- Bunion Correction
- Neuroma Excision
- Hammer Toe Correction
- Flat Foot Correction
Bunion - Hallux Valgus
Bunion comes from the Greek meaning "turnip". It is the prominent bump you see on the outside of the great toe. Hallux valgus further defines a deformity where the great toe appears to incline toward the second toe, sometimes crossing under it.
This problem is found most commonly as a result of wearing tight or poorly fitted shoes. It is more common in women than men. There is a hereditary component in some cases.
When painful, the medial side of the great toe over the bunion is usually where symptoms occur. When a deformity becomes severe other problems such as crossover of the 2nd toe, hammertoes, corns and calluses may also be present.
First steps in treatment include purchasing wider toe box shoes or having shoes stretched. Bunion pads( donut -shaped foam) can be obtained over the counter or custom fashioned using mole foam.
Surgery for bunions should be considered carefully. A painless bunion should be left alone. It is not recommended that teens have bunions treated surgically because of the greater tendency for recurrence in that population. There are numerous surgical options. Which one is appropriate depends on the severity of the deformity, the condition of the joint, the age of the patient, as well as occupational and/or recreational activity expectations.
Hallux Rigidus - Hallux Limitus
This is an affliction of the great toe metatarsophalangeal (MTP) joint. It is characterized by painful, limited motion of the great toe. Radiographs show bone spurs about the joint that restrict its motion.
It is usually caused by some type of trauma to the great toe MTP joint - either a specific injury (such as a fracture, crush, or turf toe) or repetitive eccentric loading (such as seen in jumping sports).
Conservative treatment includes using and anti-inflammatory, and resting the joint either by taping or using a thin rigid insole to limit joint movement. Modifying shoe wear to accommodate the forefoot is also helpful.
Surgical options include removing the bone spurs (cheilectomy), or if there is significant arthritis in the joint, a fusion.
Morton's Neuroma - Interdigital Neuroma
This problem is caused by impingement of the nerve that runs between the metatarsal heads. This causes fibrosis around the nerve that results in a number of annoying symptoms including a feeling of fullness under the balls of the foot (like a sock was wadded up under it. Numbness and tingling that might radiate out to the adjacent toes. Generalized burning or aching about the ball of the foot. Occasional sharp, stabbing pains around the ball of the foot that may radiate to the toes.
Symptoms are aggravated by wearing tight shoes. Massage of the foot sometimes relieves the pain temporarily.
Conservative treatment involves purchasing wide toe box shoes or having the forefoot of shoes stretched to allow for more room. Anti-inflammatory medication can also relieve pain. A cortisone injection is effective in relieving symptoms about half of the time. The longer the neuroma has been present the less likely it is to work. Metatarsal pads can work to spread the metatarsal heads and relieve the pressure from the nerve.
Surgical options include excising the neuroma. This will alleviate the pain but leaves a sensory loss between the toes of the involved web space.
Plantar Fascitis - Heel Pain - Heel Spur
One of the most common causes of posterior foot pain. Characterized by "start-up pain" - pain exacerbated by initial weightbearing in the morning or after a period of rest. The pain usually subsides with rest. It is generally located on the inside arch of the foot and is most sensitive at the front of the heel pad. Onset is usually gradual. Abrupt onset with significant pain may indicate a plantar fascia rupture. A coincidental finding on radiograph of a plantar osteophyte (bone spur) on the calcaneus is not related to the condition of plantar fascitis, although colloquially this condition has been called "heel spurs".
Conservative treatment is directed toward decreasing the inflammation and stress at the insertion of the plantar fascia. Anti-inflammatories are prescribed. Use of a night splint allows the fascia to rest at night. Physical therapy including ultrasound, deep heat, stretching, and taping techniques are all utilized. An over the counter or custom orthotic may be prescribed.
Cortisone injections may be effective in some cases but must be used cautiously as they risk rupturing the plantar fascia.
Extra corporeal shock wave therapy has been shown to alleviate symptoms in about two thirds of chronic plantar fascitis cases.
Surgery is reserved for the most stubborn cases and again must be undertaken with caution as risks include complete fascia disruption and potential nerve injury.