What is a Functional Hallux Limitus?

“Hallux” is the medical term for the big toe. Functional hallux limitus, then, is the loss of motion to the big toe joint, usually from jamming it during the course of walking or running.

It is also referred to by many doctors as a dorsal bunion for its most characteristic sign — a bump (exostosis) on the top of the joint where bunions are commonly found. Because the big toe is integral to walking through flexing itself upward and pushing off the ground to propel the body forward, a patient with hallux limitus will not have the range of motion in the affected toe to do that, so other joints will needTurf Toe to compensate and consequently putting more strain on the rest of the foot and leg. The continual stiffness and lack of motion lead to an inefficient, awkward gait, as well as increased fatigue and pain.

What Causes a Functional Hallux Limitus?

Pronation, a condition in which the foot rolls outward at the ankle, causes a person to put excessive weight and pressure on the big toe and big toe joint when walking. As the big toe joint needs to work harder to help “push” the body forward on every step, the joint cartilage becomes overly compressed and eventually wear down, leading to hallux limitus.

Feet with high arches are usually more rigid than normal, so as the person steps forward and puts all of the weight onto the balls of the feet rather than dispersing some to the arch, this forces the bones and joints in the balls of the feet, especially the big toe joint, to bear excessive weight. This deteriorates the joint cartilage in the big toe.

An elevated first metatarsal (the first long bone in the foot just behind the big toe) causes the big toe to push downward (flex) excessively at every step. When the big toe is in a flexed position and strikes the ground, it is jammed back into its joint cartilage with excessive impact. This thins and wears down the joint cartilage over time.

An abnormally long OR short first metatarsal will increase stress on the big toe joint each time it “pushes” the person forward. The joint cartilage becomes pinched between the big toe and metatarsal to cause wear and tear. (In most instances you can discern this defect simply by the fact that the big toe appears too long or short as compared with your other toes.)

• For most people, the cause of hallux limitus is repetitive stress and/or micro-trauma where the big toe is constantly jamming into the first metamarsal bone. Some of the most common causes for such “overuse” include:
• Frequent wearing of high-heel shoes, or shoes that are too short
• Improper running technique, or running on your toes so your heel does not touch the ground
• Squatting for long periods of time
• Stubbing the big toe
• Dropping a heavy object on your big toe joint

What are the Symptoms of a Functional Hallux Limitus?

The pain of functional hallux limitus is usually associated with any movement of the big toe joint, typically described as a deep ache or sharp pain. If a bone spur develop, there can be pain over the top of the extra bone growth as well. The pain tends to be minor or even nonexistent when there is no weight on the big toe, such as when it’s up in the air or off the ground, sometimes with full range of motion restored. If the condition is present, when you try to pivot forward over the big toe joint, it will not move.

The preliminary signs for functional hallux limitus include:

• A painful and/or swollen base of big toe
• Big toe hurts and feels stiff when your push it upward, as well as when walking, running, squatting, and standing on your toes
• Calluses
• Discomfort in the joint when the weather is damp and cold
• Feeling of “tightness” in and around the toe joint
• Reduced mobility of big toe; walking is difficult and painful
• Swelling and inflammation of the toe joint, especially on the top of the joint
• Hallux limitus is graded in four stages and the symptoms vary by stage.

Stage 1: You experience only vague joint pain. It is often difficult to diagnose at this stage due to the lack of clinical signs, and x-ray will not reveal any problems.

Stage 2: Pain is a dull ache in the great toe joint that increases with the time spent on your feet, with a mild dorsal exostosis (small bunion) that will show up on x-ray this time.

Stage 3: You suffer pain with all activities, and cracking and popping of the joint along with sharp pain may occur. X-ray will show a large bunion, and the joint is losing space as cartilage erodes.

Stage 4: Hallux rigidus or “turf toe,” which makes walking an agonizing chore, and you’ll feel significant pain any time you try to move the joint. On x-ray, the entire joint is enlarged and flattened with a lot of bone spurring around it. The cartilage is completely gone now, so your bones are essentially grinding at each other when you move.

How do You Treat a Functional Hallux Limitus?

The scope of conservative treatments for functional hallux limitus is narrow. A custom foot orthotic (device designed to correct foot disorders) or support is often used to restore normal motion to the joint during weight bearing. Wider shoe gear and accommodation for the deformity can be used to take the pressure off. Using shoes with stiff soles to limit the amount of motion can be helpful. Cortisone injections into the joint can reduce the inflammation and scar, bringing temporary relief.

Patients suffering pain in the big toe joint that may be due to early arthritis should seek a professional opinion early, since it will limit the need for extensive surgery.

SELF-CARE AT HOME

Immediate treatment must be directed toward reducing the inflammation, swelling, and pain in the big toe and its joint. In the early stages of functional hallux limitus, these self-help treatments can be effective:

Rest the foot by keeping weight off of it. You’re only aggravating and abusing the big toe every time you take a step. It cannot calm down if you don’t stop putting weight on it.

Wear shoes with a rigid sole (to reduce bending of the big toe), wide and deep toe box (to keep pressure off of the big toe and swollen joint), is relatively flat (to reduce compression of the cartilage in the big toe joint) and of the proper length (to lower the chances of jamming the big toe). Further, soften the pressure on the big toe joint by using a gel pad to cushion the ball of the foot.

Soaking the foot in warm water can help soothe the inflamed and painful big toe joint. The water must be comfortably warm, NOT hot, to avoid skin burns. Soaking for 10-15 minutes two or three times a day is usually recommended. If soaking increases pain, swelling, or inflammation, stop immediately.

Gentle massage with a topical pain reliever can provide comfort and reduced pain, swelling, and inflammation.

PROFESSIONAL TREATMENTS

Professional treatment is geared toward addressing the mechanical cause of functional hallux limitus, which includes the following:

• Orthotics to compensate for the flat feet, elevated or long metatarsal.
• Surgery to enable greater motion.
• Medications or injections to decrease pain or inflammation of the joint.
• Possible physical therapy to help reduce inflammation in the joint.

The doctor will choose the most effective method to change or alter the biomechanical issues that is causing problems. For example, if the condition is due to a long first metatarsal, the best treatment will be to shorten it.

SURGICAL TREATMENTS

The most common surgical procedure for functional hallux limitus is a cheilectomy. In this, the joint is cleaned up of all scar tissue and spurs to enable better range of motion. Recovery is very rapid with this procedure, but may not be a good option if you have severe arthritis. You’ll also undergo physical therapy early after the surgery to get the big toe joint moving as well as prevent scarring and stiffness.

In certain cases, a cheilectomy will also include a cut in the metatarsal bone to shorten and lower the bone to prevent jamming. Recovery is slower as there is a waiting time for the bone cut to heal, but weight bearing is immediate and you can return to full activity in about two months following physical therapy.

In severe cases when there’s a great deal of pain and very little to no motion in the big toe joint, it is surgically fused with another bone. This removes all motion from the joint, but all pain as well. Recovery takes about 6-8 weeks in a boot.

HOW TO PREVENT A FUNCTIONAL HALLUX LIMITUS?

The best way to prevent ankle sprains is to maintain good strength, muscle balance, and flexibility by:
Warming up before doing exercises and vigorous activities.
Paying attention to walking, running or working surfaces. Make sure the field or environment is clear of any holes or obstacles.
Wearing the right shoes — those that give your proper ankle support, such as high-top basketball shoes.
Heeding your body’s warning signs to slow down when you feel pain or fatigue.
Considering having a weak ankle taped to offer extra support when participating in a sport.
If you’re prone to or have repeated sprains, wearing an ankle brace may help.
You can use the exercises listed in Self-Care at Home to prevent sprains or re-injury, not just for rehabilitation, and add to them the ankle circles: stretching the legs in front of the body and sliding the ankles up and down, side to side, or rotating the joint in a circle. Flexing and pointing the toes repeatedly as well as massages with oil are also effective.

What is a Stress Fracture?

If you are a track and field athlete, you’re likely familiar with stress fracture. It is a tiny crack in a bone, usually in the weight-bearing bones of the lower leg and foot, like the tibia (bone of the lower leg) and metatarsals (foot bones). Whereas regular fractures involve major trauma or force like a car crash to break a bone, stress fractures come from a much lighter impact, but occurring repetitively for a much longer period of time. The muscles surrounding the bones become so worn down, fatigued, or overloaded from the constant pounding, they cannot absorb the shock completely and transfer the stress to a nearby bone, causing it to slowly crack. The crack could be so fine that sometimes it is called a “hairline fracture.”

A stress fracture is a common overuse injury most often seen in athletes, stemming from repeated impact or pressure on “overused” muscles. It rarely occurs in the upper extremity because the weight of your body is not supported by your arms as it is in your legs. As a result, these “fatigue fractures” often plague those who run and jump on hard surfaces regularly, such as distance runners, basketball players, and ballet dancers.

What Causes a Stress Fracture?

When most people think of a broken bone, they picture an incident where the bone takes a lot of force directly at once and breaks. A stress fracture, however, is quite the opposite. The impact is not significant but persistent. The cumulative force built up over time eventually tires out the muscles like water running over rocks and eroding them piece by piece. Naturally, weakened muscles cannot absorb stress like strong or even normal ones, so a neighboring bone has to pick up the slack and begin taking the pressure more and more for the muscles. Since the traumas add up and a bone can only take so much, it eventually cracks from the excess stress.

Repetitive application of force, such as repeatedly jumping up and down or running long distances, is the primary culprit for stress fractures. Certain fractures are more sports-specific: runners tend to develop stress fractures of the tibia (shin bone), tennis and basketball players often injure the navicular bone in the foot, etc.

In addition to muscle fatigue, the constant impact forces bones to lose cells. Because you only add new bone cells when you’re at rest, without sufficient time for recovery you’ll be losing bone cells faster than you can replace them. As a result, you develop “bone fatigue,” impairing the bones’ ability to repair the tiny chips and cracks of a stress fracture that start to form.

