Keep Your Feet Feeling Young

Spring has sprung!  The weather is getting warmer, the clothes are getting lighter, and the shoes are becoming…well…lesser.  Here in Houston, TX, sandal season comes early as our spring quickly evolves into our hot, humid summertime.

When the patients in my Houston podiatry practice come in during this time of year, they are more aware of their bunions, hammertoes and other bumps that have been hidden in shoes all winter.  They don’t like them, they don’t look nice, and they want them gone…NOW!  So practically speaking, is springtime the best time to have bunion surgery?

A bunion is when the first metatarsal bone rotates to cause a painful bump on the side of the foot, just below the big toe.  It often aches when you walk and makes it difficult to wear shoes because of the pressure.  Commonly, if you have a bunion, a parent or grandparent likely has or had one too.  Bunions can only be “removed” with surgery.  That surgery usually involves the metatarsal bone being surgically fractured and repositioned.  The bone is secured with a tiny screw.

Recovery after bunion surgery is somewhat involved.  It requires a period of time without walking and then walking with the assistance of crutches.  Stitches stay in for 2-3 weeks and it takes 6-8 weeks for the bone to be completely healed.  So…will your feet look good in sandals?

Bunion surgery is very effective for correcting the appearance of the feet and many feel little discomfort after surgery.  Best results come with great compliance from my patient to help to minimize swelling.  So lets put it this way.  If you had surgery in April, you’d probably ready to wear those strappy sandals after about 2 months…still most of the summer left to enjoy.

A few caveats…first of all, I personally don’t recommend surgery when there is a bunion without pain.  The foot is too important to bear weight and function to play with the structure.   There’s no such thing as cosmetic surgery of the foot.  Furthermore, everyone is different and procedures vary, so visit the office to see what your surgery and recovery would look like.

Happy shoe shopping!

Dr. Mehmet Oz is a MD who has been a fixture on Oprah Winfrey’s show and recently started his own talk show that focuses on explaining medicine in a way that the general public can understand. On one of his recent shows he explained how a person’s foot structure can affect their entire body. He showed the audience that there are three main foot types: high arch, normal arch and low arch.

On the show, he showed that there are two quick ways to determine what type of foot structure you have. First you can lay some paper down dip your feet in water and then take a couple of steps on the paper. In a normal arched foot you will be able to see the heel and toe of your foot as well as most of the arch. In a person with high arches their foot print will only show the ball and heel of the foot. A low arch, or flat foot, would look like a paddle.

Dr. Oz also explained that by looking at the bottoms of your shoes you can also get an idea of what your foot type is. The bottoms of your shoes will wear out in the areas where you apply the most pressure. If you have a low arch then the inside of the shoe will be worn down more quickly. However if you have a high arches the outsides of your shoes will wear out more easily.

Dr. Oz did an excellent job of quickly explaining that by having either a high arch, low arch or normal arch your body is more prone to getting different problems. For example if you have a flat foot (Pes Planus) then you are more a risk for developing heel pain and biomechanical deformities, such as bunions or hammertoes.

Although Dr. Oz only skimmed the surface of foot structure and related problems this helps give you an idea of how structure can really affect function. If you have more questions regarding what kind of foot type you have and if your foot structure is causing your health problems then, as Dr. Oz recommends, you should visit your podiatrist.

A bunion is a common foot deformity that many Americans have to deal with during their lifetime. Currently, podiatrists are the leading health care professionals for caring for this deformity. Bunions are a very unique foot problem with a specific population and appearance which you will see from the seven facts below.

1) Bunion Definition – A bunion is a bony enlargement of the bone and surrounding soft tissue of the base of the big toe. This makes your foot look like you have a bump on the inside of the base of your big toe and also causes the tip of your big toe to angle toward the second toe.

2) Who gets Bunions – Bunions are more common in women. Bunions are also more common in western countries, with as much as 30% of the population of people of western countries having bunions. Interestingly, studies have shown that people from countries where shoes are not commonly worn by most citizens have a lower incidence of bunions then western countries, suggesting that bunions may be due to the shoes people wear. Bunions are also more common in older people, with a greater incidence of bunions with age.

3) Bunion Genetics – Many studies have shown that there seems to be a genetic link for acquiring bunions. This means that if someone in your immediate family has a bunion you have an increased chance of getting a bunion then the general population.

4) Bunion Symptoms – There are many symptoms that may lead people to think they have a bunion but the most common symptoms are as follows: A bony protuberance on the base of the big toe, red callused skin over the protuberance on the inside of the big toe, pain over the joint with the protuberance that worsens with pressure, and the tip of the big toe pointing toward the second toe.

