The term "bunion" was derived from a Latin word meaning turnip. This is a term used to describe a prominence or enlargement at the great toe joint. On the contrary, this deformity is more than just a bump or prominence. It involves changes in the structural relationship between bones on the foot. Sometimes there is no bump at all, but the abnormal angulation of the first metatarsal bone which causes the visible prominence. The bone relationships are most appreciated and easily evaluated on X-ray. Hallux Abducto Valgus (HAV) is the medical term used to describe this deformity.
There are many factors that contribute to the development of Hallux Abducto Valgus. Heredity plays a role in this deformity. Although bunions are not present at birth, they may develop at an early age. Most deformities become noticeable during the adult years. This is because the deformity itself is not inherited but rather a typical foot type. The mechanics associated with his foot type are to blame. A flat foot that pronates (rolls in) excessively is more prone to develop a bunion. Shoes can also be a deforming factor. It is a fact that HAV was uncommon in Japan until western shoes were introduced. Also it is noteworthy to mention that HAV is more common in females. This is a result of the more restrictive, deforming shoes they wear. Other causes of Hallux Abducto Valgus may include trauma, neuromuscular disorders, various types of arthritis and ligamentous disorders.
Individuals with bunions are concerned about the appearance of their feet but most seek medical attention due to the painful symptoms. The pain is often due to shoe irritation. Sometimes there is an associated neuritis or bursitis. Faulty mechanics and abnormal stresses at the great toe joint will eventually cause cartilage breakdown. A painful arthritis is often the end result. This same wear and tear phenomenon occurs at other weight bearing joints such as the hip and knee. Generally it is safe to say that the severity and symptoms of this deformity increase over time.
Conservative treatment is directed at finding wider, softer shoes that decrease the pressure on the deformity or first metatarsal head. Bunion pads may also be helpful at relieving pressure. Since orthotics control foot pronation, they may prove helpful at halting the progression of this deformity. Some individuals alter their footwear and their activity and still experience discomfort. They accept the discomfort because they are told they'll have to live with it.
Surgical correction of Hallux Abducto Valgus has been discussed since the turn of the century. There are many procedures described for the correction of this deformity. With the test of time, many procedures have fallen out of favor. For example, the silicon implants used extensively for joint replacement in the early 1980s are no longer a panacea. Today they are used only in select cases. Some foot surgeons choose not to use them at all due to the potential complications. There are many techniques available to the surgeon for the correction Hallus Abducto Valgus. There is no one procedure that can be used to correct all deformities. The selection of a surgical procedure is based on the severity of the deformity. There are general guidelines that all foot surgeons must follow in their selection criteria.
Surgical correction of HAV is an elective decision made by a patient. Before making this decision, a patient must be informed of other treatment options. The patient must understand the risks, benefits and possible complications of surgery. In addition, the patient must have a thorough understanding of the postoperative course that they must follow after surgery. The decision to choose surgery is a very important choice for any patient. The importance of providing information and educating patients cannot be over-emphasized. Second opinions can sometimes be helpful when it comes to making this difficult decision. No matter which treatment regime is chosen, seeking proper evaluation is the first step in understanding this deformity and addressing this problem. Seeking early evaluation is always a good choice as compared to waiting until the symptoms become severe.
Warts are the most common viral infection of the skin. A papovavirus virus is the virus responsible for causing warts. Warts can be found anywhere on the skin, but when they occur on the bottom of the foot, they are called plantar warts.
Plantar is the medical term for the sole of the foot and, therefore, the term plantar wart is appropriate. A plantar wart can be found as a single lesion or as a cluster that is grouped together and referred to as a mosaic wart. Sometimes there is a larger wart with surrounding smaller isolated warts and these are the so-called mother-daughter warts.
Are the warts contagious? The answer is yes, under certain circumstances. First, the virus must come in contact with the skin. The virus can be introduced through a break or crack in the skin. Also, an individual must be susceptible to the virus, lacking immunity against it. It is possible to come into contact with a wart virus in a locker room or swimming pool environment. Siblings could conceivably pass the virus to one another if the above circumstances take place. Since the incubation period for warts is from one to 20 months, it is difficult to tell exactly when the virus was introduced into the body.