Not wearing the properly cushioned footwear or adequate equipment capable of absorbing shock can obviously lead to stress fractures, as the feet are not protected from impact. Increasing the time, type, or intensity of a physical activity too much, too soon is another cause, when the muscles and bones simply cannot handle the greater demand.

Dietary abnormalities and menstrual irregularities can contribute to the development of a stress fracture, too. Because both factors are relevant to bone health, any problems with diet (for example, poor nutrition, anorexia, bulimia) or menstruation (amenorrhea) can cause this type of injuries. A bone that’s been weakened by a condition such as osteoporosis (thinning of the bones) may not be able to endure even normal physical tasks, and thus a prospect for stress fracture.

Who Gets a Stress Fracture?

Stress fractures happen when the lower extremities of the body are overburdened. This includes the bones of the feet, shin, thigh, and pelvis. For that reason, the injury usually affects those who engage in an extraordinary amount of high-impact exercise (e.g., Olympic-class athletes), sports or activities requiring quick movements (basketball, soccer, tennis, gymnastics, ballet), distance running with high weekly mileage, and long marches (like military soldiers). People who sit a lot or are inactive can be prone to the condition as well when they suddenly undertake a flurry of exercise.

Body design is also a concern: The taller or heavier you are, the more force your legs have to absorb; improper muscle or bone alignment from the back to the feet decreases the bones’ ability to mitigate impact; weak muscles will absorb less force and thus heighten the stress transferred to the bones; weak bones will not accept the pressure well.

Age is certainly a factor, as bone mineral density declines as we become old.

Because of the increased potential for osteoporosis in women, they are twice as likely as men to sustain a stress fracture. This may be rooted in the combination of poor nutrition, eating disorders and infrequent menstrual cycle called the “female athlete triad,” which predisposes women to early osteoporosis.

Previous stress fractures have been identified as a risk factor. If you don’t let a prior injury heal completely, you’re especially susceptible to getting it again.

People who have flat feet or high, rigid arches are more likely to develop stress fractures from the abnormal walking/running motion that puts additional pressure on the bones.

Those of African descent are less likely to suffer stress fractures when compared with Caucasians, due to a generally higher bone mineral density.

Are There Different Types of a Stress Fracture?

Stress fractures are typically differentiated by the affected location:

• Metatarsal bones of the foot
• Navicular bone in the foot
• Calcaneus (heel bone)
• Tibia (shin bone)
• Fibula (calf bone)
• Femur (thigh bone)
• Femoral neck in the hip
• Pubic rami of the pelvis
• Sacrum
• Pars articularis of the lumbar spine

What are the Symptoms of a Stress Fracture?

Stress fractures usually have only a few symptoms. The signs include:

• Pain. This is the primary sign of a broken bone. Pain often begins toward the end of an activity and stops with rest. If the injury or symptoms are ignored, the pain will begin earlier during the exercise and continue even after completion. Eventually, the pain will become persistent with minimal activity. Pain at night is a common complaint
• Swelling at the injured region
• Tenderness in a specific spot when it’s touched

How do You Diagnose a Stress Fracture?

A stress fracture is almost impossible to diagnose on your own since the break is miniscule and all you may experience is pain. Hence, physical examination by a medical professional is important. During the exam, you doctor will ask about your symptoms, level of physical activity, and general health. He/she will press on the bones and soft tissues around the site of your pain, trying to pinpoint what exactly has been injured.

X-rays usually do not show a stress fracture, but may reveal evidence of bone attempting to heal around the injury. Bone scan or MRI (magnetic resonance imaging may be more effective in unclear cases.

How do You Treat a Stress Fracture?

The best treatment is almost always resting the injured leg. If there is no evidence that the stress fracture may shift (the bone edges move apart and out of proper alignment), simply avoiding the activity that caused the injury may just be sufficient. Otherwise, you should avoid weight-bearing on that foot by using crutches, or even putting it in a cast. The rule of thumb is “if there is pain, don’t do it!”

Self-Care at Home

You can take these measures at home to speed up the recovery:

• Rest. Avoid activities that cause pain, swelling or discomfort — but don’t give up exercising altogether! During the recovery, try low-impact, nonweight-bearing endeavors like stationary bicycling, swimming, or pool running. These will let you maintain a level of cardiovascular fitness. Don’t resume your former training routine until the fracture is completely healed, otherwise it will only prolong the pain. If the pain has you limping, consider using crutches until you can walk normally without pain.
• Elevate your injured toe as much as you can. Lift your foot above the level of your heart. Prop your foot up on a table or chair when you sit, and on a stack of pillows when you lie down. Rest your toe and do not exercise with that foot until the toe heals. Sometimes rest is all you need to treat a stress fracture.
• Do calf and anterior (front of) leg stretching and strengthening exercises twice a day.
• Apply an ice pack or cold pack to the swollen area. You can use a bag of frozen peas or corn for this. Be sure to put a thin cloth between the pack and your skin to avoid nerve damage and frostbite. Ice for 15-20 minutes at a time, at least three to four times daily or as often as hourly while letting your foot warm up to normal temperature between icing, until pain and swelling start to subside.
• Avoid walking barefoot. Wear proper shoes, one that is suited for your foot type, stride, and particular sports. Your doctor should be able to make recommendations.
• Consider taking acetaminophen (such as Tylenol) to relieve pain if necessary, but not ibuprofen (Advil, Motrin) and naproxen (Aleve) because some research suggests they can interfere with bone healing.

Professional Treatments

Rest is the key to the initial treatment of a stress fracture. The doctor may prescribe a walking boot or brace along with a cast or crutches for 6-8 weeks to help rest the injured area and limit the amount of weight-bearing.

Your rehabilitation may also include physical therapy to increase muscle strength and flexibility, which will also help prevent future injury.

Typically, after 4-6 weeks you can resume physical activities gradually, as long as they do not cause pain.

Surgical Treatments

Most stress fractures heal with time and rest. Occasionally, though, some fractures refuse to heal or displace. Such cases may require surgery. The procedure may involve pinning the fracture site, and rehabilitation can take up to a half year.

How to Prevent a Stress Fracture?

The best treatment of a stress fracture is prevention. Just follow these advices:

• Make changes slowly. Start any new exercise program or impact sport slowly and progress gradually. A good rule is never increase the intensity, time, or distance by more than 10% each week.
• Get proper nutrition. Eat healthy. Include foods that are rich in calcium, vitamin D, and other nutrients in your diet, especially if you are a female athlete.
• Use proper footwear. Make sure your shoes fit well and are appropriate for your activity.
• Build muscle strength in the legs with strengthening exercise to prevent them from tiring too quickly and enable them to absorb greater strain for longer time. Replace shoes when needed (usually every 300-400 miles for runners). If you have flat feet, ask your doctor about arch supports for your shoes.
• If pain or swelling begins, stop the activity immediately and rest for a few days. If pain persists, see a physician.

Ingrown Nails

A Condition in Which the Corner or Side of a Toenail Grows into the Flesh

What is an ingrown nail?

Ingrown nail is a painful condition that can affect the nails of the hand or feet, but occurs most often with the toenails. A toenail that is “ingrown” curves and digs into the skin at the sides of the nail, usually creating pain, redness, swelling, and heat, and often becoming infected. Interestingly, however, even when there is no pain, swelling, redness or heat, a nail that curves down into the skin can still progress into a serious infection.

What causes an ingrown nail?

Well, that depends on whose nail we’re talking about. Heredity can be a culprit — many people inherit the tendency for ingrown toenails. Other folks have nails that are just too large for the toe. And as far as toes are concerned, if yours is chubby or fleshy, it can be more likely to have a nail grow into it. Similarly, if your feet swell a lot, you can be more prone to having an ingrown toenail.

Other cases may result from an injury, such as something heavy falling on your toe — mom, watch those big tomato soup cans — or from just stubbing your toe, or going through the end of the shoes as sometimes happens during sports or other strenuous activities (have you seen some teenagers’ sneakers?). Certain repeated physical activities, such as kicking or running, can also put pressure on the toes, creating an injury by causing the nail to press into the flesh. Picking or tearing at the corners of the nails, or pressure from the toe next to the nail can also be a factor.

Most people’s ingrown nails result from improper trimming and cutting. Cutting the nail too short causes the skin next to the nail to fold over. Rounding off the tip or curving the nail can cause the nail edges to turn in. You may not even be doing this on purpose. As our eyesight begins to fail, or if we have trouble reaching our toes easily, or if our nails become too thick, it can be difficult to trim nails correctly.

Other physical conditions such as fungal or bacterial infections, lung disease, advancing age, poor circulation, bone spurs, and certain drugs can create nail abnormalities that cause the nail to curve.

Shoes that are too tight or press on the toenail — even tight socks and pantyhose — often create a problem, especially if your nails tend to curve. Ladies, how about those sleek high heel pumps with pointed toes, and your daughter’s cute flat little flats that smash from the top? Shoes that are pointed, too narrow, too short, or too shallow in the toe box (front) part of the shoe result in bunching of the toes and cause the nail to curl and dig into the skin.

Who gets ingrown nails?

About 5% of people in the United States develop ingrown nails at some point in their lives. These people are almost always adults. Ingrown nails are uncommon in children and infants, and more common in men that in women.

Young adults in their 20s and 30s are most at risk, but it is important to note that young people who wear ill-fitting shoes as their feet are growing and developing are also increasing their chances of ingrown nails.

What are the symptoms of an ingrown nail?

Pain is the most common symptom of an ingrown nail. When it’s at its worst, you can be sure that those little piggies won’t be going to market, or anywhere else. Ingrown nail pain ranges from a mild sensitivity to excruciating scream-your-head-off kind of pain — especially if you bump the affected toe, and the nail digs further into the flesh. The pain worsens with pressure, such as wearing tight shoes or even just the weight of a bed sheet.

Other common symptoms are redness and swelling at the corner of the nail and at the end of the toe. The area may feel warm to the touch. Later, as the nail continues to dig in and irritate, extra skin and tissue will grow around the sharp point and you may get yellowish drainage as well, or a watery discharge stained with blood. So even if you have no pain, if you have one of the three threats — swelling, redness, or heat — it’s time to act to head off infection.

