Arches Playing Hide And Seek? 4 Treatments For Your Painful Flat Feet

Anyone who’s ever played hide and seek knows what a thrill it is to be well-hidden somewhere, perhaps only a breath or two away from the soft shoe scuffs of the seeker, almost bursting out laughing because you know if they just twitched the curtain aside, took one step behind them, or shifted the branch slightly they’d see you, grinning, right before you dashed off to whatever upended pot, tree stump or floor-strewn sweatshirt was ‘safe.’ Possibly jealous of these childhood exploits, the arches in your feet may want to get in on the hide-and-seek action. Enter the condition known as flexible flatfoot.

People with flexible flat feet have arches that disappear when they put weight on their feet, but which reappear when the feet are not weight-bearing, or when they go up on their toes. In fact, this reappearance of the arch while the foot is non-weight bearing is really what separates this type of flatfoot from other types. It’s as though the arches take toe-standing as a general call of olly-olly-oxen-free: time to come out and tease the seeker about how great your hiding place was. In short, the arches pretty much think this is the best game ever.

Flexible flat feet usually appear during childhood or sometimes a little older, and then stick around into adulthood (arches that have gotten into the habit of hide-and-seek like to keep playing indefinitely). While often innocuous, this condition (like any childhood game) can get a bit rough. Because flexible flat feet cause the tendons to stretch more than they’re really designed for, these tendons can become inflamed and cause the condition to get progressively worse over time. Unfortunately, this type of flatfoot usually shows up in both feet, although you may not have painful symptoms in both.

Symptoms

If you’ve got flexible flat feet, you’re going to have feet that appear flat while you’re standing (or that leave wet full footprints when you step out of the shower), but which get an arch when you’re off your feet, or when you stand on your toes. Some other things might also change about the appearance of your foot: your toes and the front of your foot may start to turn outwards (i.e. towards the pinky toe), so that when you look at your foot from behind (or have someone look for you), you’ll see more toes than you should. The bottom of your heel may also tilt outward, and your ankle may turn inward.

When your feet are flat (and your arches have disappeared off to who-knows-where), it changes the way your weight is placed on your foot, and the way you move when you walk. Because of this, people with flexible flat foot may feel pain in parts of their body that are moving or bearing weight abnormally. For instance, in the foot, you may start to feel pain in your heel, arch (when your arches are willing to be found), ankle, or on the outside of your foot. You may also experience pain up into your legs (shin splints, usually), knees, hips, and lower back. Or, to keep things all equal, you may have a general ache in your legs or feet. You may also develop other symptoms such as a tight Achilles tendon, bunions and hammertoes. All fun and games, right?

Diagnosis

Your podiatrist is an excellent arch-seeker, and if you have flexible flatfoot, he or she will be able to coax it out of hiding. Making the diagnosis usually involves observing your foot both while it’s bearing your weight, and while you’re sitting or standing on your toes. Sometimes X-rays are used to find out just how far your flexible flatfoot has progressed.

Treatment

If you are not experiencing any pain with your flexible flat feet, then treatment may not be required. However, orthotics (prescription shoe inserts) may still be a good idea, to try to prevent future problems. Conversely, if your hideaway arch is causing problems such as pain or other symptoms, there are a few things you can do (or your doctor can do for you) to provide the support you need.

1)  Again, orthotics often help correct the imbalances in the foot, and may be useful in providing extra support and realigning your foot properly. Shoes and shoe inserts that support the arch are particularly helpful for obvious reasons.

2)  In addition, you may wish to eliminate or at least reduce the types of activities that are currently causing you pain, at least until your symptoms die down. (Discomfort and pain from flexible flat feet often occurs with certain types of activity, such as walking, running and prolonged standing.) If being overweight is adding to the stress on your feet, you may wish to talk to your doctor about weight loss. Losing weight may significantly reduce your symptoms.

3)  You can also reduce inflammation in your foot by immobilization (often through use of casts or braces, or sometimes being completely off your feet for awhile), taking anti-inflammatory medication (such as ibuprofen), and undergoing physical therapy, such as ultrasound treatments.

4)  If these methods fail to significantly reduce your pain, then surgery may be the best option to get your arches to stop playing around. Your podiatrist can discuss the options available to you.

