Acute Vs. Chronic Heel Pain: New Treatments Available

Dr Marybeth Crane discusses acute versus chronic heel pain in this informative video. It is important to understand the difference between acute plantar fasciitis and chronic plantar fascists and their treatments.

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!

So You Think a Broken Toe Isn't Serious?

So you think a broken toes is no big deal? Just last week I had a runner come in 6 months after breaking her 5th toe by kicking a shopping cart. She didn't have it x-rayed because in her words, "I didn't think there was anything you could do for a broken toe".

Here she was six months later because not only was she having a hard time fitting her still swollen toe in a high heeled shoe for work, but now it was bothering her in her running shoes. Pain when running will always bring a runner in the office!

What had happened is that she had an oblique fracture of her proximal phalanx which was displaced and healed in an abnormal position. In English, she broke her 5th toe and the bone healed crooked making a big lump that rubbed on her 4th toe causing a blister then a large corn in between the toes.

These types of corns known as "heloma molle" are very painful and can often get infected. In a diabetic or other patients with poor immune systems, these can even lead to a toe amputation! In my runner's case, she was treated conservatively with a silicone toe sleeve to pad it off until she had time to have an arthroplasty of the toe which is a surgery that removes part of the poorly healed bone and alleviates the rubbing. This surgery could have been prevented by seeking help earlier as soon as she broke her toe. 

Take home message: if you think you broke your toe, have it x-rayed and see your favorite podiatrist. They may tell you it is broken, but straight; or they may need to numb it up and pull it back into the correct position, so you can avoid surgery that will keep you laid up for weeks!


 

Got Painful Ingrown Toenails?

Ingrown Toenails

Perhaps not the most glamorous injury, but ingrown toenails are easily one of the more common and painful foot problems seen in our Grapevine, Texas office. In fact, in a recent survey by the American Podiatric Medical Association, they were listed in the top three with heel pain and blisters as the other most common complaints.

Also known as Onychocryptosis, there are a variety of ways an athlete could suffer from the problem. Excessive pressure on the outside of the great toe, stubbing or having a toe stepped on, tight socks and shoes, even improper trimming of your nails can cause ingrown toenails. Don’t forget the dreaded toenail fungus (Onychomycosis) which can cause an abnormally shaped nail that tends to get ingrown.

The pain isn't easy to deal with, as most athletes are usually always on their feet! With running and most other sports being a dynamic in nature, training and racing with an ingrown toenail can be incredibly painful. Soreness and sensitivity along the margins of the toenails may lead to infection (watery discharge, blood, pus). If infected, immediately visit a podiatrist.

If uninfected, treat the feet by soaking them in either salt or warm soapy water. Drying them thoroughly, applying a mild antiseptic solution, and bandaging the toe will make a difference.
However, if the athlete takes proper care of their feet, ingrown toenails can be certainly prevented. Make sure your shoes are long and wide enough. Don’t forget that socks come in sizes as well. Cut your nails straight across. Keep your toenail clipper clean. Don’t pick at them or try to perform bathroom surgery! And treat fungus as soon as it shows it’s ugly head!

For more info on infrown toenails, click here!

http://www.faant.com/library/avoid-bathroom-surgery-on-ingrown-toenails.cfm

15 Harmful Things You're Doing To Your Feet

When it comes to your health, you're hopefully already committed to eating right, getting regular check-ups, and exercising. But staying healthy means paying attention to all parts of your body, inside and outside. Taking care of your feet, for instance, can prevent all sorts of problems and conditions which could land you in the hospital. Back pain, circulation problems, infections and other injuries are common side effects from poor foot health. To prevent such issues, take a look at this list of 15 harmful things you might be doing to your poor, tired, old feet.

Wearing shoes: Certain shoes are worse than others — you'll find that out as you keep reading this list — but all shoes hurt our feet. A study conducted by the University of the Witwatersrand in South Africa found that societies who didn't wear shoes had the healthiest feet, making them believe that humans had better feet before they began wearing shoes. Why? Shoes alter our natural walking pattern and inhibit our natural gait, a system that took 4 million years to perfect. We don’t advocate that you don’t wear shoes at all unless you grew up in one of these societies, but choose your shoes carefully. Look for good construction and sturdy soles.