If the area becomes infected — which it often does — the swelling will get worse, with white or yellow pus collecting and draining from the area. Red skin may surround a lighter-colored area. In a few cases, you may even develop a fever.

How do you diagnose an ingrown nail?

The doctor will assess your ingrown nail by asking you how it happened, and when it began — for example, if you were injured, what exactly happened to you (not a bowling ball!) and when it took place (when was your son’s birthday party?). He will also ask about any other medical problems you have, what medications you take, and the date of your last tetanus immunization. He will decide whether or not there is an infection present.

Besides examining your nail and foot in detail, the doctor may also check your temperature, pulse, blood pressure, lymph nodes in the groin, and in certain cases might also take an X-ray. If you have a severe infection, he may also perform blood tests, particularly if you are diabetic.

How do you treat an ingrown nail?

After the examination, your doctor will choose the treatment that is best for your particular situation. If there is no infection, he will give you instructions for treatment such as elevating the foot, warm soaks, proper shoes, and frequent cleaning.

The doctor may choose to use a splint — such as a cotton wick, plastic strip, or plastic tube — to protect your skin from that nasty sharp corner of the invading nail. Occasionally, he may try to file or cut the nail down the center in order to change the shape of the nail as it grows. To speed up the healing — since we want to get well and train for that marathon or shopping spree as fast as possible — he may also apply local anesthetic and remove the extra tissue that has grown around the inflamed area, just to get things moving a bit faster.

If necessary, a number of different minor surgical procedures can be used to ease the pain and remove the problem, almost all of which are done in the office under a local anesthetic. If the infection is extremely severe or if your physical condition or medical history warrants it, the doctor may choose to do the procedure in the hospital instead. He may also give you a tetanus immunization.

For the procedure, the doctor will apply a local anesthetic to numb the area, so you won’t feel a thing. He will then drain the infection and remove the extra tissue that has grown around the end of the nail. Next, he will cut along the edge of the nail where the skin is growing over, removing that portion of the nail so that the skin or infection can heal without the nail pushing on it. This procedure is called “partial nail avulsion.”

Sometimes a chemical may be applied to the skin under the nail, or the doctor may use lasers or extreme cold on the cells in the nail bed. This is done to keep the edge of the nail that caused the problem from growing back because we’d all rather not have to go through this again. For annoying persistent infections that insist on returning to bother us over and over, the nail root may have to be removed. A specialist may perform a procedure called a “lateral mastectomy” which removes a portion of the nail bed.

After surgery, the doctor will apply a bandage and give you instructions about what to do. You will need to keep your foot elevated for a few hours, and rest is recommended. Most people experience very little pain after surgery and you may go back to school or work or your normal activity the next day, but you will have to wait at least two weeks before you can start running or kickboxing or engaging in similar strenuous physical activities.

Your surgeon may prescribe antibiotic medication, and you will have to take all of it even if you have no symptoms. Wearing open toed shoes to avoid pressure on the area will help you to heal faster. It will take two to four months for the nail to grow out again.

Self-care at home

There are several simple and inexpensive home remedies you can take a stab at to relieve that stabbing in your toe, as long as your condition is not severe or while you are waiting to consult your podiatrist:

Soak the foot in warm water four times a day. You may add ½ cup of Epsom salts, which contain magnesium sulfate, a substance that reduces swelling and has antibacterial properties. This soak can provide soothing relief.

Cut a lemon in half. Put your toe in the lemon, and place a sock over your foot. Let this soak overnight. Lemon has antibacterial and antiviral properties.

For brittle nails, you can apply lip-moisturizing oil on your nails every night before bed, to make nails thinner and softer and easier to trim with clippers.

You can apply Orajel or any topical tooth pain reliever to numb the pain. However, remember that medications may help with the pain, but do not treat the problem.

Place a piece of fresh onion or a clove of garlic on the nail and bandage; leave on overnight. Onion and garlic have antimicrobial and antifungal properties.

Put your foot in a warm tub of salty water for ten to 15 minutes before cutting the nail.

Apply propolis tincture — bee harvested tree resin — which is thought to have antifungal and antibacterial properties that help heal wounds. However, people who are allergic to pollen should not use propolis tincture, since there is a small amount of bee pollen present in it that might cause an allergic reaction.

Wash the affected area twice a day with soap and water. Keep it clean and dry at all times.

Wear sandals — no high heels or tight-fitting shoes.

Over-the-counter antiseptics, such as peroxide or iodine, can be used to help minor infections.

Apply tea tree oil and lavender, which have antiseptic properties.

Soak the affected toe with five drops of calendula tincture diluted in 1 / 2 cup hot water for 15-30 minutes, then wrap the toe in linen cloth. Calendula is antiviral, anti-inflammatory and fights bacteria.

Never use a needle to pierce the swelling. Doing this can cause an infection or worsen one if you already have it.

How do you prevent an ingrown nail?

The first step toward healthy, pain-free stepping is to trim your nails properly. First soften them in warm water, then cut them straight across — but not so perfectly straight that they have sharp square corners that snag and feel uncomfortable. Do not cut your nails so short that you can’t get your fingernail under the sides and end of the nail. The most important thing to avoid is cutting the nail shorter than the flesh around it.

Don’t pay attention to the old wives’ tale about cutting a V-shaped wedge out of the center of the nail so the sides will grow toward the center and away from the edge. Nails have no regard for your intentions — they grow from back to front, even if you get whimsical and cut them with pinking shears (don’t even consider this).

The second step in prevention is to wear shoes that fit well, without pressing the top or the tip of your toe and nail. Make sure that your shoes are not so narrow that they force your toes to bunch up inside like sardines in a can, and check to see that there is no friction on your skin. Sandals are great to wear, but if you have an injured or infected toe, do not wear them in places that are covered with bacteria — such as city streets — or on uneven ground that increases your chances of bumps and cuts.

Believe it or not, the color of your socks can make a difference. If you have a wound or infection, colored socks have dyes that might leak into the injury and irritate it further. Wear white socks only, especially if you are allergic or sensitive to dyes. And for those of you who love pedicures, watch out — the tools that touch your feet should be sterilized before they come near you.

People with diabetes need routine foot exams and nail care. Diabetics are particularly at risk for ingrown nail infection, for two important reasons. First, their weakened immune systems make them more prone to contracting infections in general. Secondly, diabetics can develop nerve disorders that cause loss of sensation in the feet, so they may not suffer the painful warning signs that send most people running — or rather, limping — to the doctor.

For these reasons, people with diabetes — or anyone with numbness in the limbs — should be on the lookout for any redness around the toenails, and report it to their doctor immediately. Infected ingrown nails can develop into serious medical problems, including gangrene that can result in risk of losing a limb. Diabetics with thickened toenails should see a podiatrist to have their nails trimmed under antiseptic conditions.

Finally, although we do not yet have any specific diet against ingrown nails, eating healthful and nutritious meals that emphasize green leafy vegetables and fruits rich in folic acid can greatly assist and speed up the healing process.

Toe Fracture

Broken toe, compound fracture, displaced toe fracture, foot injury, foot trauma, metatarsal fracture, nail injury, open fracture, phalanx fracture, rotated toe fracture, stress fracture, subungual hematoma

What is a Toe Fracture?

Of the 26 bones in the foot, 19 are toe bones (phalanges) and the long bones in the midfoot (metatarsal bones). So, chances are good that when one of the bones breaks in a foot, it will be a toe.

A toe fracture is a break in a toe bone. Each toe is actually made up of several bones, and one or more of them may be fractured (broken) after an injury to the foot or toes. Fractures of the big toe can be much more serious than fractures of the smaller toes. Lesser-toe fractures where the bones are still aligned with each other (non-displaced fractures) usually heal successfully without many complications.

Toe fracture is a common injury that requires evaluation by a specialist. You should consult a foot-and-ankle surgeon for proper diagnosis and treatment, even if you already received initial treatment in an emergency room.

What Causes a Toe Fracture?

Because the toes are at the front of the feet, they are the most likely part of a foot to receive injuries. Almost all toe fractures happened from stubbing a toe or dropping a heavy object on a toe and crushing it. Sometimes when a toe is bent too far up or down, or the foot and toes are twisted, the trauma can cause the toe to break. Toes can also fracture after a fall or suffering a direct blow, while playing a sport, or when exercising.

Prolonged repetitive stress or movements, as in sports activities such as basketball, soccer, and running, may result in a broken toe. This is called a stress or hairline fracture.

Who Gets a Toe Fracture?

While no one is completely immune, these risk factors do increase your chance of developing a toe fracture:

• Advanced age: the older you are, the weaker your bone structures tend to be
• Decreased muscle mass: your bones become more exposed when there’s less muscle to cushion them
• Not wearing shoes: shoes provide protection against trauma that can fracture the foot or toes
• Osteoporosis: the thinning of bone tissue and loss of bone density from this disease makes the bones more brittle and breakable
• Participation in contact sports: rigorous physical competitions always increase the chance of an injury
• Poor nutrition: inadequate or unhealthy diet deprives the body of the calcium and other nutrients necessary for strong bones, thus making the bones easier to break upon impact

Are There Different Types of a Toe Fracture?

Fractures can be divided into two categories: traumatic fractures and stress fractures.

Traumatic fractures, also called acute fractures, occurred from a direct blow or impact, such as seriously stubbing your toe. Fractures of the toe bones are almost always of this variety. Traumatic fractures can be “displaced” or “non-displaced”. In a displaced fracture, the bone is broken in such a way that it has changed its position (i.e., dislocated).

Stress fractures are tiny, hairline breaks usually caused by repetitive stress. When athletes increase their running mileage too rapidly, for example, they often suffer this injury because their feet aren’t ready for the intense pounding. An abnormal foot structure, deformities, and osteoporosis can cause stress fractures, as can improper footwear. Do not ignore stress fractures, as they require proper medical attention to heal correctly.