When Your Foot Arches Aren’t So Golden

Have you ever seen a bridge collapse? One of those old-style bridges with stone arches and fancy carvings along the side? As the structure starts to fail, the entire thing begins to come apart, piece by piece. Granted, your body does not start coming completely apart when the arches of your foot start to collapse, but you may experience some painful symptoms.

What is happening?

Basically, fallen arches refers to a flattening of the feet that takes place in adulthood. Although there may be other causes, this flattening usually occurs when the tendon (posterior tibial tendon) and ligaments that hold the arch in place gradually stretch. As we get older and our cumulative use of these tendons and ligaments increases, they lose their ability to maintain that nice arch shape, and may even begin to tear. This stretching or tearing may also be the result of an injury, obesity, or a genetic predisposition for flat feet.

Could it be normal?

Fallen arches shouldn’t (if possible) be confused with feet that are normally flat. Arch height varies a lot from individual to individual. If you have fairly flat feet, but notice that an arch appears when you stand on your tiptoes (flexible flatfoot), and if you don’t experience any pain with your flat feet, you’re more likely to be okay. However, if your feet still fail to arch when up on your toes, if your feet lose an arch you used to have, or if you experience any painful symptoms, you probably ought to see a podiatrist.

What would you feel or see?

Fallen arches may induce pain in the heel, the inside of the arch, the ankle, and may even extend up the body into the leg (shin splints), knee, lower back and hip. You may also experience inflammation (swelling, redness, heat and pain) along the inside of the ankle (along the posterior tibial tendon). Additionally, you may notice some changes in the way your foot looks. Your ankle may begin to turn inward (pronate), causing the bottom of your heel to tilt outward. Other secondary symptoms may also show up as the condition progresses, such as hammertoes or bunions. You may also want to check your footprint after you step out of the shower. (It helps if you pretend you’re in a mystery novel, and you’re leaving wet, footprinty clues that will help crack the case.) Normally, you can see a clear imprint of the front of your foot (the ball and the toes) the heel, and the outside edge of your foot. There should be a gap (i.e. no footprinting) along the inside where your arches are. If your foot is flat, it’ll probably leave an imprint of the full bottom of your foot—no gap to be had. Your shoes may also be affected: because the ankle tilts somewhat with this condition, the heel of your shoes may become more worn on one side than another.

What will your podiatrist do?

If you notice that your feet are flat, but you’re not really experiencing any pain, then you’re probably okay to go without a visit to the podiatrist (unless, of course, you have a lack of feeling in your foot). You can schedule a hair appointment instead, or maybe see a movie. However, once painful symptoms start to appear, it’s better to skip the hirsute (or cinematic) experience and go see your foot doctor. Your podiatrist will likely make the diagnosis by examining your foot visually, asking about symptoms you may be experiencing, and may test your muscle strength. You may be asked to stand on your toes (in a ballerina pose, if you prefer, although that’s certainly not required), or walk around the examining room, and you may need to show the podiatrist your shoes. He or she may comment on your excellent taste in footwear, but is more likely to check your shoes for signs of wear that may indicate fallen arches. Your podiatrist may recommend X-rays, a CT scan or an MRI in order to get a look at the interior of your foot, although the best diagnosis usually comes from the doctor’s own in-person examination.

Treatment of flat feet really depends on how far the damage has progressed. Conservative treatments often include immobilization (often by cast or brace) to reduce inflammation. Your doctor may also recommend physical therapy and anti-inflammatory medication (like ibuprofen) to get your inflamed tendon to calm down a bit. Orthotics can also offer significant relief. If these treatments fail to significantly improve symptoms, then surgery may be your best option to get the structure of your body back where it needs to be. Your podiatrist can discuss surgical options with you in greater depth.

Superhuman Or Just An Extra Foot Bone?

We all know that people are different from each other. Your Great Aunt Ophelia is nothing like your teenage son, and your boss bears little resemblance to the kid you had a crush on in second grade. But we all have things in common, otherwise we wouldn’t be human. Like the number of bones in our body. We’ve all got 206, right? Well…not necessarily. Another definition of humanity must be found, since some people (who are undeniably Homo sapiens) have some extra bones hanging around. This isn’t an indicator that they’re the next step in evolution, nor that they’ve come from another planet and are thus imbued with special powers. Sometimes people just have extra bones.

