Foot

The most common foot complaints are chronic conditions, such as hammertoes and bunions, as well as complaints of ingrown toenails, corns and calluses. However, fractures and more serious conditions are not uncommon.

Move your mouse over the foot to identify the parts.

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Bunion

There are many misconceptions about how bunions are formed. Theories about poorly fitting shoes and high heels are myths; the cause is actually biomechanical. In other words, repetitive motions affect the position of the bones. Bunions can also be inherited. The problem becomes more prominent in older populations. It is a progressive deformity that develops from a muscle/tendon imbalance. This imbalance causes misalignment of the bones, causing the joint to become inflamed and irritated. The pain can become so severe that it may make walking difficult.

A bunion is a chronic condition, which means that it gets worse over time. It is a progressive deformity in which the joint of two different bones - the metatarsal and the phalange, become misaligned. Irritation of this metatarsal phalangeal joint can result in a bunion or the misaligned bone protruding through the skin.

The bunion can be eliminated by realigning the metatarsal phalangeal joint. Other procedures require cutting the bone, moving it over, or shaving some of it off, thus reducing the pressure of the misaligned joint. Your doctor may suggest options such as:

The doctor will recommend the best course of treatment for each specific condition based on clinical assessment and radiographic result.

If surgery is recommended, the doctor should discuss the postoperative course.

Hammertoe

A hammertoe is a deformity of the second, third or fourth toes. With this condition, the toe is bent at the middle joint, so that it resembles a hammer.

Hammertoe results from a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out. Hammertoes are flexible and can be corrected with simple measures. However, if left untreated hammertoes can become fixed and require surgery.

Corns on the top and calluses on the bottom of the toe may be signs of a hammertoe. Pain may also be felt in the toes or feet making it difficult to find comfortable shoes. Poorly fitting shoes may make this condition worse or more painful - and may also be a cause.

Hammertoe may also be inherited and can be formed by trauma involving the toe(s). Hammertoe in diabetics can lead to ulcers, gangrene and even amputation due to the reduced blood flow to the legs and feet.

Treatment options include shoe inserts, anti-inflammatory medication, and if those fail surgical options may be discussed.

Toe and Metatarsal Fractures

The toes are made up of phalanges (the visible toes) and the metatarsal bones. Each metatarsal extends into the foot beneath the skin, to join up with the tarsals and other bones of the heel and ankle. Most toe and metatarsal fractures are caused by some trauma. Displaced fractures change bone position and may require surgery. Non-displaced fractures can often be treated without surgery.

Stress fractures occur over time through repetitive motion, such as occur with athletes.


Phalange Fracture
It is important to seek treatment if you suspect a toe fracture. Often people do not think they have a broken bone but rather a sprain or strain, which are muscular. It can be difficult to tell the difference between a sprain and a fracture so medical evaluation is always recommended.


Metatarsal Fracture
The toes support a lot of weight. The metatarsals are directly behind the toes (phalanges) and are very susceptible to injury. Metatarsal fractures can be difficult to diagnose and may lead to other problems, including arthritis.

Treatment of toe or metatarsal fractures may include immobilization, splinting, a cast or special shoe. In severe cases such as displacement, surgery is required.

Foot Nonunions

Nonunion, or failure of the bone to fully heal, is one of the most common complications of foot fractures and surgery. A patient's health and lifestyle choices can affect bone healing following injury or surgery. Diabetes and obesity are two factors. The heavier a patient is, the more weight the feet need to support, thus making it difficult to avoid weight bearing on the affected limb. Diabetes affects healing in the lower extremities, therefore careful attention to insulin levels is crucial to heal bones.

Surgeons may use immobilization in order to prevent nonunions. This keeps weight off of the foot. External fixation is a newer alternative to casting and may be suggested. External electrical bone growth stimulation is often recommended for foot nonunions. Often, bone stimulation is begun during initial healing to prevent nonunion, or in the case of nonunion, to encourage healing.

If surgery is required to repair a nonunion, metal hardware and bone grafting are typically used.