What are the Symptoms of a Toe Fracture?

Moderate to severe pain over the fracture is the first sign. You may notice that pain lets up over a few hours and the toe starts throbbing and becomes swollen. The toe may hurt when you put weight on it or walk, especially if you’re barefoot, and you may not be able to bend or move it at all.

There may be bruises on the skin around the toe. The toe likely will not look normal — maybe even crooked, rotated in or out, or short compared to your other toes if you have a displaced fracture or a dislocation. If the big toe is fractured, the pain can make walking very difficult. You may feel numbness or loss sensation anywhere along the fractured toe, and develop a large, painful collection of purplish blood underneath the toenail. When you bend your toes or walk, you may feel crunching and grinding at the injured area, as well as tightness and increased pain, especially if the fracture is in a joint. As well, you can find the shoes painful to wear or a tight fit.

In addition, some other complications may develop, either immediately after the injury (minutes to days) or much later (weeks to years). The immediate complications include:

• Nail injury. This is in form of blood collecting underneath the toenail (called a subungual hematoma). If large enough, it will have to be drained, by a doctor making a small hole in the toenail to let the blood out. If the hematoma is very large or painful, the entire toenail may need to be removed.
• Open fracture. Rarely, the broken bone in a toe fracture may stick out through the skin. This is an open or compound fracture. Careful cleansing of the wound and possibly antibiotic medication are necessary to prevent the bone from becoming infected.

The later complications include:

• Arthritis, pain, stiffness, or even a deformity after the toe fracture heals.
• Occasionally, surgery may be called for to fix a fractures bone that would not heal completely (a nonunion), or healed improperly (a malunion).

How do You Diagnose a Toe Fracture?

It is not true that “if you can walk on it, it’s not broken,” so it’s best to seek medical evaluation of a foot specialist soon after injury to ensure proper treatment and healing. At the very least, the injured toe should be checked every day. Call a doctor immediately if any of the following occur:

• A cast or splint is damaged or broken
• Blue- or gray-colored skin
• Cold, numb, or tingling toes
• Bleeding, drainage, redness, sores, or open wounds near the injured toe
• Worsening or new pain not relieved by pain medication and conventional treatment

The doctor will ask about your symptoms, level of physical activity, how the injury occurred, and will examine the injured toe and possibly check for other injuries. X-ray is not always necessary to diagnose a broken toe, especially if the break is in one of the smaller toes.

Due to overuse or repetitive movement, stress fractures may require an MRI (magnetic resonance imaging) for diagnosis.

How do You Treat a Toe Fracture?

Treatment for a toe fracture depends on the injury’s location and severity. The doctor may need to put the fracture back into place and in a splint or cast. If there is an open wound near the injured toe, it can necessitate a tetanus shot and antibiotic medication.

Broken toes usually take about six weeks to heal. Simple fractures normally heal well without problems. A severe fracture or a fracture that goes into a joint, however, put you at risk for arthritis and perhaps even a deformity. Proper treatment can prevent these and other long-term complications with the toe joint, such as misalignment and immobility.

Self-Care at Home

You can take these measures at home to help decrease the pain and swelling, and help the fracture heal properly.

• Avoid putting weight on your injured toe by sitting until your symptoms improve or by using crutches. You can usually rent or buy crutches at a drug or medical supply store.
• Elevate your injured toe as much as you can. Lift your foot above the level of your heart. Prop your foot up on a table or chair when you sit, and on a stack of pillows when you lie down. Rest your toe and do not exercise with that foot until the toe heals. Sometimes rest is all you need to treat a traumatic toe fracture.
• Apply an ice pack or cold pack to the swollen area over your toe. You can use a bag of frozen peas or corn for this. Because the skin on your toes is very thin and the nerves are sensitive, put a thin cloth between the pack and your skin to avoid nerve damage and frostbite. Ice for 15-20 minutes at a time, at least three to four times daily or as often as hourly while letting your toe warm up to normal temperature between icing, until pain and swelling start to subside.
• “Buddy-taping” the fractured toe to another toe with cloth athletic tape or two small Velcro® straps is sometimes appropriate to stabilize the injured toe, though it does not work well if the injury is to your big toe. Put a small piece of cotton or gauze between the toes that are taped together to prevent the skin from developing sores or blisters. Use as little tape as necessary, loosely tape the broken toe to the healthy toe next to it, above and below the middle toe joint. If the toes are taped too tightly, it leads to additional swelling and can cut off circulation to the injured toe.
• Avoid walking barefoot. If you have only mild pain and swelling and are able to walk, wear a firm-soled shoe with a good amount of space for the toes to protect the injured toe and help keeps it in the proper position.
• You may consider taking a fast-acting anti-inflammatory medication such as ibuprofen (Advil or Motrin) for pain and swelling.

Professional Treatments

Professional treatment for a toe fracture depends on which toe is broken and the type of fracture. In any case, schedule an appointment with a doctor to evaluate the injured toe and make sure it is healing properly.

Options for professional treatments include:

• Ice, Elevation, and Rest. This follows the similar guidelines as for at-home care.
• Buddy Taping. The doctor may only need to tape the injured toe to the one next to it for support if the toe fracture is minor and in one of the small toes. It is usually safe to bathe and then replace the tape afterward, but check with the doctor to make sure.
• Casting. A cast is usually not required for a simple toe fracture, and a hard-soled, sturdy, supportive shoe may be used instead, or a specially customized shoe if the foot or toes are very swollen. You may need a cast if your big toe is broken, the fracture involves a joint, a lot of small fractures occur at once, or a bone in the foot or leg is also broken.
• Reduction. You may need this if your toe bone is displaced (the two ends of the broken bone are out of place) or rotated (the toe is pointing in the wrong direction). During this procedure, the doctor lines up the broken parts of bone so they can heal normally. If the toe bone is badly injured, you may need surgery.
• Medication. Antibiotics may be prescribed to help treat or prevent an infection. A tetanus shot may be given if you scratched or tore some skin to protect you against tetanus (the bacteria that causes lockjaw).

Surgical Treatments

Surgery is usually necessary only when the break involves a joint, several small toe fractures, or if a bone in the foot or leg is broken too. Sometimes it is needed for a broken big toe. Surgery often involves inserting pins and screws into your bone to keep the broken parts lined up and stabilized so the toe can heal correctly.

How to Prevent a Toe Fracture?

You can take these steps to help cut down the chance of getting a toe fracture:

• Wear shoes to protect your feet, and always wear well-fitted, supportive athletic shoes when performing physical activity.
• Eat a diet rich in calcium (leafy green vegetables, almonds, shellfish, etc.) and vitamin D (egg yolks, butter, fish oil) to maintain bone density and better resist impact.
• Do weight-bearing exercises to build strong bones.
• Build strong muscles to prevent falls.

Morton’s Neuroma

A Thickening of the Tissue Around a Nerve Leading to the Toes

What is Morton’s Neuroma?

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is Morton’s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot. The Morton’s Neuroma is also caused because the spot where the nerves meet inside the subcutaneous tissue is close to an artery and vein and is also above the fat pad of the foot. The thickening, or enlargement, of the nerve that defines a neuroma, is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Nerves can become entangled and bunched creating something resembling a benign tumor. The bunching of nerves is referred to as a neuroma. This syndrome occurs more often in women than in men.

What you actually feel with Morton’s Neuroma is a sharp, burning pain in the ball of your foot or a sting burning to feel in your toes. Your toes might even feel numb at times.

Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton’s Neuroma may also cause numbness, tingling, or cramping in the forefoot.

What Causes Morton’s Neuroma?

Anything that causes compression or irritation of the nerve can lead to a neuroma. One of the most common culprits is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box. As you walk, the ground pushes the inflamed nerve up, and the deep transverse metatarsal ligament down, causing compression.

Symptoms of Morton’s Neuroma often occur during or after you have been placing significant pressure on the area, while walking, standing, jumping, or sprinting. This condition can also be caused by footwear selection. Footwear with pointed toes and/or high heels can often lead to a neuroma. Constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain.

Who Gets Morton’s Neuroma?

The medical name for Morton’s neuroma is an intermetatarsal neuroma because it generally occurs between the third and fourth metatarsal toe bones.

Morton’s neuroma can also develop in other parts of the foot. In this condition, repeated irritation or compression of the plantar nerve leads to swelling or thickening of the nerve and, eventually causing nerve damage. The mass that grows between the metatarsals is noncancerous but can cause pain, numbness, a tingling or burning sensation, or the feeling that a small pebble is lodged under the ball of the foot.

What Are the Symptoms of Morton’s Neuroma?

If you have Morton’s neuroma, you may have one or more of these symptoms where the nerve damage is occurring:

Burning sensation: This inflamed feeling in the foot is one of the most common signs of Morton’s Neuroma.

Pain: The front pad on the bottom of the foot can become extremely sore at the end of a long day or after exercise. In severe cases, the pain may even occur while walking normally or even during rest. The pain can be accompanied by a feeling of numbness in your foot. The numbness may come with the pain or sometimes even before the pain comes in. In the case of Morton’s Neuroma, a session of night pain is usually rare. Pain attacks come generally when you move around more and especially when you are in tight shoes. The symptoms generally do not come all of a sudden. They progress quite gradually. It may first occur only when you are wearing uncomfortable shoes or undertaking on any overly aggressive activity.

Feeling of a stone in your shoe: or a sock bunched up in your shoe is quite common. Applying pressure to area can result in a sharp and immobilizing pain. Some studies have shown that Morton’s Neuroma may be just as painful as childbirth.

The symptoms begin gradually: At first you might notice pain or numbness only occasionally, most often when wearing narrow-toed shoes or performing certain activities The symptoms may go away temporarily by removing the shoe, massaging the foot, or by avoiding aggravating shoes or activities. Over time the symptoms progressively worsen and may persist for several days or weeks. The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

How do you Diagnose Morton’s Neuroma?

To arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor will attempt to reproduce your symptoms by manipulating your foot.

