Common Foot Problems
Hammertoes | Heel Pain | Verruca Plantaris (plantar wart)
Hallux Valgus (Bunions)
What are they caused by?
Hallux valgus, also known as bunion deformity, is a condition that affects the joint at the base of the big toe. The bunion actually refers to the bump that grows on the side of the first metatarsophalangeal joint. In reality, the condition is much more complex than a simple bump on the side of the toe. Pointed shoes, such as high heels and cowboy boots, can contribute to the development of hallux valgus, while wider shoes, which provide adequate room for the toes, can decrease the chances of developing the deformity and help reduce the irritation on the bunion.
What do they look and feel like?
The symptoms of hallux valgus usually involve the bunion. The bunion can be painful and may present as a cosmetic problem. Bunions present as bumps on the inside of the big toe joint, with the big toe positioned closer to the second toe and, in severe conditions, the second toe contracted and overriding the big toe. Increasing deformity can cause the second toe to constantly rub on the shoe and create a corn. Finding appropriate shoes can become difficult, especially for women who desire to be fashionable.
How are they treated?
- Changing the type of shoes the patient wears to fit the foot. In the early stages of hallux valgus, converting from a pointed toe shoe to a wider box toe shoe may slow the progression of the deformity.
- Bunion pads may reduce pressure and rubbing from the shoe. There are also numerous devices, such as toe spacers, that attempt to splint the big toe and reverse the deforming forces, but these are found to have minimal effect on the bunion.
- If all conservative measures fail to control the symptoms, then surgery may be suggested by your podiatrist to treat the hallux valgus condition, which may consist of removing the bump, re-aligning the big toe joint, and balancing the forces to prevent return of the bunion.
Tailor’s Bunion (Bunionette)
What are they caused by?
A bunionette is similar to a bunion, but is found on the outside of the foot. It is sometimes referred to as a Tailor‘s bunion due to the sitting position of tailors while working, cross legged with the outside edge of their feet rubbing on the ground. This produces a pressure area and callus on the outer edge of their feet at the area of the fifth toe joint.
What do they look and feel like?
The bunionette is a response to the pressure from the shoe on the head of the fifth metatarsal. At first the bump is made up of irritated, swollen tissue that is constantly caught between the shoe and the bone beneath the skin. As time goes on, the constant pressure may cause the bone to thicken as well, creating an even larger lump to rub against the shoe. The swelling in the area causes a visible bump that some people find cosmetically unappealing. Bunionettes can be painful and patients often experience difficulty when buying shoes.
What can be done to treat them?
- Using proper shoes that will accommodate the width of the foot.
- Pads over the area of the bunionette can relieve some of the pressure and reduce pain. These pads are usually sold in drug and grocery stores. They are small, round and have a hole in the middle (like a small donut).
- If all else fails surgery may be recommended by your podiatrist to reduce the deformity. Surgery usually involves either removing the prominence of bone underneath the bunion to relieve pressure - or to realign the fifth metatarsal if there is splaying of the foot.
Neuroma
What are they caused by?
A neuroma, most commonly referred to as Morton’s neuroma, is a swelling or enlargement of one of the small nerves of the foot that develops between two metatarsals. There are many reasons why a neuroma forms, some of which include the patient’s foot type, shoe type and activity and, most significantly, from chronic injury to the nerve.
What do they look and feel like?
The neuroma usually causes pain in the ball of the foot with weight bearing. Many people with this condition report feeling a painful sensation while walking, and many report sharp pains that spread out to the two toes where the nerve ends. You may actually be able to feel a swelling between the toes or a feeling similar to a rock in the shoe. This can feel like electric shocks, similar to hitting your funny bone on the elbow.
What can be done to treat them?
- First line of treatment is change of shoe type, as changing to a wider shoe will reduce or eliminate the symptoms.
- An injection of xylocaine and cortisone into the area by your podiatrist may help temporarily.