The foot is especially vulnerable to irritation and injury either from footwear or contact with the ground. A small break or crack in the skin will allow the papovavirus virus to be introduced. The weight bearing points of the feet are most vulnerable and that is where the plantar wart finds a home. The most common areas for the plantar wart are the ball of the foot (metatarsal heads), the heel and the plantar aspect of the toes. The skin in these areas is subjected to the most weight, pressure and irritation, making a small break or crack more likely. Faulty mechanics or abnormal structure can place even more stress on a given area. Even a high-heeled shoe can play a role by placing more weight on the metatarsal heads.
Plantar warts are seen in all age groups, but they are most common between the ages of 12 and 16. Nearly everyone has experienced a wart during childhood or remembers a family member who had one. Most individuals do not seek treatment initially. A typical history is a patient who recalls having a single wart a few months ago and at the time of treatment the wart has increased in size and number. If the nasty appearance of a wart does not motivate one to seek treatment, pain will help in the persuasion. In the case of the plantar wart, the pain may be excruciating. Many patients describe a sensation or feeling of walking on a pebble.
A case of mistaken identity is also possible with a plantar wart. Corns and callouses found on the bottom of the foot can be similar in appearance. They also cause significant discomfort. The corn is a discrete localized core of hard thick skin caused by increased pressure at a particular point. For example, a deep-seated corn may be located under a metatarsal head, which is subjected to increased pressure. A callous is a thickening of skin over a larger area such as the ball of the foot. These corns and callouses are a result of the skin's protective mechanism in response to pressure. A plantar wart often has a callous covering making distinction between a callous or wart more difficult for a patient. Proper diagnosis is important because treatment for corns, callouses and plantar warts differs. If neglected, all of these conditions can cause severely painful ambulation.
There are many treatment methods for plantar warts. The fact is that there is no one reliable way of eliminating all warts. Plantar warts may be very resistant at times, requiring treatment over several months to be eliminated. Treatment ranges from chemotherapeutic techniques to surgery. Even psychotherapy has been cited in literature.
The best form of treatment is the least aggressive. This especially is true when dealing with children or patients who have diabetes or peripheral vascular disease.
A conservative approach to the plantar wart is application of a topical agent such as salicylic acid or monochloroacetic acid. There are many other agents that can be utilized. Liquid nitrogen application is another popular form of treatment. Usually the wart and surrounding tissue is pared down so the wart tissue is better exposed. A protective aperture pad should be applied to protect the surrounding skin from the agent, which is applied next. The pads are also used to decrease pressure from the affected wart area. This aids in decreasing the pain when bearing weight and the patient is made more comfortable. The number of treatments varies from patient to patient. Average treatments range from one to three visits.
Surgery is sometimes offered to patients with resistant, painful plantar warts. Excision is generally not recommended since painful scarring can occur. A painful scar on the sole of the foot can pose an even more severe problem. If care is taken, warts may be scooped out with the use of a curette. This can be performed quite safely without the risk of scarring. Again, this more aggressive surgical treatment is reserved for painful plantar warts, which are resistant to more conservative methods.
Early diagnosis and treatment of a plantar wart is helpful in achieving the desired success and elimination of the problem. Early treatment before pain becomes severe is advisable.
Have you ever been in a shoe store, seen a great new style of shoes, and really wanted to purchase them, but knew that they would hurt your feet because of your "bunions"? Many individuals suffer with this common foot deformity known as hallux abducto valgus or "bunion deformity". A bunion can cause severe foot pain affecting an individual's activity level, footwear choices, and self-esteem. A person with bunion deformity is usually very self-conscious about his/her feet.
The term "bunion" is commonly used to refer to a large "bump" or outward protrusion on the inside of the foot along the big toe joint. The "bunion" or bump is caused by the spreading of two foot bones that cause this large prominence on the inside of the foot. It is this protrusion of bone and skin that receives pressure from footwear that causes swelling, redness, irritation, and pain along the side of the joint. In severe cases, the big toe is pushed so far over that it pushes the second toe up onto it and the joint is effectively dislocated.
What causes this deformity to occur? There are several opinions as to the actual cause of bunion formation. While there are many factors that may or may not lead to development of this deformity, the main cause is thought to be an instability in the mechanics of the first metatarsal (foot bone) phalangeal (toe bone) joint; in lay terms, the joint at the base of the great toe. There is a normal balance of forces exerted on the bones, muscles, ligaments and tendons of our feet that allows our joints to function in a certain way when we walk. If there is a disruption in this balance, it can lead to instability at the joint causing the bones to move into abnormal positions. This instability may come from the way we walk, the foot type we have inherited, the shoes we wear, or from other sources.