These extra bones, called accessory ossicles, may show up in your foot. They usually occur because a small portion of bone (a bone growth center) fails to fuse together with the rest of the bone mass during childhood, when cartilage is turning to bone. Sometimes, the condition may be caused by an old trauma (aka injury) as well.

Extra bones may show up in numerous places in the foot, although they’re most commonly found in a few spots. These include the accessory navicular bone (also called Os Tibiale Externum or Os Naviculare) which occurs on the inside part of the middle of your foot, the Os Trigonum which shows up right behind the Talus (ankle bone), the Os Peroneum which is located next to the Cuboid bone (on the outside of the foot near the heel), and the Os Vesalinum which also occurs on the outside of the foot, near the base of the fifth metatarsal (the long bone that, along with the other four metatarsals, makes up the midfoot).

Symptoms

Having extra bones isn’t always a big deal (although it could make for an interesting conversation starter at dinner), since these accessory ossicles often don’t cause any symptoms at all. In fact, the first time you become aware of them may be when you get an X-ray for something completely unrelated.

Unfortunately, despite their usual good behavior, these bones do occasionally cause trouble. They may raise a bony bump under your skin that rubs on the inside of shoes or makes it painful to bear weight. This prominence may become reddened or swollen. Extra bones can also interfere with the proper function (or be a symptom of improper structure) of the tendons of your foot, which can lead to soreness or throbbing pain. Occasionally, these extra bones may keep other bones from moving properly, and thus cause joint pain and a reduction in joint motion.

Diagnosis

Your podiatrist is well aware that some people have extra bones in their feet, and won’t be fazed when you go in with symptoms (or if the bone simply shows up on an unrelated X-ray). In order to diagnose the condition, the podiatrist may inquire about symptoms you’ve experienced, might press on the bony prominence to determine if there’s any discomfort, and may test the motion of your joints, your muscle strength, and check the way you walk. In order to make a definite diagnosis, X-rays or other imaging methods are often suggested.

Treatment

Fortunately, there are many ways to treat this condition that do not involve surgery. (And some of you may secretly kind of want to keep that extra bone.) They usually involve reducing inflammation by using the RICE method (Rest, Ice, Compression, and Elevation), medication (such as ibuprofen or steroidal treatments), physical therapy (if muscle strength is an issue), and orthotics (which can reduce pressure on the bony prominence and help out any associated ailing tendons). Casts are sometimes also used to rest the foot and allow inflammation time to die down.

If these treatments don’t help much, then surgery might be a good option. (You’ll lose that cool extra bone, but you’ll be able to walk more easily.) Surgery usually involves removing the bone, and possibly correcting any problems with associated tendons.

Whatever the treatment, you’ll always know that you have (or had) a little extra something about you that isn’t just run-of-the-mill. You are, at least slightly, just a little superhuman. Sort of.

Orthotic Optimization – Returning Order To Your Feet

You know you can get prescriptions for eyeglasses, high cholesterol, and allergies.   You may not be aware, however, that you can get prescriptions for shoe inserts as well. These specially crafted devices, commonly known as orthotics or orthoses, are designed specifically for your foot, and are created to correct for problems in the way you walk, the way your foot is shaped, or provide additional support for weak areas of your feet. They may also be used to accommodate areas of your foot that are unusually prominent.

Basically, orthotics affect the way your foot interacts with the ground when you walk (or stand or do jumping jacks), making being on your feet much more comfortable. When you have foot problems, your podiatrist may use orthotics as a more conservative alternative to surgery. In many cases (although by no means all), they can help eliminate pain and discomfort while you walk, making it possible for you to forgo surgical treatment entirely. Orthotics generally work best when paired with other treatments, such as physical therapy and medication.

When you go in to see your podiatrist about a foot problem, and he or she suggests orthotics as a possible treatment method, you’ll probably have to have a model made of your foot in order for the orthotics to be suited to your specific needs. If time travel were possible, some famous sculptor like Michelangelo might be hired to create an exact replica of your foot. Unfortunately, scientists have not yet made time travel possible, (It’s time to get on that, scientists!), so your podiatrist will likely make a model of your foot using other methods. One such method (and possibly the coolest) is scanning your foot using an optical or mechanical scanner. The information is inputted into a computer, which constructs a 3D model of your foot digitally. Alternatively, your podiatrist may opt for the slightly less techy but still effective foam method: basically, you step into a box full of foam, which then takes on the shape of your foot. Your foot may also be modeled using the application of plaster (kind of like those art projects you did in elementary school, but in, let’s face it, a rather more useful form).