- If this fails to resolve the pain, surgery may be warranted, which may include removing the neuroma and the nerve as well. This results in permanent numbness in the area supplied by the nerve.
Hammertoes
What are they caused by?
Hammertoes are a common condition. In most cases, these problems can be traced to improper shoes, usually those that are too short or pointed. Toes that are crowded in poor fitting shoes become permanently fixed in that position and will not straighten. Shoes cause more pressure on the toes and cause painful corns.
What do they look and feel like?
Toes can be hammered at one or two joints, causing claw, mallet or hammer toes. Constant pressure due to shoes can cause corns and irritation of the toes, which can lead to swelling and pain.
What can be done to treat them?
- Changing to shoes that fit properly may slow down the progression of hammer toes unless the condition is more advanced and the toes will not completely straighten out on their own. Corns caused by the contractures can be controlled by switching to shoes that provide more room for the toes or by placing pads over the corns to relieve the pressure.
- If all else fails, surgery may be suggested by your podiatrist to correct the alignment of the toe, which may consist of correcting the contracture of the joint involved and releasing the soft tissues that may contribute to the deformity.
Heel Pain
What are they caused by?
Heel pain, also known as plantar fasciitis, can be a result of chronic inflammation of the fascia itself or of a bursa (small, fluid-filled sac) that may be present. In addition, as we age, the fat pad of the heel becomes thinner and degenerates, which can lead to inadequate padding on the heel and chronic pain in this area. Also, occasionally the small nerves that run along the plantar fascia on their way to the forefoot can become irritated and painful.
What do they look and feel like?
The symptoms of plantar fasciitis include pain in the center of the heel with weight bearing, usually most pronounced in the morning when the foot is first placed on the floor. Pain is mostly described as sharp or aching and can also occur after periods of rest.
What can be done to treat them?
- Adjustments to shoewear or use of more flexible shoes to try and reduce symptoms.
- Supporting the arch with a well fitted arch support, or orthotics, may help reduce the pressure on the plantar fascia. Heel cups can reduce the pressure on the sore area and add padding to the heel.
- Anti-inflammatory medications, such as Ibuprofen and Naprosyn, are sometimes used to decrease the inflammation in the fascia and reduce pain.
- Surgery is a last resort in the treatment of heel pain/plantar fasciitis and usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. Occasionally if a spur is present it is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves.
Verruca Plantaris (plantar wart)
What are they caused by?
A wart is caused by the human papilloma virus which invades the outer layer of skin, the epidermis, and causes some cells to grow faster than normal.
What do they look and feel like?
The skin may resemble a callus, with thick layers of dead skin overlying the wart. They often appear on the bottom (plantar aspect) of the foot on non-weight bearing areas and can be distinguished from a callus by a podiatrist. When a wart is reduced with a sharp blade, the skin may appear to consist of small folds packed together containing small black dots or bleeding points. They are usually small raised bumps in the skin about 1mm to 3mm and grow larger. They have a rough surface and clearly defined borders that may be the same color as your skin, but sometimes darker. They can be painful and usually do not itch. Warts can be transmitted by exposure of the skin to the virus, for example, on the floor of a public shower.
How are they treated?
Plantar warts are difficult to treat. Several methods have been used with success, but it must be noted that warts have a high recurrence rate and may require additional treatment. There is a potential for scarring and return of the wart with all these treatment types.
- Over the counter wart preparations such as Mediplast for plantar use, Salicylic and plasters for home use with care.
- Prescription Wart Preparations: Duofilm, Occlusal, Occlusal HP, Palofilox, Viranol gel, Cantharidin.
- Cryotherapy (liquid nitrogen) to freeze the wart and about 1mm of surrounding tissue. This method can be performed by your podiatrist and may sting or hurt slightly during the application and may require several treatments.
- Electrosurgery using "heat" to destroy viral cells.
- Surgically excision involving anesthetizing the area and completely remove it.