Physical exam: Morton’s neuroma is diagnosed by palpating the area and pressing the toes from one side to another in order to re-create the pain symptoms you are experiencing.

X-ray: The doctor will likely request an x-ray to rule out fractures and other causes such as arthritis.

MRI scan: May also be requested to rule out tumors and determine the size of the neuroma. The MRI also helps the doctor decide if surgery is necessary or not.

How do you Treat Morton’s Neuroma?

In developing a treatment plan, your foot and ankle surgeon will first determine how long you’ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.

Conservative Treatments

• Padding: Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
• Icing: Placing an icepack on the affected area helps reduce swelling.
• Orthotic devices: Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.
• Activity modifications: Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
• Shoe modifications: Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
• Medications: Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
• Injection therapy: Treatment may include injections of cortisone, local anesthetics or other agents.
• Self-care at Home
• Anti-Inflammatories Over the counter medications like Advil or Aleve or herbal anti-inflammation pills can help relieve pain and pressure. Make sure you are healthy enough to take these medications as they carry their own risks also.
• Ice. Ice can reduce swelling and dull pain. Freeze a water bottle and roll that over your foot for 20 minutes three times a day. This massaging action can help stimulate tissue as well
• Get New Shoes. Stop wearing shoes that have raised heels. Also, shoes must have ample room in the toes and not be confined at all. So flat shoes with wide widths would be perfect.
• Try an Arch Support or Shoe Insert – Custom arch supports may relieve the pressure on the nerve by supporting the other parts of your foot and reducing pressure. Some physicians also recommend a metatarsal pad or bar. Over the counter shoe inserts can also be effective for pain.
• Rest – Reduce your physical activities greatly and rest your feet and legs. Stop dancing, running, jogging, or anything that is high impact on your feet

Types of Morton’s Neuroma Surgical Treatments

Morton’s Neuroma is a common disease entity of foot. It is seen to have a presence in females more than males. Though there are conservative lines of treatment available for the same, the Morton’s Neuroma can be best solved only by surgery in some cases. Conservative treatment may fail to give relief to some patients with increased difficulties. In such cases, there is an option of two lines of surgery the patient could be asked to undergo.

Dorsal Surgery: An incision is made on the upper part of the foot, cutting the deep transverse metatarsal ligament to relieve the nerve block. A dorsal approach may cause forefoot instability, however. The good part of this surgery is that the patient does not need to use any support to walk after this surgery. This procedure will also leave the healthier tissue for secondary surgery, in case it may be required. Dorsal surgery may lead to instability in the foot that may require additional surgical treatments in the future.

Plantar Surgery: An incision is made on the sole of the foot to repair the damage. The surgery requires weeks of healing and keeping weight off of the bottom of the foot. There may be discomfort from the scars on the sole of the foot. However, this method of surgery is still more often recommended than dorsal treatment, as it allows better access to the neuroma and helps to make resects without cutting any structures in the process.

Prior to Surgery

You are about to have surgery. As you may already know, nutrition plays a very important role in proper healing. One of the most important benefits of proper nutrition is maintaining the right pH balance in your body. pH is the measurement of acidity and alkalinity. pH ranges are from one to fourteen with fourteen representing most alkaline. Seven is neutral. The most optimal pH level for humans is slightly more alkaline than acidic at around 7.36.

Undergoing surgery can increase acid levels in the body. Emotional and physical stress from both the surgery and recovery time changes your metabolism, which increases acid production. The use of both general and local anesthesia, pain medication, anti-inflammatory medications and other medications such as antibiotics will also introduce more acid to your system, lowering the alkalinity. This will delay healing and prolong recovery time.

To maintain your body’s proper pH, keep yourself well hydrated prior to and after surgery. Water helps to dilute the acid build up in your body and release it through urination. Eating alkaline rich foods such as dark, leafy green vegetables will add alkalinity. Avoid acidic foods such as meats, fried foods, coffee (and other caffeinated drinks), carbonated beverages, cigarettes, and alcohol.

Other pre-operative considerations:

• Many people may need medical clearance through their Primary Care Physician, especially if taking medications such as Coumadin.
• Stop using anti-inflammatory medication five to seven days before surgery. These include aspirin, ibuprofen (Advil), and naproxen sodium (Aleve).
• Arrange for a ride home from surgery and for someone to look after you for at least the first 24 hours.
• Avoid long trips for at least two weeks after surgery.
• Avoid eating and drinking anything after midnight the night before surgery.

Day of Surgery

Most foot and ankle surgeries are day surgeries, which means you will go home the day of surgery. You will generally be given a local anesthetic and anesthesia. After surgery, you will receive pain medication and care instructions.

Post-op Recovery

• The best results and quickest healing is achieved when patients follow after surgery instructions.
• Keep your foot elevated as much as possible for the first week after surgery.
• Keep your foot dry for at least 2 weeks after surgery.
• One week after surgery you will have your dressing changed by coming to see your attending physician.
• The sutures will be removed after the second week.
• Your doctor will advise you when you can increase weight and activities on the foot.
• Take pain and anti-inflammatory medications as prescribed by your physician.
• Vitamin C is important to heal scar tissue. It is vital in aiding in collagen formation. Take 4,000 mg spread out over each day in 500 mg doses taken for several days to several weeks after surgery.
• Omega 3 fatty acids, such as flax or fish oil, vitamin A and beta-carotene aid in the skin healing and lessen the appearance of scars.

How to prevent Morton’s Neuroma?

Change your footwear, opting for shoes that do not compress the feat. Wear high toe box and wide shoes to prevent pressure, which will cause the deformity. Avoid wearing tight-fitting, narrow or pointed toe shoes, such as women’s high heels or pumps.

Rest, stretch and massage your feet regularly, especially after spending a long time in shoes or athletic activity, to take pressure off of the foot and the nerves.

Wear foot pads, which will raise and spread the bones of the forefoot taking the pressure off the nerve. Treat existing foot problems such as high arches or flat feet. Padding and orthotics for these conditions can prevent the development of Morton’s neuroma.

Regularly visit your podiatrist to ensure proper foot health.

What is a bunion?

A bunion (from the Latin “bunio,” meaning enlargement) is a protuberance of bone or tissue around the joint. A bunion is one of the most common foot problems. Your big toe does far more work than the lesser toes. Every time you take a step, the big toe supports most of your body’s weight. It is indispensable to foot movement, and problems with it can make walking or even stand painful.

A deformity of the big toe joint, bunions are usually visible as a “bump” on the inside of the foot just behind the big toe, ranging in size from hardly visible to the size of a quarter or half-dollar. The bony bump can be accompanied with bursitis which is a “cushion” created by the body to protect the affected area from excessive pressure or friction.

This deformity can cause a deviation of the big toe as it moves toward the second toe, sometimes underlapping the second toe. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion’s “bump.”

Bunions are a progressive disorder and can be degenerative, most often caused by an inherited faulty mechanical structure of the foot.

They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent.

In addition to causing pain and discomfort, the changes bunions make to the shape of your foot, can make it harder to find shoes to wear, and in severe cases can make walking extremely difficult.

What causes a bunion

Bunions are a common problem usually affecting women. The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by improper fitting shoes. Tight, narrow dress shoes with a constrictive toe box can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Women who have bunions normally wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot.

Bunion pathology is also related to foot structure and function both of which are inherited features.

Feet that have a tendency to excessively pronate cause an over-flattening of the foot. This excessive flattening causes tension on the extensor hallucis tendon (the tendon on the top of the foot that enables you to bend your big toe upwards). This causes the tendon to “bowstring” and in doing so forces the big toe to be pulled laterally, toward the second toe. This is what causes the initial deviation.

Over time, there is a retrograde (or backward) force placed on the first metatarsal bone by the big toe and the first metatarsal bone begins to move medially (or away from the second metatarsal bone). Due to these changes, there is now more pressure on the side of first metatarsal bone from shoe pressure and this causes a hyperostosis or thickening of bone and this results in the formation of a bunion deformity.

Excessive rubbing of the bunion against the top of the shoe can lead to pain and the development of acorn. The tip of the toe is often turned down against the shoe causing pressure and discomfort.

Arthritis can also lead to deformities including bunions. Bunions can cause extreme discomfort and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.

Who gets a bunion?

Women who spend a lot of time wearing tight or ill-fitting shoes are most often susceptible to bunion. Tight fitting shoes cause muscles to lose their function for straightening the toes. Wearing tight shoes for long periods of time can also shorten the tendons and over time the muscles will not be able to fully straighten on their own, forming bunions.

Bunion deformities are also often caused by the biomechanical functions of the foot and hereditary conditions such as flat foot, high arch and pronation, which can put excessive stress on the joints causing the buckling.

Are there different types of bunions?

If your big toe bends up to fifteen degrees toward your second toe, it is considered normal. Once the angle is more than fifteen degrees then it is considered hallux valgus. Bunions can start out mild and progress to severe. Unfortunately there is no way of predicting how rapidly a bunion will progress or worsen. The severity of the symptoms will vary. You and your podiatrist must determine what treatment is best for you.

There are three types of bunions:

Mild: New bone growth stretches and stresses the joints, pushing the big to towards the lesser toes. The inside tendons tighten, pulling the big toe farther out of alignment. Mild or beginning bunion deformities should be observed to determine the rate of progression of the deformity. It is beneficial to perform corrective surgery early on before the deformity becomes severe. This will avoid a more involved surgery with a longer recovery necessary for the severe deformity.

Moderate: Most bunions fall into this category. At this stage of deformity, it is difficult to find shoes that fit comfortably, due to the difference in the width of the forefoot compared to the width of the heel. If the shoe fits in the forefoot, the heel of the shoe will typically slip up and down. If the heel is fitted properly, the forefoot is cramped.

Severe: When the angle between the bones of the first and second toes is greater than normal (more than fifteen degrees), the big toe slants toward the lesser toes. In severe cases, this may also cause the second and third toes to buckle. Severe bunion deformities require surgery at the base of the metatarsal. Because of the severity of the deformity, the location of the osteotomy (cut in the bone), patients are not allowed to walk on the operated foot for several weeks. Crutches, cast, and sometimes a wheelchair is needed during the recovery period.

