Bunions
Do you have a bunion? Do you want to know what may have caused the bunion or why you have one? Well, you came to the right spot because I am going to hopefully tell you all you want to know about bunions.
Bunions are a very common foot deformity. However, 90% of people make themselves suffer for years before seeking any treatment for them. Why suffer when you can get them treated now!
What is a Bunion Anyway?
The fancy, scientific name for a bunion is called hallux abducto valgus. I know, a big, hard-to-say name, but that’s what it’s called. Bunions are a big, bony lump on the inside of the foot by the big toe. The big lump is actually a change in the bony architecture in the front of the foot. The big toe tends to lean on the 2nd toe instead of being straight and erect. The bone behind the big toe (called a metatarsal) leans in the opposite direction, causing the lump on the inside of the foot.
Bunions get worse over time. The bump on the inside of the foot gets progressively bigger and the big toe leans even more on the 2nd toe and even the 3rd toe, bulldozing the toes out of the way. Bunions usually do not hurt until the deformity is really bad and that is when those people show up at our office wondering what to do.
Causes of the blasted Bunions
Of all the things that can cause bunions , my expertise tends to believe bunions are more hereditary than anything else. Look at Mom or Dad, or Grandma and Grandpa. If you have a bunion, I would put good money on the fact that they probably have one too. This inherited faulty architecture is unlucky, but don’t fret…..there is treatment.
In addition to genetics, you can also force yourself to have a bunion. You’re probably thinking, “How in the world can I make myself have a bunion?” Well, it’s pretty easy if you are not careful. Pointed-toed shoes are a big cause of bunions. It doesn’t have to be only high heeled shoes. Pointed cowboy boots and tight sneakers can also cause bunions. Most people find out that if they just find some wider shoes, their bunion pain disappears. It’s magic!
So if I have a bunion, what is it supposed to feel like?
You would be surprised. I have a tons of patients with terrible bunions who have no pain. No pain! You would think with having this huge lump on the inside of the foot, and the big toe cocked sideways, they would have some sort of pain. Guess what ladies and gentlemen, if I fixed every bunion that walked through the door, I would be in surgery all day, every day. So this is what I tell people with non-painful bunions: Your bunion will worsen. It will get bigger with time. If you start to develop arthritis in the big toe joint and the bone gets soft, it may be too late to get the procedure you need. Bone needs to be hard for screws and hardware to stay in place. So it is better off to fix a bunion earlier than later.
However, symptoms you might have are as follows:
1. Pain
2. Redness or inflammation
3. Burning in the joint
4. Numbness or tingling
Most of the time, symptoms occurs in tight shoes. Tighter the shoe = more bunion pain. This is probably why most ladies have more pain than men. Also, if you have a job where you stand most of the day, bunions can become very irritated.
So how do you diagnose a Bunion?
Diagnosis of a bunion is usually made right after you take off your sock. It is pretty easy to recognize, but knowing what to look for is key. Some patients have huge bunions and I say, “WOW! that’s a big bunion!” and the patient says, “What? Is that what that thing is?” I know that sounds crazy, but seriously folks, it happens.
I usually take x-rays to examine the bunion. I measure all the angles and can mathematically calculate which bunion procedure would be best for you.
How can you treat bunions without surgery?
I will be honest and say THERE IS NO CONSERVATIVE TREATMENT TO CORRECT YOUR BUNION!
Yes I said that. What you have is what you have. I cannot do anything non-surgically to correct your bunion, but we can slow the progression of it.
Things that might help you achieve a pain-free bunion without having surgery are listed below:
1. Padding – Our office, as well as every pharmacy in the United States, carries a truckload of pads for bunions. They range from gel to foam to felt.
2. Wider shoegear – Choose shoes with a wide toebox. High heels and pointed cowboy boots are gonna kill your feet if you don’t try and change.
3. Activity Modifications – Try not to stand so long. Harder to say than do, but try if you can.
4. Medications – There are medicines out there that I can prescribe or you can take over-the-counter to decrease the inflammation in the bog toe joint.
5. Ice therapy – Nothing like a good old-fashioned ice pack to decrease some inflammation.
6. Injection therapy – Nobody like shots, but a small dose of steroid can do a joint good when the inflammation is making your life hard.
7. Orthotics – a custom shoe insert is an excellent and proven method for slowing down the progression of bunions. Of all the conservative therapies, this one, by far, is the best.
What if I tried all this conservative stuff and I am ready to have surgery?
If conservative treatment has failed, and you are at your wit’s end, then surgery is needed. Bunion surgery is very common. There are 75 types of bunion surgeries that can be performed, however, I have my favorites. The type of surgery depends on how bad your bunion is. I have done surgery on the smallest bunions and the largest, most gnarly bunions you have ever seen. I would personally have to evaluate your bunion to determine which procedure would be the best for you.
Please read the following blog about bunion surgery. I have a listed several things to know concerning surgery. I hope this helps. Have a nice day.
A Case of Athlete’s Foot
An elderly gentleman presented to our clinic today complaining of itching, burning and drainage between the toes. Patient states his right and left foot have had this appearance for approximately 1 week duration.
