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ANTONIO L. KNOWLES, D.P.M.
PODIATRIST
Bunions
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If you have a bunion, you know it can be a painful
enlargement at the joint of the big toe. The skin over the joint becomes
swollen and is often quite tender. Bunions can be inherited as a family
trait, can develop with no recognizable cause or can be caused by shoes
that fit poorly.
An important part of treatment is wearing shoes that conform to the
shape of the foot and do not cause pressure areas. This often alleviates
the pain. In severe cases, bunions can be disabling. Several types of
surgery are available that may relieve pain and improve the appearance
of the foot. Surgery is usually done to relieve pain and is not meant
for cosmetic purposes.
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Heel pain
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Heel pain is extremely common. It often begins without
injury and is felt under the heel, usually while standing or walking. It
is usually worst when arising out of bed.
Inflammation of the connective tissue on the sole of the foot
(plantar fascia) where it attaches to the heel bone is the most common
cause of pain. It is often associated with a bony protrusion (heel spur)
seen on X-ray studies.
Most cases will improve spontaneously. Heel and stretching,
medication to reduce swelling of the soft tissues in your foot and shoe
inserts are quite helpful. If pain continues, steroid injections or
walking casts are used. Only in the most troubling and prolonged cases
is surgery recommended.
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Morton's Neuroma
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Morton's neuroma is caused by a nerve being pinched. This
pinching usually results in pain between the third and fourth toes.
Tight shoes can squeeze foot bones together. The nerve responds by
forming a neuroma, a build up of extra tissue in the nerve. The neuroma
results in pain, that may radiate into the toes.
Treatment usually involves wearing wider shoes and taking oral
medications to decrease the swelling around the nerve. A pad on the sole
of the foot to spread the bones is often helpful. Your doctor may also
inject cortisone around the nerve. If your difficulty continues, surgery
to remove the neuroma may be suggested.
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Corns and Calluses
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Corns and calluses are caused by pressure on the skin of
your foot. They may occur when bones of the foot press against the shoe
or when two foot bones press together.
Common sites for corns and calluses are on the big toe and the fifth
toe. Calluses underneath the ends of the foot bones (metatarsals) are
common. Soft corns can occur between the toes.
Treatment involves relieving the pressure on the skin, usually by
modifying the shoe. Pads to relieve the bony pressure are helpful, but
they must be positioned carefully. On occasion, surgery is necessary to
remove a bony prominence that causes the corn or callus.
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Hammertoes
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Hammertoes are one of several types of toe deformities.
Hammertoes have a permanent sideways bend in your middle toe joint. The
resulting deformity can be aggravated by tight shoes and usually results
in pain over the prominent bony areas on the top of the toe and at the
end of the toe. A hard corn may develop over this prominence.
Treatment usually involves a shoe to better accommodate your deformed
toe. Shoe inserts or pads also may help. If, after trying these
treatments, you are still having marked difficulty, surgical treatment
to straighten the toe or remove the prominent area of bone may be
necessary.
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Plantar Warts
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Plantar warts occur on the sole of the foot and look like
calluses. They result from an infection by a specific virus. They are
like warts elsewhere, but they grow inward. The wart cannot grow outward
because of weight placed on it when you stand. You may experience severe
pain when walking, and can have just one or many plantar warts. Plantar
warts are extremely difficult to treat, but success has been achieved
with repeated applications of salicylic acid (available over the
counter) to soften the overlying callus and expose the virus. Other
treatments include injection of the warts with medication, freezing the
warts with liquid nitrogen and, very rarely, surgery.
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Your orthopaedist is a medical doctor with extensive training in the
diagnosis and nonsurgical and surgical treatment of the musculoskeletal system,
including bones, joints, ligaments, tendons, muscles and nerves.
Foot Conditions
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