We all inherit a certain foot type or developmental pattern of our foot bones. If this inherited bone structure causes an improper alignment of the bones, when we walk, body weight and certain muscular forces may exert abnormal stresses on the bones and their joints. It is over time with the many thousands of steps we take that these stresses ultimately lead to instability and joint displacement in some individuals. There is great debate as to whether improper shoes can actually cause instability in this joint, worsen the progression, or simply aggravate the symptoms. Other causes may include: neuromuscular disorders, laxity in the ligaments, congenital birth defects, trauma, or rheumatoid arthritis. In one way or another, they all may lead to a disruption in the balance of forces at the joint leading to a bunion formation.
Evaluation: A proper examination is important in evaluating a bunion. The bunion may be classified as mild, moderate, or severe depending on the amount of displacement of the big toe joint and the amount of spreading of the key foot bones. The physician will focus his examination on symptoms that you may be experiencing, how long you have had them, and what makes the pain dissipate or increase. Other areas that are important for the evaluation of the bunion problems are past medical history and family medical history. Do relatives have bunion problems or related joint abnormalities? These are just a few of the questions that your doctor may ask you. They are all important in deciding which type of treatment may best help you. X-rays are an essential part of the evaluation process. Radiographs reveal the position of the metatarsal/phalangeal bones and the joint. With the x-rays, the physician is also able to determine the severity of the deformity and evaluate the joint for possible arthritis. Your doctor will examine how you walk, since the instability that occurs at the metatarsal phalangeal joint leading to bunion development occurs while the foot is in motion.
Treatment: Treatment options should be geared to each person individually. The first step in relieving pain that is associated with bunions is to wear wider shoes. Conversely, it is imperative to avoid those new fashionable pointed shoes. For women, this may mean switching to a dress flat and eliminating the traditional high-heeled pump. Most patients have already tried changing shoes before ever seeking care from a doctor. Sneakers or other supportive walking shoes may allow extra toe room. Proper fitting shoes may help to control the deforming forces that can lead to instability in the joint. Bunion guards or pads can sometimes be helpful in eliminating pressure over the bump. These can be purchased over the counter at many pharmacies or markets. They can range from simple felt or foam pads to the new silicone versions. Bunion splints can be worn at night or in shoes, however, these are usually employed after surgery in an effort to prevent recurrence. Orthotics, or over-the-counter insoles can help reduce biomechanical stresses on the joint and help relieve pain. Currently studies are being performed to determine if prescription insoles will impede the progression of a bunion. Many physicians also use orthotics after surgery to help better align the foot and again possibly help prevent recurrence. Anti-inflammatory medications or the short-term use of steroid and local anesthetic injections may relieve severe joint pain. It is always recommended that these conservative treatment options be attempted before considering any surgical intervention.
Surgery: The surgical treatment of hallux abducto valgus will vary depending upon the severity of the deformity and what the patient's expectations and goals happen to be. X-rays are important in determining which surgical procedure is to be performed. There are over 30 different types of bunion procedures that can be performed. The type of surgery chosen will depend on the causes and deforming factors that are present. The surgical recommendation should also be taken into consideration along with the patient's age, body type, medical history, activity level or occupational requirements. Most surgical options focus on repositioning the bones and realigning the joint. By repositioning the metatarsal phalangeal joint, the prominence or bump of bone will be eliminated. This usually relieves any ongoing joint pain. A cut is made in the bone, the bone is shifted, and then held in place either with a pin, wire, or screw. The position of the cuts in the first metatarsal bone varies depending on the severity of the deformity. Along with the repositioning of the bones, there is the release of specific tendons or ligaments that, if left untreated, would add to the continued instability of the joint. In cases where a person has a very severe and painful joint, a joint replacement procedure may be done. This is usually seen in patients with associated arthritis in the joint. A simple removal or "bone shaving" of the bump may be performed. However, it does not correct or address the cause of the deformity and usually leads to a high probability of reoccurrence.
