Foot Pain Blog

Hallux Valgus is a condition which affects the joint at the base of the big toe. The condition is commonly called a bunion (above). The bunion actually refers to the bump that grows on the side of the first metatarsophalangeal (MTP) joint. In reality, the condition is much more complex than a simple bump on the side of the toe. Interestingly, this condition almost never occurs in cultures that do not wear shoes. Pointed shoes, such as high heels and cowboy boots, can contribute to the development of hallux valgus. Wide shoes, with plenty of room for the toes, lessen the chances of developing the deformity and help reduce the irritation on the bunion if you already have one. However, shoes alone are not “solely” to blame for the development of bunions. Abnormal foot function comes into play in the development of almost all bunions, and the most common abnormality is over-pronation or excessive flattening of the foot, easily correctable with an orthotic.

Treatment
Treatment of hallux valgus nearly always starts with adapting the shoewear to fit the foot. In the early stages of hallux valgus, converting from a pointed toe shoe to a wider box toe shoe may arrest the progression of the deformity. The pain that arises from the bunion is due to pressure from the shoe. Treatment focuses on removing the pressure that the shoe exerts on the deformity. Wider shoes reduce the pressure on the bunion. 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.

If all conservative measures fail to control the symptoms, then surgery may be suggested to treat the hallux valgus condition. There are well over 100 surgical procedures described to treat hallux valgus. The basic considerations in performing any surgical procedure for hallux valgus are: to remove the bunion to re-align the bones that make up the big toe to balance the forces so the deformity does not return.

In some very mild cases of bunion formation, surgery may only be required to remove the bump that makes up the bunion.

It is more likely that re-alignment of the big toe will also be necessary. The major decision that must be made, is whether or not the metatarsal bone will need to be cut and re-aligned as well. The angle made between the first metatarsal and the second metatarsal is used to make this decision. The normal angle is around 9-10 degrees. If the angle is 13 degrees or more, the metatarsal will probably need to be cut and realigned.

This effectively reduces the angle between the first and second metatarsal bones, narrowing the foot. The bone is held in the desired position with a metal screw or pin.

In more severe bunion deformities, where the foot has widened considerably and the big toe is way out of alignment, the first metatarsal is cut at the near end of the bone (proximal osteotomy below).
The bone is re-aligned and held in place with screws or metal pins until it heals. A cast is worn and the patient walks with crutches or a walker, not bearing any weight on this foot or an extended period of time. Again, this reduces the angle between the first and second metatarsal bones.
Re-alignment of the big toe is then done by releasing the tight structures on the lateral side of the first MTP joint. This includes the tight joint capsule and the tendon of the adductor hallucis muscle. As you can see, this muscle tends to pull the big toe inward. The toe is realigned and the joint capsule on the medial side of the big toe is tightened to keep the toe straight.

Once the surgery (.avi movie) is complete, it will take about eight weeks before the bones and soft tissues are healed.

A picture of a foot showing an advanced bunion deformity which never received treatment is available. It’s not pretty.

After surgery is completed, it is essential that the two factors that caused the bunion originally be eliminated: Tight shoes must be avoided and abnormal foot function must be corrected.

Duration : 0:1:50

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Sports Injuries

Martial arts and kick boxing
A variety of injuries can occur as a result of martial arts and kick boxing. These include plantar fasciitis, Achilles tendonitis, sesamoiditis, and ankle sprains. Stretching is recommended for a minimum of 15 minutes before performing any kicking or punching.

Aerobics
Proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability. Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot.

Team Sports
Activities such as football, basketball, soccer, field hockey and lacrosse often lead to ankle and big toe joint injuries as a result of play on artificial surfaces.

Turf toe
Big toe injuries also called “turf toe,” often result from hyperextension of the big toe joint as the heel is raised off the ground. An external force is placed on the great toe and the soft tissue structures that support the big toe on the top are torn or ruptured.

Symptoms include pain, tenderness and swelling of the toe joint. Often there is a sudden acute onset of pain during push-off phase of running. Usually, the pain is not enough to keep the athlete from physical activities or finishing a game. This causes further injury to the big toe and will dramatically increase the healing time.

Treatment includes rest, ice, compression, and equipment modification or change. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used for relief of minor pain as well as to decrease the inflammation of the injury. Consult your physician before taking any medication.

Duration : 0:0:58

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Plantar fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot. Our practice can evaluate arch pain, and may prescribe customized shoe inserts called orthotics to help alleviate the pain.

Plantar fasciitis is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Also called “heel spur syndrome,” the condition can usually be successfully treated with conservative measures such as use of anti-inflammatory medications and ice packs, stretching exercises, orthotic devices, and physical therapy.

Duration : 0:1:44

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Heel Pain Common, But Not Normal

I have always stated that Pain is Never Normal. With this understanding, however, Americans suffer from foot pain on a regular basis. Of the causes of pain, including bunions, curly toes, corns and dry, cracked skin and even injuries like sprains or fractures, one particular ailment — heel pain — has been show in a new survey by the American Podiatric Medical ociation (APMA) to be a leading cause of pain.

The recent poll questioned close to 420 Americans aged 18 and older. The results included 39 percent of adults that experienced heel pain more than any other foot ailment within the last 12 months. Additionally, nearly 60 percent of respondents believed they suffered heel pain due to wearing ill-fitting shoes. In fact, many found that this pain was interfering in activities that they liked to participate in. So they have all seen a doctor right? No, about 64 percent of respondents said they had not yet visited a medical professional — such as a podiatrist — to diagnose and treat their heel pain, even though the pain has not subsided.

