Foot Check-Up- What Am I Looking For?

Last night I checked my feet. I don’t know why. They do not hurt. But I gave them a good look over on the bottoms, tops, heels, in between my toes. A foot check-up!  It has been a while since I’ve done that! I see and help so many feet during the day in my occupation, and I am very good about wearing good shoes, but checking my feel regularly? Admittedly, I have not! We are all guilty of ignoring our feet unless they make us pay attention to them!

As I was looking, I realized many of you out there reading this may now be thinking about doing so yourselves, but have no clue what you are looking for. And if you found something, would it be something you would need me to look at? I thought I might share with you a list of things you may want to see your podiatrist for!

 Looking at those feet, notice the nails. Are they yellowish or opaque? Are they brittle? You may have a nail fungus. A fungus that has taken root in your nail is very rarely rid of with over the counter topical product (and that is assuming you are willing to use that product consistently for at least 8 months!)

 Do you have a dark stripe or splotch under the nail that has not grown out with the growth of the nail? Do you have a mole that has grown, darkened or become irregular? Or maybe a mole has developed that was not there before? Or maybe there is just a strange looking discoloration you did not have before. Believe it or not, skin cancer can happen on the foot or under the nail! If there is any question, have it checked out!

 Look in between the toes. Is it scaly? Is it red? You may have athletes foot (a form of fungus!) or worse, a bacterial infection! Fungus like to start here where it is especially dark and moist between the toes before spreading the sides or bottom of the feet! What is the quality of the skin on the sides and bottom? When fungus gets a hold, feet or nails, it is tough to shake off quickly. Scratching can introduce bacteria into those areas and no fungal cream out there will make bacteria go away! Get to it before it starts letting you know it’s around!

 Look for areas of the skin that look thicker. Is it a pin point callus, a broad callus or is it a wart? Or could you have possibly stepped on something? Sometimes it is hard to tell. They are all treated differently, but one thing is common for all. They all do worse in the long run if they are picked at with whatever contraption you may have gotten a hold of in the bathroom!

 Do you have what looks like a mini grand canyon invading your heels? We call these “fissures”. This condition is hereditary and does not go away with simple lotions. Worse, the deeper the canyons get, the greater the chance of you developing a bacterial infection in the deepest grooves. Treatment is advised for fissures before they become painful.

 Feel the bottoms of your feet with the pressure of a massage. (Not a bad idea in either case!) Do you feel any deep lumps? You should not have any. If you do, let us take a look and feel. It is good to get what we call a “baseline” or early measurement. Getting a look and feel and measuring these lumps will give us the best information on whether this lump something that needs to come out or whether it just needs to be monitored.

Are you checking yet? If you can’t see the bottoms, use a mirror or have someone else take a look! Don’t have either option? We won’t retire for a while! Come out for visit!

Is Bunion Surgery Worth It?

Is Bunion Surgery Worth It?

Interesting question that can be answered yes and no.

Yes, if you have pain every day in your foot around the bunion and it is keeping you from doing the things you want to do.

No, if you just think the bunion is ugly and it is keeping you from wearing cute shoes.

In general, surgery for bunions is only recommended when pain from the bunion prevents a patient from wearing normal shoes and performing their normal daily activities. If your bunions only hurt when you are wearing pointy toed, high heeled shoes; surgery is not your best option. You should try padding, wider shoes, orthotics and injections; as well as much more sensible wider toe box, lower heeled shoes.

There is a common misconception that surgical treatments for a bunion are better and quicker than non-surgical treatments. Unfortunately, patients who rush into surgery may have unrealistic expectations, and may be unsatisfied with surgery.