Summary: A simple evaluation or examination by a Podiatrist can determine if you have a bunion deformity. The Podiatrist can inform you of specific treatment options that best suit your situation. All conservative treatment options should be exhausted before pursuing a surgical recommendation.
Heel spur syndrome is a painful condition, which afflicts all age groups. It is one of the most common problems treated by podiatric physicians today. It is called a syndrome since there are many causes for this condition. A well-known fact is that bone spurs are not usually the primary cause of pain, and in many cases, there is no spur present when x-rays are taken.
Many causes for this painful condition have been described in the medical literature. A popular theory is that the pain is due to a mechanical strain on the foot. More specifically, there is a strain on the plantar fascia, which is the major ligament or band of tissue in the sole of the foot. The pain that results from this strain is present at the heel bone where this plantar fascia attaches. Some of the other causes of heel pain may include an injury, stress fracture, bursitis, nerve entrapment or various forms of arthritis. Referred pain to the heel can even be caused by a low back problem.
Patients with this heel syndrome will often express common symptoms such as severe pain when first rising out of bed in the morning. They also state pain is severe when they first stand after sitting for a while. Most patients do not remember any initiating factors such as an injury or a fall. Some patients have this painful condition in both heels. Many patients put off treatment in the early stages only to find that pain worsens. It is also not uncommon to see patients who have been treated by multiple practitioners of varying specialties. Many patients give up and accept this painful condition which changes the way they live because they are told there is nothing more that can be done.
Treatment varies from conservative measures to surgical intervention, which should always be the last resort. It is agreed upon that 95% of patients with heel spur syndrome will respond to conservative care. Conservative care includes anti-inflammatories, steroid injections, heel cups, heel pads, taping, arch supports, ice massage, stretching exercises and various forms of physical therapy. For many patients, a prescription orthotic corrects the imbalance that was the initial source of strain mentioned previously. These orthotics support the foot and regulate the way it functions while in contact with the ground. These orthotics support and put the plantar fascia at rest by decreasing stressful forces.
In a few cases, all conservative treatment fails to give a patient relief of pain. Surgical intervention in select cases may be a viable option. The medical status of the patient along with the cause of the pain is important in reaching this decision. As with any surgery, there are risks along with benefits, which must be fully explained to the patient. The surgery can be very beneficial when it becomes the only remaining option left to gain relief from this painful condition. The alternative is living with the pain.
Surgical procedures and techniques vary from surgeon to surgeon. There is an innovative procedure that utilizes a portable fluoroscopy unit in the hospital operating room. Another procedure, called an endoscopic plantar fasciotomy, uses a small camera similar to those used for knee arthroscopy. This technique enables the surgeon to be very precise in his approach using a small incision, less than a half inch. Special instruments are used throughout these procedures to minimize the injury to the tissues. The disability with the recovery from this procedure is much less than with standard traditional approaches to heel surgery. Once again, it should be emphasized that surgery is elective and should only be considered for chronic painful heels resistant to conservative treatment.
Heel spur syndrome can become a chronic disability disrupting even the most inactive lifestyles. Due to the nature of this problem, it is very important to seek early diagnosis and treatment. The longer this condition is present, the more difficult it is to treat.
When your feet hurt, you hurt all over. Foot pain affects a person's physical and mental well being. Simply speaking, pain in the feet can be a real pain in the butt.
Foot pain has a way of nagging away throughout the day. Unfortunately, almost everyone will experience a foot problem at some point in his or her lives.
A Morton's neuroma is one of the more common problems treated by podiatrists today. It is one of the typical nagging, bothersome foot problems. This foot ailment was first described by the Queen's chiropodist, Louis Durlacher, in 1845.
This neuroma was later named after T.G. Morton who, incidentally, was from Philadelphia. In addition to Durlacher and Morton, many others have written about this foot neuroma.
A Morton's neuroma is an irritated, swollen nerve in the ball of the foot, classically described as a pain in the ball of the foot located between the base of the third and fourth toes. The involved nerve lies sometimes squeezed and irritated by these adjacent metatarsal heads causing the painful neuroma to develop. The metatarsal heads are located in the ball of the foot. This area is already subjected to considerable pressures from shoes and walking.
We now know from experience that a neuroma can also develop between the second and third metatarsals. In fact, a neuroma can develop anywhere there is a nerve. This Morton's neuroma is more commonly a problem in females. High-heeled shoes with cramped pointed tips cause additional pressure and irritation on these nerves in the ball of the foot.
