FAQs about Foot Problems and Surgeries
BUNION
Q: I have a bunion at the base of my big toe. When should I consider surgery?
A: A bunion is a bump made up of bone and soft tissue that forms on the joint at the base of your big toe. Surgical intervention for bunions is most commonly considered when the pain associated with the bunion becomes frequent and severe. Many times the discomfort inhibits walking, even in the best of shoes. If left untreated, bunions tend to get larger, more painful, and more difficult to manage surgically. A podiatrist can evaluate you and determine if you might benefit from outpatient bunion surgery. There are risks associated with all surgeries, but studies have found that 90 percent of patients who undergo bunion surgery enjoy a permanent, pain free correction of their bunion deformity. Special care should be taken after surgery to prevent the recurrence of a bunion by always wearing properly fitting shoes: No narrow-pointed shoes or tight shoes that force your foot into an unnatural position.
Q: Can you describe bunion surgery and the recovery process?
A: If conservative treatment, consisting of a change of shoe wear and/or customized pads, does not relieve bunion pain, then surgery to correct the bunion deformity may be necessary. As with most other surgical procedures, there have been major improvements related to a bunionectomy. What used to be in-patient surgery requiring a 2-3 day hospital stay, is now an outpatient procedure.
In most cases, the deformity is corrected with bone alignment so there is a very low incidence in the possibility of developing a recurrence of the bunion deformity. Years ago, metal screws or pins were necessary to maintain the position of the bone. At the Foot Health Center, an innovation known as a dissolving pin, has been used for the past 15 years. This eliminates the need to ever have to remove metal from the foot involving a second procedure. Most patients wear a surgical boot for several weeks before gradually wearing normal shoewear. Very little disability is involved and the discomfort can be easily controlled with oral pain medication.
Q. If I have bunion surgery, how long will I be off work?
A: Provided that your job does not require a great deal of standing, you could possibly be back to work within a week wearing a protective shoe or removable boot cast. The surgery generally involves realignment of the bone, which, when performed, provides an excellent success rate and a very low incidence of recurrence of the bunion deformity.
In years past, metal screws or pins were necessary to maintain the position of the bone for 4-6 weeks until the bone was healed. However, in the past 15 years, Dr. Kent Magrini and Dr. John Wright have utilized a new innovation referred to as an absorbable or dissolving pin. This eliminates the concern of requiring a second procedure to remove the metal from the foot if this were to cause any irritation. There is very limited disability and discomfort involved and only oral pain medication is required. A return to casual shoewear such as an athletic shoe is usually possible at approximately 6 weeks.
CORN/CALLUS
Q: Can the doctor cut out my corn or callus and permanently remove it?
A: In most cases, corns and calluses are caused by pressure over a bony prominence. This might be shoe pressure on the top of a toe, or weight bearing pressure on the ball of the foot. In such cases, surgically cutting out the corn or callus wouldn't be helpful. The lesion would only return once the pressure resumed. It is necessary to remove and/ or realign bone. In this way the pressure is permanently removed and the thick skin disappears. Sometimes the pressure can be removed without surgery. For example, changing shoe type or wearing orthotics. Some lesions appear to be corns but are not caused by pressure, for example warts. Often these occur on non-weight bearing areas, and may respond to simple surgical removal.
DIABETIC FOOT HEALTH
Q. I’ve been diagnosed with diabetes. What can I do to minimize problems with my feet?
A. Because you are diabetic, your feet have fewer defenses against everyday wear and tear. If decreased sensation develops, it may mean that you can’t feel injuries. Pressure problems, such as calluses or blisters, can develop without your being aware of them. Reduced blood flow may prevent injuries from healing. In fact, even minor injuries may quickly progress to serious infections.
To begin to take good care of your feet, start monitoring your foot health and guarding your feet from harm. Be very careful about the shoes you wear. Slight pressure from a poorly fitted shoe might cause a corn or blister, but for a diabetic the problem can often be much more serious. You should also schedule regular exams by a podiatrist. As a physician specializing in diagnosing and treating foot disorders, a podiatrist is well trained and experienced in foot problems related to diabetes. After a thorough evaluation, your podiatrist will develop an individual foot care program for you, which may include self-care, customized footwear, and regular appointments with the podiatrist for trimming nails and treating minor wounds and infections.