5) Shoes leading to Bunions – It has been shown that narrow shoes, cowboy boats or high heel shoes can lead to bunions. This may explain why bunions are more common in women and also why they are more common in western countries where high heel shoes are more commonly worn.

6) Diagnosing a Bunion – If you think that you have a bunion and present with the symptoms above that indicate a bunion then go to a local podiatrist to have a bunion diagnosed for sure. A podiatrist will have a good idea if you have a bunion just by sight but they will also x-ray the area to confirm the presence of a bunion.

7) Bunion Surgery – If a bunion is so painful or so enlarged that it interferes with your quality of life then a treatment option is to get a bunionectomy. A bunionectomy is a surgical procedure commonly performed by a podiatrist that helps to straighten out the big toe.

As with all problems, the sooner you catch it the easier it is to treat. Don’t simply assume that surgery is required for a bunion. Bunions in very early stages can be controlled with non-surgical means that may even prevent the need for surgery in the future! The best thing you can do is visit with your podiatrist to see what the best options are.

When we think of a bunion, we usually think of a large bump forming on the side of the great toe joint. Bunions can also occur on the top of the same joint, however, but for different reasons.

When a bunion occurs on the side of the foot, it is due to biomechanical forces that cause shifting and rotation of the first metatarsal bone. These forces are usually inherited. A bunion on top of the foot is known as a “dorsal bunion.” A dorsal bunion is due to excessive mechanical force causing damage to the joint, such as a sprain or hyperextension injury such as turf toe.

When this joint is injured, it leads to a bone spur forming on the top of the head of the first metatarsal. This spur limits the smooth gliding of the joint, with an abrupt blockage of motion. Repetitive motion causes stress and inflammation to occur, which continues the growth of the spur.

Pain from a dorsal bunion can come in different forms. As the spur enlarges, a solid bump forms on top of the joint. This can become painful due to pressure from shoes. Pain can also be due to activities that require more motion than is available in the joint. Tennis, golf, basketball, and running, especially on hills, are some such activities. A deal breaker for many women is when they are forced to limit their heel height, when the spur limits too much motion.

Treatment for a dorsal bunion varies and is based on when treatment is sought. Early treatment involves prescribing a custom orthotic to biomechanically stabilize the foot. This increases the available motion around the joint and helps to limit the forces that continue to damage the joint. In cases that are already more progressed, surgery to remove the spur and remodel and decompress the joint may be necessary.

Of course, as with any injury, treating it sooner will lead to much quicker control of the problem. Time only allows for continued injury to the joint. If you are in pain, be sure to give us a call today!

There was a comment on my blog asking me about my profession and what I do. I’m going to open that up to what podiatrists do in general and how caring for an often neglected body part saves lives. I’m further spurred on to write this by the irresponsible remarks by Rep. John Shadegg (R-AZ) made on Neil Cavuto’s Fox News Channel Program. He lumped Podiatry in with aromatherapy and acupuncture, calling them an “esoteric demand that most people don’t have or don’t need.” I won’t place judgements on the other slighted professions, but I do have strong feelings about Podiatry.

Most people are fortunate to be born with two feet. Unlike shoes, which wear out after a period of time, these feet must last a lifetime. The average person takes thousands of steps each day and walk the circumference of the Earth twice over their lifetime. Your car needs routine maintenance every few thousand miles. Shouldn’t the same be true of your feet.

When something goes wrong with your feet, who is there to fix them? Family practice physicians and internists often prescribe medication. Many orthopedists look to correct the problem with surgery. Podiatrists look for the root of the problem…the underlying biomechanical deficiency…and treat the cause of the issue, not just the effect.

I can talk all day about what we do…people coming into our offices in miserable pain and leaving feeling relieved that there is a solution. The Podiatric profession is responsible for technological improvements in surgical technique, biomechanical correction, such as orthotics and bracing, that have benefited many. Talk to someone who had foot surgery 25 years ago and another who had one recently and you’ll find two very different experiences.

The greatest contribution, in my opinion, is the contribution of Podiatry to the care of diabetics. We just can’t quantify how many feet and legs have been saved by the direct and indirect influence of a podiatrist. While many are quick to amputate a toe, foot, or leg that is deemed unsaveable, the podiatrist will do everything possible to save the limb. New wound dressings are constantly coming to market, one better than the next, which podiatrists have helped develop. New wound healing therapies are developed with the research by podiatrists. New products are developed to help keep the diabetic foot healthy so these wound dressings and therapies are never needed.

These developments do not just benefit the podiatric profession. I’m proud to have colleagues like Dr. David Armstrong, Dr. Larry Harkless, Dr. Jon Steinberg, and so many others who travel around the country and world educating physicians of all types about the latest techniques and research to save diabetic limbs. Not to mention the thousands who are walking on two feet due to their research, teaching, and development.