Individual complaints for a neuroma vary. Frequently, a burning sensation is experienced in the ball of the foot. Patients also complain of cramping in the foot. A sharp pain is sometimes experienced between the bones (metatarsal heads) at the base of the toes. This pain and sometimes a "feeling of numbness" may involve the corresponding toes that the nerve a supplies.
Walking in shoes aggravates pain. Often a patient will state there is a relief after removing their shoes. Many patients will massage their foot after removing the shoes. Less commonly, a patient describes a sensation of "walking on a pebble" because the inflamed, swollen nerve is felt under the ball of the foot. A neuroma may be the result of an injury to the foot. The traumatic event might just be the result of shoes. Most of the time there is no recollection of any injury.
A diagnosis of neuroma is based on the symptoms described by the patient and a good clinical exam. Tenderness is reproduced when specific areas of the foot are touched. Sometimes the examiner feels a mass (the neuroma). The clinical exam will rule out other disorders, which may be present with similar symptoms. Stress fractures, metatarsalgia, rheumatoid arthritis, diabetic neuropathy and referred pain from the back are just a few conditions, which cause foot pain.
Treatment begins with conservative padding and strapping of the foot. Orthotic devices, anti-inflammatories, physical therapy, steroid injections and the changing of shoe types are used in treating Morton's neuroma.
In chronic cases, surgical excision of the involved nerve mass provides the best relief from this painful condition. Early diagnosis and treatment of the problem will increase the success of conservative care. Neuromas as well as other foot problems can be treated.
Corns and callouses on the feet often cause severe pain if they are neglected. They are aggravated and sometimes caused by shoes. If neglected, these common skin lesions limit daily activities by causing discomfort when walking. Simply stated, when your feet hurt, you really hurt all over!
A callous is a thickening of the outer layer of the skin. This thickening is the response to pressure or friction. Callouses occur anywhere in the body where there is a constant irritation to the skin over that area. This can be viewed as a protective measure by the body to prevent a break in the skin.
On the foot, this thickening results in a painful lesion caused by an increase in pressure on a particular bone. A common area of involvement is over a metatarsal head. The resulting callous is often secondary to foot structure and sometimes foot mechanics. The bottom line is "It hurts!."
Corns are often found over a discrete, small area such as the knuckle of a toe. The medical term for a corn in this area is helloma durum. The shoe rubs the toe joint especially when the toe is contracted, as in the case of a hammertoe. Corns also develop between toes. These corns are softer in consistency, but just as painful. In this area, a prominent bone in the toe or an irregular edge (spur) may be the culprit. Other types of lesions such as warts or porokeratoses are sometimes mistaken for corns. Although pain is just as great, the treatment differs.
The treatment for corns and callouses ranges from conservative care to surgery in select cases. Conservative care may be regular, periodic trimming or shaving of the area to maintain comfort. Pads over toes or between them are also successful in reducing pressure and pain.
Larger, wider, softer shoes almost always increase comfort. Accommodative orthotics reduce pressure on discrete, painful areas on the bottom of the foot.
Functional orthotics help change foot mechanics, decreasing callouses caused by abnormal shear or friction. In the case of diabetics or rheumatoid patients, special custom molded shoes are fabricated.
Surgical correction of an underlying deformity is an option available to some patients. A hammertoe operation is a good example of where a toe is straightened and the pressure on the area is no longer present. As a result, the pressure-related corn disappears.
The first step in treating corns and callouses is a good evaluation. See your podiatrist, ask questions, and discuss treatment options. Corns and callouses are often neglected until the pain is unbearable.
Care for your feet is important since pain-free ambulation is the key to independent living. Remember all young feet will grow older. Most painful foot problems become more severe with age.
A foot orthotic is a device that is fabricated from a casted impression of an individual's foot. Foot orthotics are prescribed for many types of painful foot disorders. They are very helpful in correcting mechanical foot imbalances, which place abnormal stresses on the joints and ligaments within the foot.
Foot orthotics are especially effective for individuals whose foot problems are compounded by work and activities which place extra demands on the foot. Although not a panacea, when indicated, foot orthotics are the answer to pain limiting foot problems.