Orthotics generally come in two different varieties: accommodative (aka ‘soft orthotics’) and functional (aka ‘rigid orthotics’). Accommodative orthotics are generally constructed of more flexible material, such as foam, leather, cork, or rubber (marshmallows, although soft, are generally not durable enough to work well in orthotics). As the name suggests, accommodative orthotics are there to accommodate your feet: they help relieve pressure on painful or prominent spots, absorb some of the force of the steps you take, and in general make things nice, soft and cushiony. They’re used a lot for diabetic patients who have developed painful ulcers on their feet, calluses, or those who are arthritic or who have serious foot deformities.

Soft orthotics tend to be fairly easy to break in, since the materials from which they’re made from themselves readily to your foot shape. Unfortunately, that same flexibility also makes them wear out rather quickly, so they may need more frequent replacement than rigid orthotics. They also tend to be a bit more bulky than rigid orthotics, so you may not be able to wear them with all shoe types.

Functional orthotics tend to be made of less flexible materials, such as rigid or semi-rigid plastics, or even graphite.  They’re designed to help improve the operation of the foot by correcting for irregular foot function, and may also be used to treat problems with other parts of your personal walking mechanism, such as your ankles, legs, knees and hips. Functional orthotics may also be used in the same way as accommodative orthotics:  providing accommodation for painful parts of the foot.

Rigid orthotics tend to be, no surprise, rigid in nature, so getting used to wearing them may be a bit more difficult than with the soft variety. However, once you’re used to them, they tend to be a lot more durable, requiring fewer replacements or adjustments than their cushier cousins. They also tend to be on the thin side, so slipping them into a wide variety of shoes shouldn’t be too difficult.

Using specialized shoe inserts can be of particular benefit to children, whose feet may need to be corrected early on, and athletes, who may have special needs for those spectacular athletic moves.

Children with foot deformities may need to use orthotics in order to get as much foot function as possible as they grow. Generally, when a foot deformity is recognized (often flat feet or toes that abnormally point inward or outward), orthotics should be introduced pretty soon after the child begins toddling around (and getting into pots and pans and in general making a great deal of mischief). The child should be fitted for new orthotics when he or she has grown two shoe sizes (which may seem to occur about once a week during growth spurts).

In general, athletes tend to work best with semi-rigid orthotics. These provide both cushioning and structural support for the athletic foot, allowing it to move without pain according to the demands of the athlete’s particular sport.

Don’t Attack When Your Heels Crack

On occasion, particularly during dry weather or times when you’re wearing sandals a great deal, you may notice that your heels have taken on the texture of a rough concrete wall. Eventually, you may find that your heels have begun to crack in spots. Now, those cracks might be minor ones, or they may be deep enough that they bleed and make it quite painful to walk. In some rare cases, they may even become infected.

You see, heels are under a lot of pressure pretty much any time you stand up. If you weigh a bit more than average, or if you’re on your feet a great deal (either at work or at home) the pressure is even greater. Under that pressure, the fatty pad under your heel (which usually serves as a kind of cushion for the weight coming down your leg and into your foot) tries to expand outward. If your skin is dry, or if you’re wearing open-heeled shoes that offer no support to shore up that expansion, the skin around your heel may begin to crack. Which can be pretty unpleasant, actually, since skin is generally nicest when it stays in one piece.

Sometimes dry or cracked heels may be a symptom of an underlying condition, such as diabetes or hypothyroidism, which can reduce sweating and therefore make your feet a bit more dry. Some skin conditions can also be at the root of the problem, such as eczema or psoriasis. If you’re concerned about these conditions, you’ll want to check with your podiatrist during your visit for advice about treatment.

Cracks in your heel are a pretty easy symptom to spot. However, you are also likely to have associated symptoms, such as dry or thickened skin, sometimes appearing with a yellowish or brownish callus along the heel. If your cracks are deep, they may bleed, and if infected, they may become inflamed (red, warm to the touch, swollen and painful).

Your podiatrist can usually make the diagnosis by performing a visual examination, although he or she will probably ask you if there’s any pain while you stand, and will likely check to be sure there are no signs of infection. If an underlying condition such as diabetes or thyroid problems is suspected, your podiatrist may suggest further testing.