So, Congressman, I’m happy you have two healthy feet. I’m glad you’ve never awoken with a sharp, stabbing pain in your heel. I’m thrilled that you’ve never known the fear of losing a limb or the elation of knowing that you’ve “only” needed two toes amputated, but still have a foot to walk on. But just know, that when you do need a podiatrist, you’ll be pleased that this “esoteric demand that most people don’t have or don’t need” is here to help you.

A bunion is a common foot deformity that presents as a bump on the inside of your great toe joint. Especially in warmer climates, such as Houston, where people tend to wear open shoes year-round, people with bunions become concerned about the appearance. When they put on a closed shoe, the pressure on the bunion can cause a sharp, stabbing pain.

Most people think a bunion is a growth of bone on the side of the foot, but in most cases this is incorrect. A bunion is formed by the rotation of the first metatarsal bone which is caused by mechanical forces. This bone shifts over and causes the great toe to move over towards the second toe. This can even cause the great toe to push up the second digit, forming a hammertoe.

The worse and more painful the bunion becomes can require surgery. This often involves the bone being surgically fractured, repositioned, and repaired using a tiny screw. Needless to say, the recovery is involved, since the bone must heal. The good news is that bunions do not form overnight and steps can be taken to prevent their progression once they are noticed.

A bunion typically does not form because of bad or tight shoes, although they can contribute to them. The potential for developing a bunion is hereditary. If a parent or grandparent has a bunion, it puts you at greater risk for developing one yourself. This is because you inherit the mechanics that causes a bunion to form. So when you notice a bump on the side of your foot beginning to form, see a big callus on the side of your great toe, or start seeing your great toe drifting towards your second toe, that is the time to take action.

An orthotic is a custom insole or shoe insert that works to correct the mechanics that causes a bunion to form. By addressing the forces that cause a bunion deformity, an orthotic helps to neutralize them and redistribute them across the foot. The orthotic essentially fools your foot into functioning more efficiently and stops the bunion deformity from progressing.

To have an orthotic made properly, a podiatrist should perform a biomechanical examination to learn what forces are coming into your foot from the lower back, hips, knee, and ankle. A gait analysis is often performed to see how the foot functions when walking. Ultimately a mold of the foot is taken with plaster or fiberglass while holding the foot in a stable, neutral position. It is from this mold that the orthotic is fabricated.

The orthotic will do much more than prevent bunions from progressing! By making your feet, which are your base of support, more stable, it takes the pressure off of the knees, hips and back. In fact, many people who suffer with knee and back pain find that an orthotic removes the pressure and relieves the pain.

Bunions will reach a point where orthotics will no longer help and surgery may be your only option. The sooner you visit with a podiatrist, the more likely you will be to prevent a bunion from becoming worse and, hopefully, will be able to avoid surgery altogether.

Former, and possibly future, Olympian Paula Radcliffe won the New York Half Marathon on Sunday. This is her first race since the New York Marathon in November and also her first after recovering from bunion surgery. She will assess her progress in the next few days to see if she will pursue the World Championships Marathon in Berlin.

This is great news. One of the most common concerns my patients have when considering bunion surgery is whether or not they will be able to return to running, triathlons, or any other athletic activities. I’m pleased that I’ll be able to point to Ms. Radcliffe as someone who recovered from bunion surgery and rehabilitated several other injuries and has been able to return to a world-class level.

One treatment that is likely helping her at this point is a custom orthotic. An orthotic is a custom insole that supports and stabilizes the lower extremity. It balances the mechanics to remove the forces that deform the foot and cause a bunion. An orthotic allows the foot to work at it’s most efficient and prevents a recurrence of the bunion. I hope that Paula’s doctors have her in a custom orthotic so she can continue to pursue her goals.

Seriously…that was a real question that one of my patient’s was asked on her Facebook page. No, it wasn’t a joke. She mentioned that she was going to see the Podiatrist and her friend responded “What’s that? An iPod doctor?” I’m stunned too!

He’s not alone though. I remember traveling by bus from New York to Philadelphia for my interview. The guy who sat next to me asked what I was going for and I told him and interview for Podiatry. He then spent the next hour telling me how much he loved kids. Podiatrist, pediatrician, close enough, right?

