Shoes aggravate a pre-existing condition. Bunions are nothing more than anatomic or genetic variation. God and your parents get all the blame. Barefoot populations and men get bunions.
Yes, a bunion is a knot on the inside of your foot. Exceptionally, it can be there from previous trauma. Most of the time it shows up gradually; sometimes in teens, more often in middle age. It occurs principally at the first metatarsal phalangeal joint; kind of where the toe bones, phalanges, connect to the longer foot bones, metatarsals…the MP joint or simply the MPJ.
Try this. Place your hand on a flat surface and close the thumb next to the index finger. On the inside your hand, you see a prominence at the MPJ, in the hand the metacarpal phalangeal joint.
By analogy, this prominence is what we see in the variant foot. In the hand, the first metacarpal diverges away from the rest of the hand bones. In the foot with a genetic bunion, the first metatarsal diverges away from the rest of the foot. The great toe is not opposable like the thumb, instead, it ends up nestling next to the second toe, rather limp and useless. When we walk on the foot the great toe gets pushed towards the second toe in propulsion or toe off. Over time the MPJ on the foot becomes more prominent.
If your foot rolls in more, as in over or hyper-pronation, the great toe easily pushes towards the second toe. Thus part of conservative treatment would include an orthotic to minimize this effect of excess pronation.
Generally, mild bunions are not operated on. When moderate and progressive they can be painful especially depending on the shoe and activity. Yoga may strain the bunion. Women have more bunion operations than men. While shoes do seem the be the reason here, the underlying genetic incidence of bunions is the same for women and men.
When conservative measures fail, surgical correction involves correcting the diverged metatarsal. The bump is shaved, and the metatarsal is cut to be moved closer to the second metatarsal eliminating the divergence in the horizontal plane. The metatarsal must also be “rolled” some to correct its position in all three planes. Fixation of the cut requires screw(s) and/or plate(s). One is often non-weight bearing for a month using a scooter and/or crutches, followed by a walking cast for an additional month. It generally takes up to three months to heal and some physical therapy may be indicated.
Each of us are uniquely stamped with a degree of anatomic variation we inherited from our parents. Often one leg and foot will not be the same as the other. From generation to generation, a bunion may present itself as mild, moderate or severe. For more information on living with or correcting bunions, call our office today for a consultation.
For more information on Bunion in the Overland, KS area call Dr. Mark Landry at (913) 438-9898 today!
Blisters develop from excess friction where the top layer of skin separates from the underlying dermis. The dermis is the white skin seen when an abrasion occurs. The dermal layer of skin has live cells and specialized glands. The top layer or epidermis is protective and without live cells. Over time a callus, an adaptive thickening of the epidermis can occur. Hands and feet are commonly afflicted with blisters.
Direct causes of excess friction and blisters can be from ill-fitting shoes, or simply from a lot of walking or running on any surface. Pivoting the foot in basketball or tennis can bring on a blister under the ball of the foot. Using a tool in your hands repeatedly can cause similar blisters and calluses as seen in the feet.
Indirect causes can be the form or function of the foot.Form is the shape of the foot. For example, a bunion, hammertoe or prominent bone can rub more easily in the shoe. A high arch foot may put more pressure on the heel and ball of the foot.
Function of the foot can affect excess friction. In a flexible hyperpronated foot the toes grab more to compensate and can contribute to blisters at the ends of the toes. A supinate high arched foot might cause more friction on the outside of the heel.
Form and function refer to you, and what God gave you to get around on: the shape of your foot and how it pronates or supinates. You get the idea.
Identifying the causes, means of prevention, and finally, treatments will be covered here. A “normal” amount of pronation occurs in the foot followed by a normal amount of supination during the “stance” phase of walking when the foot is on the ground. Shoes alone can be the source of blisters.
They can be ill-fitting, made of non-yielding materials or simply have a design flaw. Man made “uppers” are usually synthetic and non-yielding. Leather or canvas shoes can stretch to give room for normal movement of the foot. A design flaw could be the thick stitching in the upper crossing over the toes or other prominent parts of the foot.
Runners soon learn to master self-treatment. This blog will help us compare notes to better prevent those blasted blisters.