In general, treatment involves moisturizing the skin of the heel and providing support for it. You can remove some of the dry skin on your heel by gently rubbing a pumice stone over your heel when you shower or bathe. Then, when your feet are all nicely dried off afterward, you can smear on some moisturizing cream (ones with oil bases tend to work best) to keep your skin supple and less susceptible to cracking. By the way, DON’T go after your dry skin with a pair of scissors or a razor. Cutting off calluses yourself can lead to bad complications like cutting too deep and getting infections. Think of children trying to cut their own hair: it really doesn’t ever work the way it’s supposed to.

Avoid wearing open-heeled shoes (things like flip flops or other sandals) for awhile, or at least alternate their use with shoes that do have heels. You can also purchase a heel cup to provide further support, keeping your heel from that outward spreading that leads to cracking.

Infected cracks will need additional help, such as antibiotic medications.  Your doctor can effectively evaluate and treat in either case.

7 Things You Can Do For Your Hammertoes and Why

Putting toes and hammers together often results in some major misfortune. So, as you might imagine, the condition called hammertoes isn’t really an ideal state for the digits of your feet. (Although really, it’s hard to say whether the name came about because the toes resemble hammers, or simply look as though they’ve been hammered.) When you have hammertoes, the joints of one or more toes become semi-permanently or permanently bent, making the middle joint of the toe jut up, just as if your toe had decided to take on the shape of a tent. Hammertoes often start out flexible, meaning you can still bend the joint—it just tends to revert to the crooked position when you leave it alone, although they do become inflexible over time. As the condition worsens, the joints become locked in place, which is not the way joints are supposed to behave.

Hammertoes may have several causes, but most commonly come about due to muscle imbalances. The tendons pulling the toe inward may be stronger than the ones that pull the toe straight, thus resulting in a toe that’s bumped up in the middle. Hammertoes (or a tendency to develop them) might have been something you inherited from your parents (or grandparents, or third cousins), although they may also be caused or exacerbated by wearing shoes that scrunch the toes up into a small space (i.e. shoes with tiny little toe boxes and/or high heels—the usual lineup of suspects). They may also develop due to an injury, such as a break in the toe, or arthritis.

Some people may not experience uncomfortable symptoms until their condition is a little more advanced. However, the first sign that something’s up is the visibly obvious bending of the toe upward at the middle toe joint, making the toe look like a hammer or a claw. This may be followed by pain or even corns on the top of that pointed toe joint (caused when your shoe rubs against the raised toe), and callouses on the ball of your foot (they form because the base of the toe is now jutting down abnormally and putting extra pressure on the ball of the foot).

As things get a bit more severe, the joint itself may begin to feel stiff and painful, and it may become inflamed (red, swollen, warm to the touch). Eventually, you may not be able to move the joint very well, or at all.

It’s a good idea to go in to see your podiatrist when your toes begin to take on that hammer-like or clawed appearance, especially if you’re finding it painful to walk because of the condition. Your podiatrist will likely make the diagnosis by examining your foot visually, and may test the joint for flexibility and pain. He or she may also suggest X-rays in order to get an insider’s look at what’s going on in your foot.

Treatment options are varied, and depend a great deal on how far progressed your hammertoes are.

1)  When the joint’s still pretty flexible, it may be possible to treat the condition entirely without surgery. This will likely be accomplished by your podiatrist prescribing orthotics (fancy shoe inserts designed specifically for you) that will help correct the imbalance in your foot that’s causing the hammertoes.

2) Your podiatrist may also try taping the toes (that is—he or she will put tape on the toes, not take the toes in for a session in a recording studio) in order to straighten them and provide additional support.

3) Exercising your calves and toe muscles will also help provide additional strength and stability for your foot.

4) There are also a few things you can do to relieve some of the painful symptoms that come with hammertoes. You could try using pads to reduce the pressure on the tops of your toes: hammertoe pads or corn pads may be available over the counter, but you may want to avoid the medicated ones—the acid in the medication may be harmful, particularly to those with circulation problems.

5) If your toe joint is swollen and inflamed, you can try applying ice (20 minutes on, 40 minutes off, and always use a thin towel between the ice and your skin) or taking anti-inflammatory medication (ibuprofen, or you can talk to your podiatrist about a cortisone shot) to reduce inflammation.