Foot orthotics are prescribed for an array of foot problems. Heel pain, arch pain, diabetic ulcerations, shin splints, prevention of recurring stress fractures or knee and back pain resulting from poor foot mechanics are just some of the conditions which respond well to orthotics. It is a well known fact that abnormal foot mechanics cause stresses that result in foot, leg, knee and low back pain.
Types of custom orthotics vary depending on the purpose for which they are used. There are basically two types of foot orthotics. First, there is the functional orthotic which is used to control the motion of joints within the foot. This type of orthotic would be helpful in controlling abnormal foot pronation or "rolling at the arch". The second type of foot orthotic is an accommodative device. This is fabricated from a softer material and is used to decrease pressure on a select area. An accommodative orthotic can be very helpful in treating and preventing diabetic ulcerations. Various combinations of materials and modifications may be used to custom fabricate an orthotic for a specific problem. The final product is a result of your prescription, which is sent to the lab with the casted foot molds.
There are many steps in fabricating a custom orthotic. At the lab, materials are cut, heated, shaped, ground, glued, smoothed and measured. The most important step is in the foot doctors office. The impression of your foot and the manner with which it is taken will directly influence the final result. From the first impression, a duplicate or positive mold is made of the foot. The lab uses this copy of a foot and with the use of the doctor's orders, a custom prescription orthotic is fabricated.
As mentioned above, orthotics are not a panacea for any painful condition. A good evaluation is a prerequisite to determine whether they are indicated.
For more than 4,000 consecutive days, Alan Sotak has never missed his daily run!
In 1975, Alan Sotak started running as a young soldier in Ft. Raleigh, Kansas. He ran avidly until December 1996. On December 27, 1996, he upped the ante and started a running streak that continues to this day. For more than 4,000 consecutive days, Alan Sotak has never missed his daily run.
Alan has run approximately 13,000 miles in every kind of weather. He has braved temperatures dipping 40 below zero as well as heat indexes trumping 120; he has run all over the United States and in more than half a dozen foreign countries. In other words, nothing comes in the way of his morning run. To him, it's as necessary as a cup of coffee is to the rest of us.
A few years ago, Alan started experiencing pain in his foot. He equates the sensation to that of pressing a thumb tack into his heel. Alan visited multiple physicians and received a variety of treatments, including injections, physical therapy and multiple sets of orthotics. Unfortunately, nothing worked. After a year of suffering, he finally decided surgery was his only hope. When he told a colleague of his plan, the friend recommended Dr. Ray Fritz of Allentown Family Foot Care.
Dr. Fritz understood Alan's passion. He knew the runner would never miss a work out. As Alan says, "He acts as a personal guide and makes decisions based on the patient's lifestyle." Dr. Fritz counseled Alan on all of his options and suggested that surgery be an absolute last resort.
They began first with cortisone shots and then moved onto ultrasound wave treatments. When neither worked effectively, Dr. Fritz recommended the Anodyne Therapy System, an FDA-approved light-emitting device that speeds up the healing process. The treatment, in conjunction with custom orthotics made by Dr. Fritz, has virtually eliminated his pain. Alan feels that the Anodyne was the biggest factor in settling things down. To this day, he remains pain free.
In the words of Alan Sotak, "I just can't speak highly enough about Dr. Fritz and his team at Allentown Family Foot Care!"
Diabetes is the leading cause of heart disease, strokes, eye problems, blindness and kidney disease in the United States. According to the Centers for Disease Control and Prevention (CDC), 25.8 million Americans are affected by diabetes. Of those, 7 million go un-diagnosed! In 2006, there were 65,700 lower extremity amputations performed as a result of diabetes.
This is where podiatry plays a significant role in foot care.
A comprehensive diabetic foot examination should be performed at least once a year. The comprehensive diabetic foot exam includes a vascular exam, neurological exam, dermatological exam and a musculoskeletal exam. This can identify areas of poor circulation, loss of sensation, as well as foot deformities that may lead to ulcerations. By helping to prevent ulcerations, this will help to decrease the rate of amputations. Higher risk patients may need more than one diabetic foot examination per year.
If you or someone you love has been recently diagnosed with diabetes or has had diabetes for a while, make sure to schedule an annual comprehensive diabetic foot examination with your podiatrist. For more information about diabetes, do not hesitate to visit: www.cdc.gov and search for diabetes.
Presently, we are seeing all
at our Allentown Offices