The patient stated he had a long history of athlete’s foot, but has never had it this bad. Patient had applying over-the-counter antifungal and hydrocortisone creams in between the toes. Patient stated that his feet actually looked “pretty good” as compared to the past few days.
The patient was ultimately placed on the following medications:
1. Prednisone orally – a steroid to calm down the inflammation of the area
2. Gris-Peg – an oral antifungal taken 3 times per day
3. Augmentin – an antibiotic to fight any secondary bacterial infection
4. Naftin Gel – a topical antifungal to placed between the toes followed by separation of the toes with cotton balls.
5. Betadine – iodine based products to dry out between the toes
Patient was advised to let his feet air dry for 3-4 hours day and use an oscillating fan to “air out” the feet.
Patient is to return in a week for follow-up. More pictures will be posted as this patient continues to improve. Stay posted.
If you have athlete’s foot, please come see the doctors at Advanced Foot & Center for treatment.
McKinney Office Location
4501 Medical Center Drive: Suite 300
McKinney, TX 75069
To schedule an apppointment, please call : 972-542-2155
Prosper Office Location
140 N. Preston Road: Suite 30
Prosper, TX 75078
To schedule an appointment, please call: 972-542-2155
Don’t Be Fooled!
As I was walking through a Walmart in McKinney buying groceries, I ventured over to the foot product section by the pharmacy. What I saw made me a little disappointed. I saw this “machine” by Dr. Scholl’s claiming to analyze your feet and prescribe you “custom orthoses”. To the layman, this may seem like a good deal, however, I feel this is very misleading to the consumers. It must be known that every orthotic sold at Walmart, CVS, Academy Sports, Walgreens are NOT custom orthotics. They are pre-fabricated in a factory. Custom orthotics are completely different and are manufactured by taking a cast or mold of the feet, sending the mold or cast to an orthotist, who produces an orthotic specific for your feet. The orthotics by Dr. Scholl’s may be something to try initially, but if you continue to have pain, please seek a professional opinion from Dr. Silvers. We can provide “true” custom orthotics.
Subungual Exostosis
True subungual exostoses arise from the tuft of the distal phalanx. They are composed of mature bone with a fibrocartilaginous cap. Lee et al (2007) noted that half of their subungual lesions were actually osteochondromas arising from the proximal part of the distal phalanx and covered with hyaline cartilage organised as in a growth plate. True exostoses are commonest in young adults with a female predominance. They mainly occur in the great toe, although they also occur in the lesser toes and fingers.
They present with a complaint of pain in the toe, sometimes localised to the nail fold. Sometimes the swelling itself may cause pressure on the shoe. Some have a history of trauma or previous nailbed surgery (which may have been for an “ingrowing toenail’ that was, in fact, the exostosis).
Examination shows a firm swelling under the nail, usually in the medial nail fold. It is usually covered with epidermis, but may be raw or granulating.
The main differential diagnosis is ingrowing toenail, with a nailbed tumour such as melanoma, squamous carcinoma or glomus tumour as a much rarer possibility.
The lesion normally continues to grow so is best removed when diagnosed. This can be done under digital block anaesthesia as a day case. Sometimes the nail fold can be elevated and preserved, but usually it cannot be separated from the lesion and must be sacrificed. Even with careful excision of the whole lesion, the recurrence rate averages about 10%. A few patients require removal of so much nail bed that there is significant post-operative nail deformity, so that plastic nail bed reconstruction may be consdered (Suga 2005).
If you feel you may have a painful subungual exostosis, please see Dr. Silvers at Advanced Foot and Ankle Center for treatment.
References
- De Berker DA, Langtry J. (1999). Treatment of subungual exostoses by elective day case surgery. Br J Dermatol 140(5): 915-8
- Dalle S e al. Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol. 2007;156(5):871-4
- Gray RJ et al. Diagnosis and treatment of malignant melanoma of the foot. Foot Ankle Int 2006; 27:696-705
- Lee SK et al. Two distinctive subungual pathologies. Subungual exostosis and subungual osteochondroma. Foot Ankle Int 2007; 28:595-601
- Suga H et al. Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail. Ann Plast Surg. 2005;55(3):272-5
Madura Foot
What is Madura Foot?
Madura foot is terrible, destructive infection of the skin and deeper tissues. Oftentimes, the infection can reach deeper tissues such as muscle and bone.
It is noted that different species of fungus or bacteria can cause madura foot.
In the United States, Madura foot is most often caused by an organism called Pseudallescheria boydii. Now that’s a mouth full!
Although Madura foot may occur throughout the world, it is most common in dry, tropical, and rural settings. Therefore, this may not be seen very often in Texas, especially North Texas.
Madura foot is usually painless and has 3 characteristic features:
1. Formation of a nodule or lump at the site where the organism is first received, such as a penetrating injury like a puncture wound.
2. There is noted pus and tunneling into the skin at the site of the wound.
3. There is noted “grains” or “granules” within the drainage.
The infection can cause severe swelling and enlargement of the affected leg or foot. The infection can become painful if bone is involved.
Treatment often involves antibiotics and antifungal medications, but amputation is often the end result.
If you feel you may have Madura foot, please come see Dr. Silvers and he can refer to the proper Infectious Disease specialist.