What are the symptoms of bunions?

• Deformed shape: Bunions exhibit a deformed bumped curve at the joint of the big toe, pushing the toe towards the lesser toes.
• Redness: Redness and tenderness at site location or inside of the foot at the big toe joint are also usually present.
• Pain and tenderness: There will commonly be a pain in the toe joint and difficulty wearing shoes, sometimes causing difficulty walking, cramping in toe, foot and leg. The bursa (fluid-filled sac) on the inside of your foot at the big toe joint may also become painful and tender to the touch.
• Swelling: Inflammation may be present on the inside of the foot at the big toe joint.
• Numbness: Tingling, burning or total numbness in the big toe (hallux).
• Immobility: Decreased motion at the big toe joint.
• Corn: A corn can develop in between the big toe and second toe from the pressure caused by the bunion moving the toes.
• Callous: formation on the side or bottom of the big toe or big toe joint Callous under the second toe joint

How do you diagnose bunions?

To diagnose bunions, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a bunion.

Pathological exam: Direct observation of the bunions, typically makes the diagnosis. Your doctor will ask you questions about the symptoms you are having while examining your foot. You may also be asked to stand and walk barefoot to further assess your foot function. Bunions are usually termed mild, moderate or severe.

X-rays: May often be necessary to get a better understanding of the deformity and what the best type of treatment is. The podiatrist will measure angles between the bones to help determine the stage of the bunion.

How do you treat bunions?

• Foot problems causing pain should be given prompt attention. Ignoring the symptoms can aggravate the condition and lead to a breakdown of tissue, or possibly even infection.
• Conservative Treatments
• Padding: A doctor may fit your foot and show you how to properly pad it to reduce friction and minimize pain.
• Corticosteroids: Injections of cortisone steroids may be administered at an office visit if the bursa sac is excessively inflamed. Corticosteroids can suppress inflammation, reducing pain and easing discomfort.
• Functional orthotics: prescribed and cast by your doctor are designed to relieve pressure within the big toe joint.
• Shoe Therapy: including supportive shoes or modifications for your foot type and activities.
• Activity modifications: By avoiding strenuous foot activity, you may be able to slow the development of bunions and bring relief to those already formed.
• Injection therapy: Corticosteroids may help in treating an inflamed bursa, but because of the risks of further damaging the foot, injections are not most commonly recommended.

Self-Care at Home

• High Toe Box Shoes: To prevent further irritation to the toe, shoes with a high and broad toe box (toe area) are recommended. Shoes such as Crocs, clogs or Birkenstocks may be enough of a change to allow pain free walking.
• Icing: Treat the affected area with ice packs daily by raising the feet above the heart, resting them comfortably and gently massaging with an ice pack or even a bag of frozen vegetables can work. It is best to ice 15 minutes at a time with a 15-minute break in-between.
• NSAIDS: Take over the counter medications such as ibuprofin or acetaminophen to reduce inflammation and manage pain.
• Foot Spacer: The doctor may recommend you use toe/foot spacers to prevent underlapping.

Surgical Treatments

• Who should have bunion surgery?
• If a deforming or potentially deforming bunion has been determined by your podiatrist (by clinical exam /x-rays).
• You have a bunion but your podiatrist feels conservative care is not working.
• Bunions prevent normal daily activity. Shoes no longer fit properly or excessive pain is involved.

Types of bunion surgery

Different people will respond to different types of surgeries. Some procedures allow you to walk much sooner and avoid crutches, but run an increased risk of the bunions returning. Other procedures may require crutches for a few weeks, but may offer longer lasting results.

Head osteotomy procedures (around the great toe joint): the bone is cut and the head of the metatarsal moved over to correct the bunion. Various types of bone cuts can be performed depending on the necessary correction. Some cases of flexible bunions will respond to a release of the flexor tendon. This procedure releases the tight tendon allowing increased range of motion. The procedure may be performed in office or as an outpatient procedure. Head procedures are usually performed for mild to moderate bunions, or for patients who cannot be off their feet for any length of time. Typical healing time can vary from several days to several weeks. Return to a loose fitting shoe such as a tennis shoe would begin approximately 3-4 weeks.

Base osteotomy procedures (near or at the joint behind the great toe joint): Base procedures are commonly indicated for a moderate to severe bunion. They are performed around the base of the bone behind great toe (the 1st metatarsal). Base procedures can involve cutting a wedge shape out of the bone, a crescentic osteotomy, which involves making a semi-circle cut and rotating the bone, and Lapidus bunionectomy—fusing the joint behind the big toe joint. Once realigned, the bone is held in place with surgical pins.

Prior to Surgery

You are about to have surgery. As you may already know, nutrition plays a very important role in proper healing. One of the most important benefits of proper nutrition is maintaining a right pH balance in your body. pH is the measurement of acidity and alkalinity. pH ranges are from one to fourteen with fourteen representing most alkaline. Seven is neutral. The most optimal pH level for humans is slightly more alkaline than acidic at around 7.36.

Undergoing surgery can increase acid levels in the body. Emotional and physical stress from both the surgery and recovery time changes your metabolism, which increases acid production. The use of both general and local anesthesia, pain medication, anti-inflammatory medications and other medications such as antibiotics will also introduce more acid to your system, lowering the alkalinity. This will delay healing and prolong recovery time.

To maintain your body’s proper pH, keep yourself well hydrated prior to and after surgery. Water helps to dilute the acid build up in your body and release it through urination. Eating alkaline rich foods such as dark, leafy green vegetables will add alkalinity. Avoid acidic foods such as meats, fried foods, coffee (and other caffeinated drinks), carbonated beverages, cigarettes and alcohol.

Other pre-operative considerations:

• Many people may need medical clearance through their Primary Care Physician, especially if taking medications such as Coumadin.
• Stop using anti-inflammatory medication 5 – 7 days before surgery. These include: aspirin, ibuprofen, Advil and Aleve.
• Arrange for a ride home from surgery and for someone to look after you for at least the first 24 hours.
• Avoid long trips for at least two weeks after surgery.
• Avoid eating and drinking anything after midnight the night before surgery.

Day of Surgery

Most foot and ankle surgeries are day surgeries, which means you will go home the day of surgery. You will generally be given a local anesthetic and anesthesia. After surgery you will receive pain medication and care instructions.

Post-op Recovery

• The best results and quickest healing is achieved when patients follow after surgery instructions.
• Keep your foot elevated as much as possible for the first week after surgery.
• Keep your foot dry for at least 2 weeks after surgery.
• One week after surgery you will have your dressing changed by coming to see your attending physician.
• The sutures will be removed after the second week.
• Your doctor will advise you when you can increase weight and activities on the foot.
• Take pain and anti-inflammatory medications as prescribed by your physician.
• Vitamin C is important to heal scar tissue. It is vital in aiding in collagen formation. Take 4,000 mg spread out over each day in 500 mg doses taken for several days to several weeks after surgery.
• Omega 3 fatty acids, such as flax or fish oil, vitamin A and beta-carotene aid in the skin healing and lessen the appearance of scars.

How to prevent a bunion?

Wear comfortable, wide shoes to prevent uneven or excessive pressure on the foot.

Avoid wearing tight-fitting, pointed toe shoes, such as women’s high heels or pumps as these will cause your foot to stay in an unnatural shape for too long, which can increase the risk of developing bunions.

Treat and prevent bunions at the onset to reduce the risk of them causing deformity. This is key to your foot health. See a podiatrist right away and make any necessary changes to your footwear and activity.

Treat foot irregularities such as flat feet or high arches as they may also contribute to the development of bunions by affecting how shoes wear on your feet.

Regularly visit your podiatrist to manage your foot health.

What is a fungal nail?

A fungal nail is an infection caused by nail fungus. The fungus is a plantlike organism that reproduces by spores. When the fungus is in a fingernail or a toenail, the nail may appear as thickened or discolored. The most common form of fungal nail often starts as a discolored area at the corner of the big toe, slowly spreads toward the cuticle until the toenail eventually becomes thickened and flaky. Fungal nails are more common in the feet than the fingers.

What causes fungal nails?

Even though you will hear that fungi (many fungi) are everywhere, fungi that are a problem for our fingers and toes thrive in warm moist areas like sweaty feet, shower floors, locker rooms, and swimming pools. No studies prove that these places are the source of the fungus causing fungal nails, but the environment compels good hygiene such as spraying footgear, changing socks, avoiding bare feet on athletic floors and daily washing of the feet. Preventing the nails from “breathing” comfortably can also encourage the environment for fungal nails so tight shoes (keeps the toes warm and moist), nail polish and acrylic nails can make the nails more susceptible to fungal infection. Poor hygiene, exposure of exposed nails to warm moist environments, and preventing nails from breathing can all be causes of fungal nails. Toenail fungus is caused by a group of fungus call dermatophytes. They feed on the keratin that makes up the surface of the toenail. When the feet are allowed to remain in sweaty socks or the fingernails are constantly under acrylic nails, the nails are susceptible to breeding fungus.

Who gets fungal nails?

Everyone can get fungal nails. But men over 40 seem to be most susceptible according to studies. Toenails are affected more than fingernails. People who frequent public swimming pools, gyms, or shower rooms ; people who perspire a lot; people with skin or nail injuries; people who wear closed in footwear, are all susceptible to fungal infection. If you have decreased immunity or an abnormal pH level, the opportunity to contract a nail fungus is increased. Nail fungus is not highly contagious. It is not uncommon for more than one person in a household to have nail fungus, but that is because the condition is so common, not because it is contagious. Person to person transmittal requires prolonged intimate contact.

Are there different types of fungal nails?