“Heel pain is a detrimental foot ailment that affects millions of Americans every day, and foot pain of any kind is not normal,” said Ronald D. Jensen, DPM, president of the APMA. “If detected early, most types of heel pain — including the most common, plantar fasciitis — can be treated with non-invasive treatment options. However, the longer one waits to have their heel pain evaluated, the more difficult it is to successfully treat.”

Are you among the sixteen percent of Americans that regularly experience heel pain? Heel pain can be avoided by wearing shoes that fit well, wearing the proper shoes for each activity, not wearing shoes with excessive or uneven worn heels or soles, and stretching foot and ankle muscles properly before and after exercising. Visiting a podiatric physician, also known as a podiatrist, as soon as foot pain is experienced drastically improves the chance of finding a solution for heel pain, and can help you return to regular activities without limitation of heel pain. Remember Pain is Never Normal!

Duration : 0:1:44

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http://tanglewoodfootspecialists.com/serv/ortho.htm
CUSTOM DESIGNED ORTHOTICS

Orthotics are custom designed insoles for your shoes. The orthotics reposition your foot to allow them to work as efficiently as possible and provide for a stable base of support for the rest of your body. They are made from a mold of the foot taken in a neutral position that is modified based on a comprehensive biomechanical examination of the lower extremity. You should consider orthotics as a solution if you suffer from bunions, hammertoes, heel or arch pain, Achilles tendinitis, shin splints, tired feet, or any pain in your feet, legs, knees, hips, or back during walking or exercise.

To find out more about orthotics and if they are the right treatment for you contact our office. Dr. Andrew Schneider, a Houston, TX foot doctor, will provide a comprehensive evaluation for orthotics to get you feet working more efficiently and feeling better than ever before.

To order Dr. Schneider’s FREE book “One Step Ahead: The Foot Owner’s Manual” visit http://www.tanglewoodfootspecialists.com. Visit our blog at http://tanglewoodfootspecialists.blogspot.com. Our specialty running blog can be found at http://www.houstonrundoc.com

Duration : 0:1:12

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Heel Pain Has Many Causes

In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we’ve suffered.

When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury.

Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.

Heel Pain

Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight.

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.

Heel Spurs

A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.”

Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Plantar Fasciitis

Both heel pain and heel spurs are frequently ociated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.

The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.

Excessive Pronation

Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.

As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

Duration : 0:1:54

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Plantar fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot. Our practice can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.

Plantar fasciitis is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Also called “heel spur syndrome,” the condition can usually be successfully treated with conservative measures such as use of anti-inflammatory medications and ice packs, stretching exercises, orthotic devices, and physical therapy.

Duration : 0:1:20

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What Is a Bunion?

A bunion is an enlargement of the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. Since this joint carries a lot of the bodys weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunionfrom the Latin “bunio,” meaning enlargementcan also occur on the outside of the foot along the little toe, where it is called a “bunionette” or “tailors bunion.”

Symptoms

Development of a firm bump on the outside edge of the foot, at the base of the big toe.
Redness, swelling, or pain at or near the MTP joint.
Corns or other irritations caused by the overlap of the first and second toes.
Restricted or painful motion of the big toe.
How Do You Get a Bunion?

Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This can lead to instability in the joint and cause the deformity. They are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk, and our inherited foot type, our shoes, or other sources.

Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.

Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.

Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.

What Can You Do For Relief?

Apply a commercial, nonmedicated bunion pad around the bony prominence.
Wear shoes with a wide and deep toe box.
If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
Avoid high-heeled shoes over two inches tall.
See your podiatric physician if pain persists.
Conservative Treatment For Bunion Pain

Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. Podiatric medical attention should be sought at the first indication of pain or discomfort because, left untreated, bunions tend to get larger and more painful, making nonsurgical treatment less of an option.

The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. A podiatric physician may recommend these treatments:

Padding & Taping
Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.

Medication
Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by joint deformities.

Physical Therapy
Often used to provide relief of the inflammation and from bunion pain. Ultrasound therapy is a popular technique for treating bunions and their ociated soft tissue involvement.

Orthotics
Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

Duration : 0:2:32

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Heel Pain Has Many Causes

In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we’ve suffered.

When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury.

Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.

Heel Pain

Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight.

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.

Heel Spurs

A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.”

Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Plantar Fasciitis

Both heel pain and heel spurs are frequently ociated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.

The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.

Duration : 0:1:43

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According to the American Diabetes ociation, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.

Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.

With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror.

Here’s some basic advice for taking care of your feet:
Always keep your feet warm.
Don’t get your feet wet in snow or rain.
Don’t put your feet on radiators or in front of the fireplace.
Don’t smoke or sit cross-legged. Both decrease blood supply to your feet.
Don’t soak your feet.
Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
Use quality lotion to keep the skin of your feet soft and moist, but don’t put any lotion between your toes.
Wash your feet every day with mild soap and warm water.
Wear loose socks to bed.
Wear warm socks and shoes in winter.
When drying your feet, pat each foot with a towel and be careful between your toes.
Buy shoes that are comfortable without a “breaking in” period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don’t wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don’t lace your shoes too tightly or loosely.
Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.
When your feet become numb, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced “sharko”) foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn’t hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast.

The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot’s movement and supports its contours if you don’t put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.

Duration : 0:0:48

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