Careless pedicures: Many women enjoy decades of weekly pedicures without consequence, but there's still a risk for infections. Going to get a pedicure on the same day you shaved your legs or if you have cuts or wounds on your feet or toes raises the risk of infection. Poorly or unsterilized instruments are also a threat, and make sure your technician doesn't trim your toenails too short or push back your cuticles, your toenails' natural protector.

Flip-Flops: Once just a beach or pool-side "shoe," this form of footwear is an American staple, symbolizing our casual attitude or chronic laziness and disrespect for basic manners, depending on your viewpoint. But besides the gauche-ness of flip-flops, there's a health issue at hand, too. Flip-flops offer no arch support, which causes feet to roll inward and develop pain over time. Other problems include overworked muscles and tendons, calluses, heel fissures, lower back pain, and leaving your feet vulnerable to sharp pebbles, glass and other debris.

Walking barefoot in public areas: It's sounds disgusting, but it happens more often than you'd think. Walking barefoot in locker rooms, and even in seemingly clean and posh spas or saunas puts you at very high risk for Athlete's foot, a fungal infection that causes uncomfortable itching and burning, as well as plantar warts, which can become very painful.

Cramped shoes: Wearing shoes that are too tight in the toe area don't let your toes stretch out, leading to hammer toe over time. You can perform various toe exercises to stretch them out.

Narrow-toed high-heels: Cramped shoes lead to hammer toe, but narrow-toed high-heels can cause you to develop painful and/or unsightly bunions, which cause the big toe to point outward because of an enlarged joint or even extra bone formation. Swelling, redness and discomfort accompany bunions, which can be treated by wearing more comfortable shoes, applying cold packs, taking anti-inflammatory medication, or simply resting the foot.

Wearing shoes that make your feet sweat: Wearing shoes too long or wearing shoes that don't breathe don't just make your feet stinky. You end up breeding bacteria and fungi in your socks and shoes, and also allow blisters to develop with all of that chafing and slipping going on against your poor heels or toes.

Forgetting sunscreen: We usually remember to slather the sunscreen on our shoulders, backs and even faces, but our feet are often forgotten. And when you're suntanning for hours at the beach, your poor feet — which aren't used to being exposed to the sun in such an extreme way — can get toasted very easily.

Forgetting the socks: When you wear shoes without socks — especially tennis shoes, boots or other tie-up shoes, you increase your chances for developing calluses and corns. Wear thick enough socks to avoid the slipping and friction that causes these painful, ugly developments.

Not taking extra care of your feet if you have diabetes: Diabetics need to take extra care of their feet to avoid injury and other problems as they lose feeling and circulation in the area. Washing feet in warm water daily, moisturizing, cutting toenails, wearing socks and correctly fitting shoes, and examining your feet for cuts, sores or calluses is recommended.

Not protecting your feet against the elements: If you're hiking, skiing or just walking in extremely cold conditions, you've got to take care of your body, especially your feet. Frostbite occurs after cells begin to die when they're exposed to frigid temperatures, and continue to die after they've been denied oxygen. Wear thick socks and shoes designed for such temperatures, and never expose your skin directly to the air or snow.

UGGs: Like flip-flops, the hefty sheepskin boots — and all their knock-offs — are either loved or hated. Fans of UGGs praise their comfort and warmth, but a Philadelphia podiatrist found that the boots lack any kind of arch support, and many women complain of tired feet if they wear their UGGs too long. Knock-off UGGs have result in the highest risk for discomfort and bad arch support.

Not getting enough -iums in your diet: Calcium, magnesium and potassium are integral for good muscle health, and painful charley horses can attack when you're not getting enough of these nutrients in your diet. They can also point to dehydration and can cause soreness that lasts for days, so take supplements or modify your eating habits accordingly.

Not cutting your toenails correctly: Avoiding ingrown toenails or nails that are cut too short (and lead to painful infections or sores later) involves more than cutting straight across. Cut nails when they're dry, filing instead of cutting, and leaving the cuticles are recommended techniques.

Wearing old shoes: Shoes that have more than 350-500 miles logged aren't giving you the arch support you need. They may also be worn on the insides, which allows for more slipping, chafing and friction, causing blisters, corns and calluses.

Content adapted from http://www.nursingschools.net/blog/2011/02/15-harmful-things-youre-doing-to-your-feet Thanks!