There are several different types of fungal nails. Trichophyton rubrum: This type tends to infect the skin, starts at the end of the nail and raises the nail up and is the most common. It may first appear as a discolored spot near the corner of the nail and slowly spreads toward the cuticle until the nail becomes thickened and flaky. Proximal subungal onychomycosis: This is the least common type of fungal nail and starts at the base of the nail (cuticle) and slowly spreads toward the nail tip. This form of fungal nail most often occurs in people with a damaged immune system. Yeast onychomychosis: This is a yeast based fungal infection, different that #1 above. It is often in fingernails and is the most common cause of fungal infections in fingernails causing a yellow, brown, white, or thickened nail.

What are the symptoms of fungal nails?

Several factors help identify a nail problem as fungal. Changes in the look of the nail: Nail changes are the primary symptom of fungal nails. These include brittleness, changes in nail shape, crumbling of the nail, debris trapped under the nail, discoloration, loosening of the nail, loss of luster and shine, and thickening of the nail. Nail odor: Fungal nails may also emit a foul odor which will make you want to address the problem. Inflammation and pain: When ignored, fungal nails can lead to inflammation and redness or pain with walking and wearing shoes affecting your day to day life. The inflamed area may drain pus.

How do you diagnose a fungal nail?

Looking tells a lot. Brittleness Changes in nail shape Crumbling of the nail Debris trapped under the nail Discoloration Loosening of the nail Loss of luster and shine Thickening of the nail are all conditions indicating nail fungus? Symptoms will determine if the nail should be scrapped for a culture, or a microscopic examination may be conducted to identify the type of fungus. The two most common diagnostic tests are KOH and fungal culture. The KOH test can be performed quickly while the fungal culture takes 3-4 weeks, but has the advantage of identifying the exact fungal organism.

How do you treat a fungal nail?

A range of treatment is available for fungal nails, ranging from home remedies to cutting edge medical intervention. Self-care at home

• Vinegar is often recommended for home treatment but its effectiveness has not been proven or disproven by a medical study. Mix equal parts water and apple cider vinegar and soak your toenails for 15-20 minutes. Wash and dry the area thoroughly. Remove dead skin by making a paste of ground rice flour with a few spoons of apple cider vinegar. A mixture of equal amounts of olive oil and lemon juice massaged into the foot will help keep the skin soft and control the infection.
• Tea tree oil is considered a potent natural antiseptic and fungicide. Apply undiluted tea tree oil with olive oil to the affected nail or rub in small amounts on the nail daily.
• Equal parts of tea tree oil, thyme oil and olive oil can be applied to the affected nail, allowed to remain for 10-15 minutes and then gently scrubbed using a toothbrush or small brush to ensure that the oil covers the nail completely and gets under the nail. This also helps gently remove the uppermost layer of the nail which usually contains most of the fungus. The tea tree remedies must be used for several weeks even after the infection appears to have cleared because the fungus is likely embedded deep within the nail.
• Equal amounts of tea tree oil and lavender oil applied to the infected area with a cotton swab 2 or 3 times a day will help fight the infection and prevent skin irritation. Warm these oils before using them to increase the amount of oil absorbed by the skin. Apply daily. Woolen socks over the mixture at night can help increase the effectiveness of this treatment by trapping body heat.
• Two drops of oregano essential oil blended with a teaspoon of olive oil on the affected area daily for not more than three weeks can also be used to treat the fungal infection. Oregano essential oil has antiseptic, antibacterial, antiparasitical, antiviral, analgesic and antifungal properties.
• Listerine mouthwash. This is a powerful antiseptic reported to leave the toe nails looking healthy because it contains several compounds and alcohols like alicylate thymol and euchalyptol which together form a strong toenail fungus treatment. Mix with a natural acid like apple cider vinegar or undiluted lemon juice to increase the effectiveness of the treatment since the acid retards the growth of fungus to prevent it from spreading. Soak your feet for 20 minutes or so in an equal amount of vinegar/lemon juice and mouthwash at least once a day. Or every day you can simply paint your nails with the mixture, or soak a wad of cotton and wrap it in place for about 45 minutes followed by a toe scrub with a small amount of the solution.
• Vinegar, hydrogen peroxide and baking soda are mixed together in equal quantities. The nail is filed thoroughly. Wet a cotton ball with alcohol and squeeze the alcohol out and then apply large amounts of the mixture to all toes with particular attention to the infected toes. Repeat three times and then allow the toes to dry (about 5 minutes) without touching. Apply Vicks vaporub heavily until it disappears and between the toes as well. Repeat twice a day and within 72 hours you will begin to see results.
• Isopropyl alcohol (91%) applied with a Q-tip to the area where the nail and skin meet and under the nail as best as can be accomplished. Do this twice each day. Nails are reported to resume their normal pinkish color. However, when the alcohol was discontinued, the fungus was reported to return.
• Garlic crushed and applied to the nail can be left as long as you want and is completely natural.
• After any topical treatment, make sure you wash and dry the affected area thoroughly. There are no studies to support the effectiveness of these at-home treatments.

Over-the-counter treatment

It is generally accepted that over-the-counter creams and ointments generally do not help treat fungal nails. Nails are just too hard for the kind of penetration that would be needed for a cream or ointment to work. A medicated nail lacquer called Penlac (generically ciclopirox) is available to treat finger and toenail fungus. However, it only works about 7% of the time.

Professional treatments

• Oral antifungal medications
• Nails grow slowly. It may be 9 to 12 months before you really know if treatment has been successful because that is how long it takes the nail to grow out.
• Like most oral medications, oral antifungal medications have significant side effects and may interact with other medications you are taking. Talk to your doctor. Periodic lab tests must be performed during the time you are taking this oral antifungal medicine.
• Lamisil (generically known as Terbinafine) is 70%-90% effective when used as prescribed. It reacts with caffeine and cimetidine. Generally, the dosage is 250 mg and is taken for 6 weeks for fingernail infections and 12 weeks for toenail infections.
• Sporanox (generically known as Itraconazole) and is also 70%-80% effective. Since this drug reacts with many other medications, it should be taken with food. It can be taken once a day in a 200 mg dose for 6 weeks for fingernails and 12 weeks for toenails or 200 mg twice a day for one week per month for 2 or 3 months.
• Fulvicin, Grifulvin, Gris-Peg (generically known as griseofulvin) has been the mainstay or oral antifungal treatment but is not very effective against toenail fungus.
• Diflucan (generically known as Fluconazole) is not FDA approved liked Lamisil and Sporanox but studies show that it is effective. The advantage of this drug is that it only needs to be taken weekly in a dose of 450 mg. Studies show it is 72%-89% effective.
• The oral prescriptions are often associated with potentially severe side effects including liver damage which is why many people look to home remedies for treatment.

Medical Intervention

• Laser treatment
• Of all the treatments of fungal nail infections, this seems to be the most promising. The laser light destroys the fungus in the nail bed. Each treatment session lasts approximately twenty minutes and requires about three sessions.
• Noveon-type laser treatment has proven to be quite effective as a cure for toenail fungus. It is the kind of laser treatment used for some cataract surgery and has proved to be both effective and painless.
• Pinpointe laser treatment has not yet developed an adequate library of evidence showing it to be both effective and harmless since there is some concern that the Pinpointe toenail treatment can cause burns to the surrounding tissue.
• Nail removal
• When other remedies have not been successful, it may be necessary for the health care provider to remove the nail. Because nails grow slowly, it may take up to a year to know if treatment is successful since it takes that long for a clear nail to grow in.

How to prevent fungal nails?

• Help your body fight the infection with a healthy diet. Probiotics (healthy bacteria) such as yogurt and kefir will help your body get rid of the fungus. Reduce sugar intake, dairy products and vinegar. Diet doesn’t cause fungal nails, but a healthy diet can significantly improve the effectiveness of treatment by strengthening your immunity and minimizing susceptibility to infection. Olive leaf extract is an excellent internal anti-fungal agent.
• Protein is an important constituent in the nails. Incorporate lots of fruit and raw vegetables in your diet, maintain good water intake and be certain to consume sufficient vitamin A (to help the body process protein), vitamin B (to help strengthen nails), vitamin C (to prevent hangnails) and vitamin D (to absorb calcium and prevent dry and brittle nails).
• Good general health and hygiene are the first steps in preventing fungal infections. Wash your feet frequently and dry between your toes. Ingrown nails are not necessarily symptomatic of fungal nails, but failure to care for the problem can cause the ingrown nail to develop into a more serious problem.
• If you come in contact with any fungal infection, wash and dry your hands thoroughly.
• Avoid bare feet in gyms and public showers (wear flip flops!
• Don’t share footwear
• Use an antifungal powder inside your shoes.
• Wear cotton socks.
• Keep your nails trimmed in a straight line with edges smoothed with a nail file and avoid polish.

Summary

Fungal nails are discoloration and brittleness in the finger or toenails occurring most often in men over 40. There are no specific causes for the condition, but warm moist environments will allow the fungus to grow as will tight or closed environments around the nails. Many home and commercial remedies are available to the person suffering from the fungal nail. But treatment and prevention are both improved by a healthy diet. Eat well and care for your fingers and toes. They, in turn, will provide you with excellent agility, mobility, and support!

What is a Mallet Toe?

Mallet’s toes are found in the DIPJ (distal interphalangeal joint) of the lesser four toes. Those four smaller toes are like fingers, with three bones separated by joints (the big toe has only two bones). Mallet’s toes occur when the joint at the end of the toes (nearest the nail) cannot straighten because of strain or injury, causing the toe to bend out of shape looking like a mallet. A mallet toe diagnosis is indicative of the joint at the very end of the toe buckling, while a claw or hammer toe diagnosis involves abnormal positions of all three joints. The affected toe may be either flexible or rigid. If you are suffering from a mallet or claw toe, it is most likely visibly deformed. There is often a pain in the toe, and you may have difficulty wearing certain shoes, notice discomfort when walking and experience pain in other parts of the foot. In some cases, a blister-like bursa forms over the joint, which can become inflamed causing bursitis. Excessive rubbing of the mallet toe against the top of the shoe can lead to more pain and the development of acorn. The tip of the toe is often turned down against the shoe causing pressure and discomfort. Mallet toes can cause extreme discomfort and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.

What Causes Mallet Toes?