6) Also, (and this may be an obvious one, but it’s a method some people ignore), you should probably ditch the shoes with the tight toes and high heels. Give your toes plenty of room in the toe box (about half an inch past the end of each toe) and avoid heels over two inches (and lower, if possible), since they tend to squish your toes into the end of your shoe.

7) If doing all that doesn’t really seem to help, or if your toes have gotten to the point where they refuse to bend at all (the stubborn little things), then it may be time to consider surgery. Your podiatrist knows a lot of options and can discuss which ones will be most likely to fit your particular needs.

Recovery time will vary, depending on what treatment method you use. But, if all goes well, you can once again have toes that resemble toes, and not something you find in a greasy toolbox.

7 Things You Can Do When Your Bunion Hurts You

You may have noticed Podiatrists are not big fans of the kinds of shoes that some people go nuts over: sharply pointed toes, heels that come up higher than the knees…you get the picture. However, the reason for this is not that your podiatrist has an evil plan to make you as unfashionable as possible. It is simply that the shoes considered fashionable are often the same shoes that can seriously aggravate numerous foot problems. Take bunions. Now, bunions aren’t actually caused by wearing poorly-fitting shoes, but they do make an already tough problem much worse.

Bunions, in most cases, are caused because of inborn misalignments within the foot. These inherent structural problems with the foot will place more stress than usual on the joint where the big toe connects with the 1st metatarsal (the long bone that attaches to the big toe and stretches down the length of the middle of the foot). Eventually, this stress may cause the tissues around the joint to stretch and become less supportive, thereby leading to further misalignment of the bones. Eventually, the metatarsal starts jutting towards the inside edge of your foot, and the big toe begins to point toward the other ones. This often results in a bump on the inside edge of your foot right next to the big toe.

The problem many of you may be most interested in is that bunions may make it difficult or even impossible to wear shoes. The truth is that ill-fitting shoes are often the things that turn bunions from juvenile delinquents into outright criminals. Shoes with tight toes, or pointed heels, may put even more stress on an already stressed-out toe joint, further aggravating the misalignment of the foot. The good news is that sometimes giving up those pointy, high-heeled shoes may make your bunion problem much easier to bear.

The only way to correct a bunion permanently is through surgery.  There are things that you can do, however, to get yourself out of pain.

1)Get rid of the darn high-heels and pointy-toe shoes. Seriously. The best shoes, especially for people with bunion problems, have toe boxes (the space for toes at the end of your shoe) that accommodate all of your toes (not just the ones fashion says you should have), and enable them to move around a bit.

2)Avoid heels that are higher than an inch or two (the lower the better). For some people (although not everyone), this may be all you need to do to rid yourself of the pain associated with bunions. However, many people will find that they need more extensive treatment.

3)Sometimes putting felt or over-the-counter bunion pads on your bunion will reduce the pressure on the prominence and provide considerable relief.

4)Taping the foot (you can ask your podiatrist how to do this properly) may also help hold things in proper alignment, thus reducing the stress on your joint.

5)You can reduce the inflammation associated with bunions by applying ice for twenty minutes an hour (always use a thin towel between ice and your skin), or by using anti-inflammatory medications such as ibuprofen. (Your podiatrist may occasionally prescribe a more potent anti-inflammatory oral or injected medication.)

6)Some people also find that physical therapy (specifically ultrasound therapy) may reduce bunion pain.

7)If your podiatrist deems it necessary, orthotics may be used to try to correct the original misalignment that caused the problem and thus prevent the bunion from worsening.

Unfortunately, sometimes the above treatments don’t correct the problem enough to enable you to live without significant pain. If that’s the case, then it may be time to discuss surgical options with your podiatrist. Whatever the treatment you use, be sure to follow the advice of your doctor. Doing so will make it much less likely that your bunions will return to haunt your life again.

What You Should Know About Your Broken Toe

“I thought I didn’t need to see a Podiatrist for a toe break but this hasn’t been getting any better!” Horace said.  I looked down and couldn’t help but smile.  I had heard this from Penny and Rod (names have been changed to protect the . . . health information.  Please google HIPPA) the week before.  It’s an excellent idea to consult your podiatrist whenever you injure your foot, particularly if you suspect a break. Many fractures of the toe can be treated. Depending on the severity of the break, many may respond to conservative treatment, but some might be serious enough to require surgery. Failing to get proper treatment may result in improper healing of the fracture. Deformity in the toe or foot might follow, making it more difficult to wear shoes comfortably, and reducing the function of your foot. Improper healing may also cause arthritis, or other long-term pain.