As we age…
Just when you think you know how to prevent blisters, for example using duct tape, moleskin or Vaseline on the ball of the foot, a new kind of blister developers at the end of your toes. At least this happened to me, and of course, I should know better.
So let’s start with what happens over time. Your feet increase in shoe size. Gravity flattens the arch some over years; a size 10 and a half in college can be an 11 by 40 years of age and a 13 when in your sixties! Now that might be extreme, but in runners, shoe fit is more critical when banging the ends of the toes. At least it happened in my case where my feet are more on the flat side to start with.
Other orthopedic deformities, form or shape conditions, are seen more as we age. Mild hammertoes become more hammered, bunions enlarge, and we lose the fat under the ball of the foot. In losing the fat pad, a metatarsal bone can be more prominent, dropped, or susceptible to pivoting shear force.
I was so surprised when a local running store jumped me to a size twelve when in my 50’s. More recently, I mistakingly was using my son’s size 13 when doing a Mainly Marathon series (where runs are done up to seven days in a row). After using his 13’s, on series in the Fall, I went back to my size 12’s for a Mobile, Alabama marathon in January. My feet had caught up with the shoe length, and I suffered from blood blisters at the ends of my great toes. I now regularly wear size 13’s.
If the shoe doesn’t fit don’t wear it…
Recently, a high school runner presented himself to my office with blisters on the outsides of his feet in back of his little toes. He was a big-boned with wide feet. We have a lot of those in the Midwest. While cross country was his thing, shorter track events took place in Spring. And he was using spikes bought online.
To evaluate the correct shoe size, I had the patient stand on a sheet of paper and drew an outline of his foot. Then I placed the shoe with spikes inside the outline, there were almost two inches of extra width in the outline of his forefoot! He had an early Taylor’s bunion, a knot where the small toe joint connects to the foot. This “form” had a little to do with the blisters; most of the cause, however, was the pair of narrow spikes bought online.
So first and foremost, proper shoe fit, preferably at a running shoe store is periodically recommended. It’s best to fit shoes at the end of the day when the feet are slightly larger from swelling.
My right foot functions poorly. It turns out more flops or hyper-pronates. To help correct this, the long flexor tendons that insert to the end of the toes tend to grab or pull more, to protect the arch. Its fancy name is “flexor [tendon] substitution”. This can still happen, even with orthotics, when first doing your long run or race of ten miles.
I remember it as a ten-mile race that gave me a large blister on the bottom of my fifth toe, and to a lesser extent on the fourth toe. The fifth toe was so injured that there was blood in the blister, a blood blister.
So function, as well as form of your foot, can be indirect causes. To treat this for future long runs, I Vaselined my toes, but I also cut back my insole so that my toes had more room to grab.
Treatment of Blisters
So how do we address blisters? First-aid is, of course, to clean, drain, apply antibiotic and a bandaid.
How we drain the blister is paramount in preventing the blister from re-forming. I believe in the approach that makes a large enough draining hole that won’t reseal, while still leaving most of the skin intact to protect the dermis. One should do this aseptically. I do not burn and sterilize a needle because the resulting hole is not large enough and will re-seal. The dermal cells are alive and have been inflamed; fluid will continue to seep if there is not sufficient drainage.
What has worked for me is to use a pair of scissors to nip a small 1/8″-1/4″ hole in the blister. This usually prevents resealing of the blister. Of course, the scissors are clean and wiped with alcohol for good measure. Again, the blister is covered with antibiotic ointment and a band-aid or a second skin product such as the ones developed by Spenco.
As mentioned above, vaseline is my first choice in the prevention of blisters. Regular foot or talcum powder works well in triathletes. The shoes are powdered ahead of time. I use orthotics of ¾ length so my toes have plenty of room. This length also can be cut just behind the ball of the foot to effectively lift the ball of the foot more, minimizing friction blisters there. When one does a street marathon like Chicago, the Street-effect is like repeated slapping of the forefoot. The ¾ length insole rise helps keep the feet cool.
Second Skin products, first done by Spenco, help when you are still recovering from a relatively new blister. I have used these band-aids like covers with impregnated gel on the ends of my great toes and on the ball of the foot. Straight moleskin applied to a day old blister works for many. Moleskin is a thin felt product with an adhesive backing. You then cut the pad to cover the affected area. Duct tape has been used preventively, but again I preferred vaseline.