Patients considering bunion surgery should understand the following about surgical treatments of bunions and also dispel some common misperceptions or myths about bunion surgery:

Myth #1: It is a common myth that bunion surgery is often unsuccessful or “botched”. This is simply not true. Almost 95% of patient surveyed 6 months after bunion surgery would not only do it again, but would recommend it to their friends and family. That’s a pretty good success rate. Patients must have realistic expectations. Bunion surgery can be helpful at relieving pain, but patients should not expect to have "perfectly normal" feet after surgery. And surgery cannot make your foot fit into a 4 inch heeled shoe comfortably.

Myth #2: Bunion surgery is extremely painful. Again, simply not true. Bunion surgery is not particularly "more" painful than other surgeries.  There is pain after surgery, but most patients only require narcotic pain medication for a few days after surgery then use anti-inflammatories to control their discomfort and swelling. Foot surgery, in general, can lend itself to increased pain post-operatively because the foot is below the level of the heart and blood can rush to the area, causing a throbbing feeling. This can be well controlled with a post-operative pain management program.

Myth #3: Bunions come back even after surgery. Again, not true. A majority of patients are satisfied with their outcome after bunion surgery. Recurrence is possible, but not particularly likely. And, return of a bunion is not necessarily a complication, but something that can happen over time. Some patients have excessive motion in the foot that may predispose them to recurrence. This is why functional foot orthotics are needed in many patients post0operatively to control foot function. Another possible reason for recurrence occurs when a procedure that was performed did not best suit the severity of the particular bunion -- so it's important to have the surgery tailored for your particular bunion. Discuss this with your surgeon or get another opinion prior to surgery.

Myth #4: Bunion Surgery = cast and crutches for months. While this was true years ago, more modern techniques have allowed surgeons to mobilize patients quicker. Mild bunions typically involve walking in short walking boot cast for one month, then a sneaker for another month. Surgeons consider casting with crutches with larger bunions because setting the bones is more complex. Some surgeons have moved away from bone cuts and instead perform a fusion procedure that allows for realignment of the entire deviated bone. This fusion procedure is called the Lapidus Bunionectomy, and contemporary approaches allow for early protected walking at four to six weeks postoperatively. Recent technological advances in medical implant devices have also helped surgeons modify their techniques to get patients moving quicker.

Myth #5: You have to be off work. This, again, is simply not true, and a function of the demands of your workplace. A patient can return to a sedentary desk job within a week of the surgery, and varies based on surgeon protocol and type of bunion surgery performed. Jobs that require excessive walking, standing and physical activity may require a medical leave of absence -- which can be up to two to three months depending on healing and job requirements. Getting around can be difficult and driving may be off limits if you have your right foot operated on and/or drive a manual. Job demands of a pilot certainly differ than those of a secretary.

Myth #6: Don't fix a bunion unless extremely painful. The concern with surgically correcting a non-painful bunion is that the surgery can result in longstanding post-operative pain that may not have been there prior. The old rule-of-thumb, if it ain’t broke, don’t fix it. However, people do have surgery for non-painful bunions if the bunion interferes with activity, continues to become larger, or if they have difficulty wearing certain shoes. Surgeons strongly prefer that patients have a painful bunion before they consider surgery. Fortunately, pain is the most common reason people seek treatment.

Myth #7: Bunion surgery results in ugly scars: Surgical healing is part of the process with any surgery, and bunion surgery is no different. Incisions can be minimized, or alternate surgical approaches may be used to hide surgical scars. Bunion incisions are usually located on the top of the foot and technique varies based on surgeon. A surgeon may perform a plastic surgery-type closure to keep scaring minimum. Decreasing swelling, avoiding infection in the postoperative period, and scar cream can also minimize scars.

Bunion surgery, just like any surgery, has its share of myths. Basically, because not all bunions are treated the same, information that may apply to someone with a large bunion may not apply to someone with a small bunion. Take the time to discuss your reservations and alternatives with your surgeon. Often you will find that myths like the 7 discussed are just simply not true. 

The majority of patients, having bunion surgery for the right reasons, end up with a good to excellent outcome and would tell you that bunion surgery is definitely worth it!