So…just in case you want to bring me your iPod or that I’ll help your kids with their ear infection (I do treat kids’ foot problems, though). Here’s my explanation:

A podiatrist is a doctor that specializes in treating all disorders of the foot and ankle. After college a podiatrist attends four years of school and then a hospital-based residency program. Podiatrists treat children, my youngest patient is under one year old, and also treat adults into their geriatric years. In my practice, I’ll see the marathon runner who has developed pain due to overtraining and poor mechanics. I’ll see the person with diabetes who has an open wound due to pressure. I take care of warts, ingrown toenails, athlete’s foot, and infections. If someone steps on a tack, I’ll be here to take it out. If you suffer with bunions, hammertoes, or a neuroma, I can do the surgery to get you feeling better. If you have flat feet, I can fit you for a custom orthotic so you won’t even think about it. Break a bone? No problem, come on in and I’ll x-ray it and get you fixed up.

Get it now? Simply put, a podiatrist is the premier physician to handle any foot or ankle problem. To learn more, order my FREE book “One Step Ahead: The Foot Owner’s Manual” by clicking here.

By the way…I am pretty good with an iPod too!

I previously discussed Victoria Beckham (aka Posh Spice) and the questions that have been posed about her bunions. Does she have them? (Yes) Did she have surgery? (No) Did she get rid of her bunion without surgery? (Definitely not!) Click here to see the original post.

As you can see in the photo, Ms. Beckham has started wearing shoes that are too big for her, so her bunion can be comfortably accommodated. While on the surface this seems like a good idea, it certainly can cause other issues.

When a closed shoe, such is the one in the photo, is worn, it is meant to have a nice snug fit. The way it is fitting Victoria, there is lots of motion that will come from it. For one, her heel not only is sliding up and down, which can most certainly cause a painful blister to form, but the heel will also rock back and forth during the course of a step. This rocking motion will put forces on the back of the heel that can also cause blistering. The pressure can also impact the back of the heel bone, causing a bone spur to form. This is known as a “pump bump” or Haglund’s deformity. If it becomes bad enough, it may also need surgery.

Wearing a shoe too large has biomechanical effects as well. The Achilles tendon is forced to work too hard, which can cause it to inflame. The muscles on the front of the leg and top of the foot will also work too hard, which can cause hammertoes to form.

It seems that, in the short term, the shoes are a good fit and the bunion does not hurt her. In the long run, she may be looking at creating new situations that may also need to be treated surgically in the future. Victoria…find shoes that fit!!

British marathoner Paula Radcliffe lately has been plagued by injuries. In fact, she had to pull out from this weekend’s London marathon after breaking a toe. She since has had bunion surgery and is hoping the realigned foot mechanics will end her long stream of injuries. After running the marathon for the Beijing Olympics just four months after breaking a leg, she is focused on her 2012 goal of medaling in the London Olympics, her home city.

A bunion is an enlargement of the great toe joint. It, however, is not from a growth of bone, but rather a shifting of the first metatarsal bone due to unstable mechanics. The forces causes the great toe to shift towards the second to and the metatarsal bone to shift out of alignment. Bunion surgery, when necessary, realigns the relationship of the bones, but does not alter the underlying mechanics that caused the bunion in the first place. If left uncontrolled, the bunion can return over time and can even require a second surgery.

The best way to balance the lower extremity is with the use of a custom orthotic. An orthotic redistributes the mechanical pressures, permitting the feet to function as a more stable unit. This allows for more a more efficient gait in walking and running. It also helps to moderate the deforming forces that caused the bunion in the first place.

In 2012, Paula Radcliffe will be 38 years old. It is not unheard of for a woman of 38 to win Olympic gold in the maraton. Constantina Dita of Romania won the Beijing marathon this past summer at the same age. Lets just hope that Paula is able to rehabilitate and resume her training, injury free, while taking all the necessary precautions to allow her body to function at peak performance.

I recently read a blog post (you can check it out here) focusing on Victoria Beckham’s (aka Posh Spice of Spice Girls fame) bunions. The claim was that she was tired of the bunions and didn’t want surgery because of her inability to wear high heels after surgery. She wore a simple night splint and the bunion disappeared in a short period of time.

A bunion is often perceived as a bony growth on the side of the foot. It is, however, the bone behind the big toe shifting out towards the side of the foot. The surgical correction usually involves breaking that bone, shifting it over, and securing it with a screw or pin. While there are bunion deformities that are due to soft tissue contracture, it is the minority.

I often use bunion splints as postoperative aids. I have not had the experience of a bunion be “cured” simply from a device such as this (for an example of a night splint, click here). It can, however, help with some of the deformity and resulting pain.

As for Ms. Beckham, the pictures shown on the site are hardly evidence that the bunion has disappeared. For her sake, however, I hope she chooses her shoes more sensibly so the bunion does not worsen. Otherwise, surgery may end up being her only option.

If you’d like to learn more about bunions, their cause, and treatment, including an informative video, visit our website.