Q: I am diabetic and want the best shoes possible to avoid future problems with my feet. What shoes do you recommend?
A: When it comes to shoes, one size does not fit all. Different individuals require different shoes designed to fit the unique shape and needs of their feet. This is especially true for the diabetic patient as one in four Americans with diabetes will develop potentially serious foot problems related to the disease. The Foot Health Center of Cooper Clinic offers an exclusive line of shoes known as “Dr. Comfort.” Dr. Comfort shoes are designed by board-certified podiatrists with extra width and depth in the toe box and forefoot area to prevent pressure on swollen feet, bunions, hammertoes and other problem spots. The shoes come with custom inserts that are individually molded to your feet by the specially trained health care professionals at the Foot Health Center. There are many comfortable styles and colors from which to choose for both men and women. Medicare provides diabetics with one pair of Dr. Comfort shoes annually along with three pair of Elite custom inserts.
Q: I am diabetic and have an ingrown toenail. What should I do?
A: Because of impaired circulation and nerve damage common to people with diabetes, the help of a podiatrist should be sought for any abnormality of the foot, including an ingrown toenail. A minor foot problem can quickly turn into a major infection in an individual with diabetes so home remedies are risky. A podiatrist will help you by treating any infection that has resulted from the ingrown nail and by trimming or removing the ingrown portion of the toenail. He will educate you regarding diabetic foot care and how to properly trim your nails. Always cut your toenails straight across, do not round the edges, and wear shoes and socks that fit properly. Keep your feet clean and dry and check your feet daily. The podiatrist can also introduce you to shoes designed specifically for the diabetic patient.
As a diabetic, it is imperative that you seek professional help for any foot problem. Early intervention to prevent infection is essential. The podiatrists at the Foot Health Clinic are accepting new patients. Please call for an appointment if you have foot health concerns.
FLAT FEET
Q: What causes flat feet and are treatments available?
A: Your feet are highly specialized structures. Each foot is made up of 26 bones held together by 33 joints and more than 100 muscles, tendons and ligaments. The intricate alignment of these structures results in the formation of your arches. For most people, their arches develop throughout childhood, but some persons never develop arches, resulting in flat feet. This is a normal variation in foot type. Arches sometimes fall over time due to years of wear and tear weakening the tendon that serves as the main support structure for the arch. An overload to this tendon (wearing high heels, obesity, injury, arthritis) can cause inflammation of the tendon (tendonitis) and even tearing of the tendon. Once the tendon is damaged, the foot’s arch loses support and can flatten.
In many people, flat feet don’t cause problems. If foot pain is a problem, ask your podiatrist for the treatment that is right for you. Several options are available including over-the-counter insoles, custom-designed arch supports, or surgical intervention.
HAMMERTOE
Q: What is a Hammertoe and how does it develop?
A: A hammertoe is a contracture-or bending-of the toe at one of the toe joints. Any toe can be involved, but the condition usually affects the second through fifth toes.
A hammertoe is formed due to an imbalance of the muscles in the toes. This abnormal balance from flat feet or high arches can cause this contracture. Heredity, trauma and arthritis can also lead to the formation of a hammertoe. Wearing shoes that are too tight and cause the toes to squeeze can also be a cause for a hammertoe to form.
A visit to your local podiatrist will be very helpful as you will have the opportunity to discuss treatment options.
HEEL SPURS
Q: What are heel spurs?
A: If when you first jump out of bed in the morning there is severe pain on the bottom of your heel which makes you limp, then you may have a condition known as a heel spur or a heel spur syndrome.
The spur is frequently visible on an x-ray, but actually, there is no correlation to the size of the spur as to the amount of discomfort. The pain is a result of severe strain of the muscles and ligaments that attach from the heel to the ball of the foot. Therefore, when the foot has no support while going barefoot, wearing sandals, house shoes or loafers, it is under maximum strain. This condition is also aggravated by obesity, running or jogging, improper or excessively worn shoes, or the natural process that occurs in which the feet gradually break down, spread flatter, placing more strain on this ligament.