Your toes bend and straighten by the use of two muscles. The most common cause of mallet toes is shoes that force the toes to stay in a bent position for too long, restricting the muscles’ ability to flex, and tendons to shorten, causing tightening and making it more difficult to straighten the toe. Compressive women’s footwear is the most common shoe culprit. Arthritis can also lead to mallet toes by causing inflammation in the joints, which prevent proper movement of the tendons and muscles. There are some inherited foot defects such as flat feet and high arches that will put excessive strain on the muscles and tendons making them more susceptible to mallet deformity. Diabetes is often a cause of mallet toe. Twenty-five percent of diabetics will develop foot problems. Diabetic foot conditions arise from poor circulation and neuropathy, which can cause the muscles to become bent in mallet toe formation. Neurological conditions that affect nerves and muscles, such as strokes, cerebral palsy and degenerative disc disease can also cause mallet toes, as can circulatory issues such as peripheral arterial disease. Being bedridden for any length of time can contract the muscles if they’re not being used, causing mallet toes to form. A broken bone in the toe or foot may heal improperly or cause damage to the muscle, tendon or joint, forming a mallet toe.

Who Gets Mallet Toes?

Women who spend a lot of time wearing tight or ill-fitting shoes are most often susceptible to mallet toes. Tight fitting shoes cause muscles to lose their function for straightening the toes. Wearing tight shoes for long periods of time can also shorten the tendons and over time the muscles will not be able to fully straighten on their own, forming mallet toes. Mallet toe deformities are also often caused by the biomechanical functions of the foot and hereditary conditions such as flat foot, high arch and pronation (turning inward), which can put excessive stress on the joints causing the buckling. People who have broken their toe run the risk of developing a mallet toe. People suffering from arthritis, brain, spinal cord or nerve injuries such as stroke, cerebral palsy and degenerative disc disease, poor blood circulation, diabetes and People suffering from injuries such as broken toes are at an increased risk of developing a mallet toe.

Are There Different Types of Mallet Toes?

Deformed shape: Mallet toes exhibit a deformed, bulbous curve at the end of the toe, causing a mallet-like appearance. Pain and stiffness: There will commonly be a pain in the toe joint and difficulty moving the toe, sometimes causing difficulty walking. Cramping and pain in other toes, areas of the foot and the leg are often reported. Pain is also often present on the ball of the foot, which compensates for the toe. Corns and calluses: The misshaped toe can often begin rubbing against the inside of your footwear causing rough patches of skin forming corns and calluses on the top of the toe. They may also form at the end of the toe. In more severe cases, corns can form on the sole of the foot from the pressure of the mallet toe. Infections and Ulcers: Common in diabetic cases of mallet toe, ulcers and infections may be present on the affected toe.

How do you Diagnose Mallet Toes?

To diagnose mallet toes, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a mallet toe. Pathological exam: Observing the mis-shaped mallet toe typically makes the diagnosis. The doctor will ask questions about the pain or discomfort if there is any difficulty wearing shoes and may want to watch you walk on the foot. X-rays: Often your doctor will determine that x-rays may be necessary to get a better understanding of the extent of the deformity and what the best treatment is for the affected toe. This is more common with rigid mallet toes that may be a candidate for surgery.

How do you Treat Mallet Toes?

Forefoot problems causing pain should be given prompt attention. Ignoring the symptoms can aggravate the condition and lead to a breakdown of tissue, or possibly even infection. Treatment may take considerably longer to effect a cure, if it is not possible for you to avoid the causes of your mallet toe, such as neurological disorders. Additional causes, such as pressure and friction on the foot may also make it more difficult to heal a mallet toe.

Conservative Treatments

The first method of treating mallet toes begins with accommodating the deformity. The goal is to reduce friction and relieve pressure on the sensitive area. Padding: Prescribed gel pads from your doctor can help prevent irritation to corns and calluses that have developed from the mallet toe. Over-the-counter pads are also available. New Shoes: Avoiding shoes with pointed toes or high heels and shoes that are too short in the toe box will prevent the mallet toes from being forced against the front or top of your shoe. Comfortable shoes with a wide and roomy toe box and short to no high heels will offer more support and comfort to the toes. Orthotic devices: A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance, bringing pain relief. Injection therapy : Corticosteroid injections are sometimes used to ease pain and inflammation associated with mallet toes. There are some risks with corticosteroids as they can cause damage and weaken the muscles, so your doctor will likely try other avenues first. NSAIDS: Over the counter oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen sodium (Aleve) may be recommended to reduce pain and inflammation. Splinting/strapping: Your doctor may apply splints or small straps to attempt to straighten out the toe. This is more common with flexible types of mallet toes.

Self-Care at Home

There are several at-home treatments you can use to help relieve your symptoms:

• High Toe Box Shoes: To prevent further irritation to the toe, shoes with a high and broad toe box (toe area) are recommended. Shoes such as Crocs, clogs or Birkenstocks may be enough of a change to allow pain-free walking.
• Avoid high heels: Ladies, shoes do not make you beautiful, but being in pain can make you feel lousy. Opt for comfortable and supportive shoes so that without the pain your beautiful smile shows up from ear to ear.
• Toe props: These can be used to straighten the toe if it is still in the flexible state.
• Pads: Opt for the non-medicated pads that you can put over the toe to decrease the friction caused by the mallet toe.
• Stretching: Flexing and stretching the muscles and gently massaging may alleviate some of the pain and help relax the muscles and tendons.
• Epsom Salts: Soak the foot in a tub of warm water mixed with 1-2 cups of Epsom salts. Soak for thirty minutes, gently massaging the toe during the soaking.
• Treat your diabetes: Because so many people are suffering from diabetes, there are many other ailments erupting as a result of complications from the disease. If you actively manage your diabetic condition, you can address or avoid the complications that may come along with it.

Types of Mallet Toe Surgical Treatments

In the very early stages where the toe is still flexible, the deformity can be corrected by relaxing the tendons. This is done through a small incision, which often doesn’t require a stitch. An incision is made on the top of the toe and a small portion of the bone is removed. This allows the toe to relax and assume a straighter position. Following this procedure, the patient can return to comfortable shoes and resume normal activity. In some cases, a flexible mallet toe will respond to a release of the flexor tendon. A cut releases the tight tendon allowing increased range of motion of the joint. The procedure may be performed in the office or as an outpatient procedure. Typical healing time can vary from several days to several weeks. Return to a loose fitting shoe such as a tennis shoe after approximately 3-4 weeks. The most common procedure involves resecting or removing the affected toe knuckle, releasing the flexor tendon. In more severe cases, tendons can be relocated to another area of the toe to flatten out the mallet toes and bones fused. The procedure may be performed under local or general anesthesia and in conjunction with a tendon release on the top of the foot. The combination of these procedures will cause the toe to lay flatter and avoid direct pressure from the shoe.

Prior to Surgery

You are about to have surgery. As you may already know, nutrition plays a very important role in proper healing. One of the most important benefits of proper nutrition is maintaining the right pH balance in your body. pH is the measurement of acidity and alkalinity. pH ranges are from one to fourteen with fourteen representing most alkaline. Seven is neutral. The most optimal pH level for humans is slightly more alkaline than acidic at around 7.36. Undergoing surgery can increase acid levels in the body. Emotional and physical stress from both the surgery and recovery time changes your metabolism, which increases acid production. The use of both general and local anesthesia, pain medication, anti-inflammatory medications and other medications such as antibiotics will also introduce more acid to your system, lowering the alkalinity. This will delay healing and prolong recovery time. To maintain your body’s proper pH, keep yourself well hydrated prior to and after surgery. Water helps to dilute the acid build up in your body and release it through urination. Eating alkaline rich foods such as dark, leafy green vegetables will add alkalinity. Avoid acidic foods such as meats, fried foods, coffee (and other caffeinated drinks), carbonated beverages, cigarettes, and alcohol.

Other pre-operative considerations

Many people may need medical clearance through their Primary Care Physician, especially if taking medications such as Coumadin. Stop using anti-inflammatory medication 5 – 7 days before surgery. These include aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Arrange for a ride home from surgery and for someone to look after you for at least the first 24 hours. Avoid long trips for at least two weeks after surgery. Avoid eating and drinking anything after midnight the night before surgery.

Day of Surgery

Most foot and ankle surgeries are day surgeries, which means you will go home the day of surgery. You will generally be given a local anesthetic and anesthesia. After surgery, you will receive pain medication and care instructions.

Post-op Recovery

The best results and quickest healing is achieved when patients follow after surgery instructions. Keep your foot elevated as much as possible for the first week after surgery. Keep your foot dry for at least 2 weeks after surgery. One week after surgery you will have your dressing changed by coming to see your attending physician. The sutures will be removed after the second week. Your doctor will advise you when you can increase activities and put weight on the foot. Take pain and anti-inflammatory medications as prescribed by your physician. Vitamin C is important to heal scar tissue. It is vital in aiding in collagen formation. Take 4,000 mg spread out over each day in 500 mg doses taken for several days to several weeks after surgery. Omega 3 fatty acids, such as flax or fish oil, vitamin A and beta-carotene aid in the skin healing and lessen the appearance of scars.

How to prevent a mallet toe?

Change your footwear, opting for shoes that do not rub the toes. Wear who’s that have a high toe box and are wide enough to prevent the pressure that can cause the deformity. Avoid wearing tight-fitting, narrow or pointed toe shoes, such as women’s high heels or pumps. Prevent or treat arthritis, diabetes and neurological disorders to help reduce the risk of developing mallet toes. Avoid trauma to the toes, such as broken bones, which can cause mallet toes. In the case of a toe injury, seek immediate medical attention to make sure the bone is set to avoid the onset of mallet toes. Stretch and massage your feet regularly, especially after spending a long time in shoes. Regularly soak feet in Epsom salt baths, which relaxes the muscles and loosens the joints. Treat existing foot problems such as high arches or flat feet. Padding and orthotics for these conditions can prevent the development of mallet toes. Regularly visit your podiatrist to ensure proper foot health.