet toes, arthroplasty is the primary choice. Hammer toes are much more common and will be discussed for the remainder of this blog. Arthrodesis provides a more predictable result, but often times the toe is too straight. Arthrodesis means fusion of the the two bones that make up the joint. Typically this is held in place with a pin that goes through the toe and is left in for six weeks. Arthroplasty just means removal of the end of the first bone. This is also held in place with a pin for three to six weeks. This procedure tends to provide a little more normal appearance to the toe, but the toe can shift once the pin is removed.
A newer modification arthrodesis procedure is the use of the Smart toe implant instead of a pin to hold the toe in alignment. The Smart toe has a straight and angled design. The straight design also makes the toe too straight in my opinion. I am a big fan of the angled design, which puts the toe in about a 10 degree downward position. This provides a more normal appearing toe and the toe tends to sit on the ground better. The implant stays in permanently and provides stability. The Smart toe is made by MMI and more information is available at http://www.hammertoetreatment.com/mmi_smarttoe/index.html
If you have a hammer toe deformity, first have it evaluated by a podiatrist. Ask what your treatment options are. If you are having pain, corn formation, difficulty wearing shoes or redness; a surgical procedure may be the best option. Ask about the type of procedure being recommended. Ask why that procedure is being recommended. Ask if the doctor has any experience with the Smart toe implant. I hope this helps give you some guidance for you treatment of your hammer toe.
Patrick A. DeHeer, DPM