Conservative therapy is effective 90% of the time, consisting of stretching, application of ice, avoidance of going barefoot and appropriate shoe wear. Frequently, anti-inflammatory medication or corticosteroid injections, as well as physical therapy treatments are necessary. Arch support devices may also be required, with surgery considered only after all other treatment regimens have failed.
INGROWN TOENAIL
Q: How do I recognize an ingrown toenail?
A: An ingrown toenail occurs when the corner or side of the nail grows in to the soft flesh of your toe. It is a common condition, usually affecting the big toe. Many times an ingrown toenail causes no symptoms at its onset. But, typically you will experience tenderness, redness, and/or swelling along one or both sides of the nail. Drainage from the toe and symptoms that worsen after 2-3 days of self-care are signs of infection and professional medical help is advised. If the ingrown toenail has not progressed to infection, home treatment is an option including warm soapy or Epsom salt water (1 teaspoon per pint of water) soaks 2 - 3 times daily, topical antibiotic ointment, and cutting the toenail straight across as it grows out – do not taper the corners!
Early recognition of an ingrown toenail will hopefully prevent any adverse affects. But if infection is a problem or home treatment is not successful, the podiatrists at the Foot Health Center are here to help. Please call for an appointment for evaluation of an ingrown toenail or any other foot health need.
Q: When is it time to seek professional help for an ingrown toenail?
A: An ingrown toenail is a fairly common problem occurring when the corner or side of the toenail grows into the soft flesh of the toe (particularly the big toe). The problem can be managed at home if it is caught early. Excessive pain, redness, swelling and drainage around the site of the ingrown toenail are signs of infection and require the attention of a physician. An infected toe that is left untreated can lead to more serious problems. This is especially true for diabetics and individuals with impaired circulation. Your physician may recommend an oral antibiotic to relieve the symptoms of an ingrown toenail. Sometimes it is necessary to remove the ingrown portion of the toenail or the entire toenail itself.
Prevention is the best medicine. Remember to wear shoes or stockings that do not crowd your toes, and be sure to cut your nails straight across; never too short or curved on the sides. As a Podiatrists, we specialize in treating foot problems, including the discomfort of an ingrown toenail. Call for an appointment or if you have an ingrown toenail, bunion, hammertoe, neuroma or other foot disorder.
Q: What is the best “home remedy” for an ingrown toenail?
A: An ingrown toenail is characterized by tenderness, redness, and swelling along one or both sides of the nail. Ingrown toenails should be treated as soon as they are recognized, before the area becomes infected. Soaking your foot 2 – 3 times each day in warm, soapy water or warm salt water (1 teaspoon Epsom salts per pint of water) helps to reduce swelling and tenderness. After soaking, placing a small amount of cotton under the ingrown edge of the toenail will help it to grow above the edge of the skin. Wear comfortable shoes, preferable open-toed until the problem resolves. Apply a topical antibiotic to the tender area and cover it with a bandage. For pain relief, take ibuprofen or acetaminophen. If there is no improvement in 2 – 3 days, or if the condition worsens (severe pain, redness that is spreading, drainage), seek the help of a physician, especially if you are diabetic. Although a primary care doctor may be able to treat this problem, you might want to consider contacting a podiatrist who specializes in foot disorders.
PLANTAR WART
Q: What treatments can be used to remove a plantar wart on my foot?
A: There are several ways to treat warts, depending on their size and location. Medication, surgical removal, or both may be effective. One method involves using acidic medication which causes the wart to be broken down. Blister forming medicine may also be used. Treatment of this type may need to be repeated over several weeks. Another treatment involves removing the wart with a small spoon shaped instrument called a curette. This is performed in the office with a local anesthetic. Under some conditions, an outpatient laser procedure is required to vaporize the wart.
Unless first discussed with your podiatrist, over-the-counter medications for wart removal should be avoided. Some of these treatments can damage skin and may be dangerous if you have diabetes or poor circulation.
After your podiatrist treats your warts, protect your feet from future infection by keeping them clean and dry. Avoid going barefoot in public places like showers, gyms and locker rooms. The wart virus may spread easily in moist settings like these so wear sandals on your feet.