One type of break is a traumatic fracture, which results from a particular event, such as stubbing your toe on that wretched enormous dresser in the middle of the night, or possibly dropping an armful of bricks on your foot. In the case of Horace, a couple of weeks ago he had been going to get his mail (barefoot) and while returning back to the house tried walking and reading at the same time.  H0race was so engrossed in the daily mail he neglected to lift his foot up on the curb at the right time and . . . WHAMMO. This type of fracture may be displaced (the broken bone has shifted from its proper position) or non-displaced (the bone is cracked, or even broken through, but it hasn’t moved from where it’s supposed to be).

Another type of break is a stress fracture, which occurs when repeated strain is put on a bone, resulting in small breaks that develop over time. Athletes who precipitously increase their activity (particularly runners), people with osteoporosis, and those who have abnormalities in the structure of their feet may be most susceptible to this type of fracture.

After taking x-rays of Horace’s foot and diagnosing the fracture we discussed what things he should do to get better quicker.  In Horace’s case the break did not require surgical correction.  “Horace, you need to transfer your weight to your heel as much as possible.”  I produced a small cushioned splint and held it up for him to see.  “This splint with the padding will protect the toe.”  I demonstrated how it wrapped the toe bringing it securely around the adjacent uninjured one.

To help align a broken toe

I also advised Horace the key to proper healing of breaks is immobilization.  Finally I fit Horace for a sexy stiff-soled shoe that would keep the toes open and prevent rubbing as well as make it easier to walk on his heel.

If the bones had been dislocated or highly displaced, I would have needed to realign the bones (aka reduction) in order to get the right pieces to knit together with the other right pieces.  Many times I can do this manipulation of the bones without surgery. However, especially with particularly bad breaks/dislocations, surgery may be needed to keep all the pieces of the broken bones together as they heal. Surgery often involves placing pins, screws or plates into the bone fragments to keep everything nicely aligned.

Horace was relieved to know he didn’t require surgery and decided that he would limit his multitasking to walking and chewing gum.

When The Toenail Goes Bad

Gertrude (names changed to protect the . . . health information – google HIPPA) came into the office and I noticed right away that she was very distressed and wringing her hands.  When I see a patient for the first time, we go through their medical history.  This includes any current medical information, medications, allergies, past surgeries and just overall how they are feeling.  What Gerty (for short) had is one of the few things that I just have to look at once and I immediately know what is going on.  There is perhaps nothing that disrupts the serenity and beauty of a foot more than an ugly blackened toenail. (Well, there may be a few more disruptive things, but black toenails are pretty icky, all the same.) Dark discolorations in the toenail don’t always have to be black, either. They may also look purplish or brown, two other colors that don’t go very well with the foot’s natural décor.  As soon as she saw me Gerty threw up her hands pointing at her left big toe nail saying, “I just woke up with this and I don’t know how it got there.”

The cause of these discolorations is usually pretty straightforward—generally they’re from a blood clot or bruising under the toenail, most likely caused by that time you dropped your toolbox on your foot, or possibly the way you keep jamming your toes during football practice.

However, occasionally the cause could be something more severe, such as melanoma (or skin cancer) that’s growing under the nail. In this case, you likely see the discoloration as a brown or black streak under the nail. This type of melanoma is more likely to occur in people with dark skin (it accounts for about 30-40% of melanomas in the non-white population), although it strikes both men and women fairly equally.

Black toenails may also occur because of fungal infections, really bad ingrown toenails (often when they’re recurring), or other health concerns, although these tend to be more rare.

These are fairly easy to pick up just clinical examination and Gerty had none of these.  Obviously, the main symptom of a black toenail is…well…a black toenail. Gerty’s discoloration was caused by bruising under the nail, the bleeding caused some pain with pressure to the area, since the blood has no easy escape route.  Gerty just about jumped through the false ceiling of my treatment room when I applied the lightest touch.

Gerty, much to her credit, had become very suspicious what was happening because she couldn’t remember injuring the toe in any way.  Melanomas will tend to show up as a streak under the nail, usually dark but occasionally white.  Because they can show up in any form, it’s usually a good idea to treat any nail discoloration with suspicion—checking with me was a good idea.

