Zeehan S. Husain, DPM
Charles G. Kissel, DPM
Michael S. Schey, DPM
Angela
Stoutenburg, DPM
Board
certified by the
American Board of
Podiatric Surgery.
Subtopics
1.
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 will not 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 occur 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 do not 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 is 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
will not 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 avoid shoes with
pointed tips 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 (NSAID), such as ibuprofen, may
help to relieve pain. |
|
Icing—
Applying an ice pack several times a day helps to 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.
This is primarily done for acute painful episodes only. |
|
Orthotic
devices. In
some cases, your podiatric surgeon may design custom orthotics. |
When
Is Surgery Needed?
When
the pain of a bunion interferes with daily activities, it is time to
discuss surgical options with your podiatric surgeon.
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. Some
procedures allow immediate weightbearing and others may require six to ten
weeks of non-weightbearing. The
length of the recovery period will vary, depending on the procedure or
procedures performed.
2.
Hallux
Rigidus (top)
Each
day, with every step you take, your big toe bears a tremendous amount of
stress, a force equal to about twice your body weight.
Most of us do not realize how much we use our big toe.
We tend to take it for granted, unless a problem develops. One problem that afflicts the big toe is called hallux
rigidus, a condition where movement of the toe is restricted to varying
degrees. This disorder can be
very troubling and even disabling, since we use the all-important big toe
whenever we walk, stoop down, climb up, or even stand.
If you have pain and/or stiffness in your big toe, you may have
this condition.
What
Is Hallux Rigidus?
Hallux
rigidus is a disorder of the joint located at the base of the big toe.
It causes pain and stiffness in the big toe, and with time it gets
increasingly harder to bend the toe.
“Hallux” refers to the big toe and “rigidus” indicates that
the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis
(a wearing out of the cartilage within the joint that occurs in the foot
and other parts of the body).
Because
hallux rigidus is a progressive condition, the toe’s motion decreases as
time goes on. In its earlier
stage, motion of the big toe is only somewhat limited, at that point, the
condition is called “hallux limitus”. But as the problem advances, the toe’s range of motion
gradually decreases until it potentially reaches the end stage of
“rigidus” where the big toe becomes stiff, or what is sometimes called
a “frozen joint”. Other
problems are also likely to occur as the disorder progresses.
Early signs and symptoms include:
|
Pain
and stiffness in the big toe during use (walking, standing, bending, etc) |
|
Pain
and stiffness aggravated by cold, damp weather |
|
Difficulty
with certain activities (running, squatting) |
Swelling
and inflammation around the joint
As
the disorder gets more serious, additional symptoms may develop,
including:
|
Pain,
even during rest |
|
Difficulty
wearing shoes because bone spurs (overgrowths) develop.
Wearing high-heeled shoes can be particularly difficult. |
|
Dull
pain in the hip, knee, or lower back due to changes in the way you
walk |
|
Limping,
in severe cases |
What
Causes Hallux Rigidus?
Common
causes of hallux rigidus are faulty function (biomechanics) and structural
abnormalities of the foot that can lead to osteoarthritis in the big toe
joint. This type of
arthritis, the kind that results from “wear and tear”, often develops
in people who have defects that change the way their foot and big toe
functions. For example, those
with fallen arches or excessive pronation (rolling in) of the ankles are
susceptible to developing hallux rigidus.
In
some people, hallux rigidus runs in the family and is a result of
inheriting a foot type that is prone to developing this condition.
In other cases, it is associated with overuse especially among
people engaged in activities or jobs that increase the stress on the big
toe, such as workers who often have to stoop or squat.
Hallux rigidus can also result from an injury even from stubbing
your toe or by certain inflammatory diseases like rheumatoid arthritis or
gout. Your podiatric foot and
ankle surgeon can determine the cause of your hallux rigidus and recommend
the best treatment.
Diagnosis
of Hallux Rigidus
The
sooner this condition is diagnosed, the easier it is to treat.
Therefore, the best time to see a podiatric surgeon is when you
first notice that your big toe feels stiff or hurts when you walk, stand,
bend over, or squat. If you wait until bone spurs develop, your condition is
likely to be more difficult to manage.
In diagnosing hallux rigidus, the podiatric surgeon will examine
your feet and manipulate the toe to determine its range of motion. X-rays are usually required to determine how much arthritis
is present as well as to evaluate any bone spurs or other abnormalities
that may have formed.
Conservative
Treatments
If
your condition is caught early enough, it is more likely to respond with
less aggressive treatment. In
fact, in many cases, early treatment may prevent or postpone the need for
surgery in the future. That
is why it is important to see your podiatric surgeon when you first begin
to notice symptoms. Treatment
for mild or moderate cases of hallux rigidus may include one or more of
these strategies:
|
Shoe
modifications—
Shoes
that have a large toe box should be worn, because they put less
pressure on your toe. Stiff or rocker-bottom soles may also be recommended.
Most likely, you will have to stop wearing high heels. |
|
Orthotic
devices—
Custom
orthotic devices may improve the function of your foot. |
|
Medications—
Non-steroidal
anti-inflammatory drugs (NSAID), such as ibuprofen, may be prescribed
to help reduce pain and inflammation.
Supplements such as glucosamine-chondroitin sulfate and some
vitamins and minerals may also be helpful. |
|
Injection
therapy—
Injections
of corticosteroids in small amounts are sometimes given in the
affected toe to help reduce the inflammation and pain. |
|
Physical
therapy—
Ultrasound
therapy or other physical therapy modalities may be undertaken to
provide temporary relief. |
When
Is Surgery Needed?
In
some cases, surgery is the only way to eliminate or reduce pain.
There are several types of surgery that can be undertaken to treat
hallux rigidus. These
surgical procedures fall into two categories:
|
Some
procedures reconstruct and “clean up” the joint.
The surgeon removes the arthritic damage from the joint as well
as any accompanying bone spurs, and then alters the position of one or
more bones in the big toe. These
procedures are designed to preserve and restore normal alignment and
function of the joint as well as reduce or eliminate pain. |
|
More
aggressive procedures are used when the joint cannot be preserved.
These may involve fusing the joint, or removing part or all of
the joint and, in some cases, replacing it with an implant, such as is
done for the hip or knee. These
procedures eliminate painful motion in the joint and provide a stable
foot. |
The
procedure that is used to correct hallux rigidus depends on many factors,
including the cause of the condition and the severity, as well as the
patient’s age, occupation and activity level. Your podiatric surgeon is trained to select a surgical
procedure best suited to your particular condition and needs. If surgery is performed, the length of the recovery period
will vary, depending upon the procedure or procedures performed.
3.
Tailor’s Bunion
(top)
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.
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 architecture 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, wearing shoes that are too narrow in the
toe produces constant rubbing and pressure aggravating the symptoms of a
tailor’s bunion. 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.
Conservative
Treatment
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
modification—
Wearing
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
medications—
Non-steroidal
anti-inflammatory drugs (NSAID), 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.