If I had suspected melanoma I would have obtained a biopsy of the tissue.  This is really the only way to find out for sure if the tissue is cancerous. Melanoma is certainly no fun, but early detection makes treatment that much easier, and often more successful.

Knowing Gerty had developed some trauma to the area (and likely within the past day) it was just a matter of going through her itinerary of the day before.  Gerty had gone dancing the night before.  She pulled out the dancing shoes from 10 years before.  “It had been awhile, I know,” she said. “And they felt a little tight but I just had to use them,” she said with a wistful smile suggesting more of a nostalgic rather than functional motive for subjecting her tootsies to these shoes of bygone days.  She also mentioned that during the course of the evening she frequented the bar at the club and by the end of the evening required the help of her husband to get back home.  She could not, for the life of her recall how she got from the venue to her bed.

I explained to her that her feet had enlarged over the years and as her right foot was a little smaller (and likely always had been) than her her left that the right great toe did not get as much pressure.  I had to numb up Gerty’s left great toe and remove the nail to make sure no additional damage was done to the nail bed and to relieve the pressure from the bleeding under it.

If I suspected that Gerty had a melanoma this would have required more aggressive treatment. If the disease is caught early enough, I can just cut out the melanoma (again with the toe numb of course). However, in more advanced stages, it may be necessary to amputate the affected toe. Removing nearby lymph nodes may be needed to prevent the spread of the cancer, and treatment may also involve other cancer-fighting methods, such as chemotherapy.

After much reassuring and a followup visit Gerty was relieved to know we did not have to call the toe truck.

Athlete’s Foot – Not Just For Athletes

Athlete’s foot is one of those conditions that’s more gross and nasty than debilitating, although it may seem like a serious annoyance. Like a monster in a bad science fiction film, the fungus that causes athlete’s foot (the tinea fungus) lives off of human flesh, quite literally. It tends to thrive in damp, dark places, like the inside of your shoe (particularly when your feet are sweaty). And, despite the name, it doesn’t affect just athletes (although they may be particularly susceptible because of sweaty feet and shared locker rooms and showers).

In fact, Kay (names have been changed to protect the . . . health information – google HIPPA) a 60 year old patient of mine, came in complaining of itchiness between her toes.  Athlete’s foot is likely to be spread by contact with contaminated damp surfaces, such as those found in locker rooms, showers and swimming pools. Kay mentioned that she had been swimming at the YMCA.  Wearing shoes in such areas, or washing and drying feet immediately after contact, will help prevent infection. The fungus also likes Kay’s feet because they were getting nice and sweaty, so drying off her feet and changing her socks and shoes frequently will help the fungus feel decidedly not at home, keeping it from hanging around.

The fungus that causes Kay’s athlete’s foot usually causes a burning or itching sensation in the affected area (which is often, although not always in the feet). The skin is likely to become dry and scaly, and as the conditions worsened, may become reddened and develop painful blisters. The fungus will often show up on the sole of the foot (although it may occur in other areas as well), and will sometimes spread to the areas between the toes and even into the toenails, making the nails brittle and yellow. Adding insult to injury, bacteria may take advantage of your foot’s weakened state and cause an infection.

To determine if you have athlete’s foot, I will often inspect the foot visually, checking for the symptoms listed above. I may also scrape the skin to see if the fungus grows from a culture, or may check the sample under a microscope. (However, cultures might take up to three weeks to grow, so there isn’t always a quick 100% sure diagnosis.)

Getting rid of this clingy fungus usually involves a couple of different methods: discouraging it from growing by making conditions less pleasant for it, and using medication to kill it. I told Kay that she should take measures such as making sure to dry her feet thoroughly after they become wet and changing her socks or shoes frequently to prevent a damp environment from forming around her feet. Luckily Kay had a fairly mild case and so I did not have to prescribe medication (or an effective over-the-counter meds) to combat and kill the fungus itself. Such medications often take the form of creams, powders or sprays, although an oral anti-fungal medication may be the most effective at getting rid of a deep-seated fungal infection. I also warned her that fungus is like a weed the garden.  Even though the weed is picked it can always come back and very likely will unless some of the treatments prescribed are continued described above.

Stick with it, Kay, and you may be able to say a permanent (or at least lengthy) goodbye to your unwelcome fungal visitors.