Spenco insoles were originally designed to prevent blisters on the balls of the feet when playing tennis. Consider the shear force. The green cover is on a neoprene rubber with injected air bubbles that help absorb the sideway or shear friction force. Dr. Spencer, behind the Spenco name, liked to play tennis.
Double layered socks help with blister prevention. Avoid cotton as it absorbs moisture, may clump and cause a blister. Most socks made for runners are of synthetic materials. The support stockings are popular these days. They come either toe to knee, or ankle to knee and can vary in pressure from mild (15-20 mmHg) to fairly tight (40-60 mmHg).
With the tight support full-length stocking, it can be a disaster if you get a blister on the foot halfway through a marathon. The calve-only length will allow you access to a burn spot or early blister to Vaseline if necessary. Often Vaseline is available in the latter half of a marathon at the aid stations.
Pressure on hammertoes can be eliminated with a wider and deeper toe box, such as the one seen in Altra shoes. In addition, a neutral or negative heel lift can help offload the ball of the foot and blisters that occur there.
A recent patient presented with a history of repeated ankle sprains on her left foot. The ankle tends to “give out” from under her, especially going down stairs. Now she favors the foot in gait with pain.
A bad sprain leaves the ankle “unchecked”, abnormal motion can lead to spurs and loss of cartilage. This patient’s ankle was worn with significant cartilage loss, leading to a possible fusion or ankle replacement. Early intervention is important.
An unstable ankle can be controlled with an Ankle Foot Orthosis (AFO), and physical therapy. If the ankle continues to give out, the ligament can be repaired as an outpatient procedure. New “internal braces” are now available to improve results and allow full return to sports.
If I can help you, and for more information, please contact our office for an appointment. An X-ray checks the wear of the ankle and options are reviewed.
When we age, we gradually lose muscle and gain fat, which typically contributes to declines in strength and issues with gait and balance. A recent study published in the Journal of the American Geriatric Study examined the effects of various of forms of exercise in lowering fall risk. Findings concluded that while programs including brisk walking had no effect on falls, those that included resistance training and challenging balance exercises were extremely effective in preventing falls. Strength and resistance training, even for the elderly, can greatly improve gait and therefore decrease fall risk. Simple exercises such as balancing on one leg while lightly using a table or chair for support can help gauge balance and strength.
Proper foot care is something many older adults forget to consider. If you have any concerns about your feet and ankles, contact Dr. Mark Landry of Kansas. Our doctor can provide the care you need to keep you pain-free and on your feet.
The Elderly and their Feet
As we age we start to notice many changes in our body, but the elder population may not notice them right away. Medical conditions may prevent the elderly to take notice of their foot health right away. Poor vision is a lead contributor to not taking action for the elderly.
Neuropathy – can reduce feeling in the feet, and can hide many life threating medical conditions.
Reduced flexibility – prevents the ability of proper toenail trimming, and foot cleaning. If left untreated, it may lead to further medical issues.
Foot sores – amongst the older population can be serious before they are discovered. Some of the problematic conditions they may face are:
Gouging toenails affecting nearby toe
Shoes that don’t fit properly
Loss of circulation in legs & feet
Edema & swelling of feet and ankles
Diabetes and poor circulation can cause general loss of sensitivity over the years, turning a simple cut into a serious issue.
If you have any questions, please feel free to contact our office located in Overland Park, KS. We offer the newest diagnostic tools and technologies to treat your foot and ankle needs.
While proper foot care is important for everybody, senior citizens have the tendency to be more susceptible to certain conditions. The elderly should therefore be well informed about any problems that may arise and about what they can do to properly avoid or treat them.
Some of the most common foot problems seniors are susceptible to include foot ulcers, ingrown toenails, fallen arches, and fungal nails. A foot ulcer is an open sore on the foot and can be a result of diabetes and decreased sensation in the feet. An ingrown toenail is defined as when the nail grows into the side of the toe. Fallen arches are indicated by the instep of the foot collapsing. A fungal nails is a condition that results in deformed and discolored toenails.
In order to avoid these conditions it is recommended that the feet be inspected by the patient on a regular basis. If these inspections are carried out routinely, there is a good likelihood that problems can be identified before they become severe, or can even be avoided altogether. If any abnormality is discovered, it is important that the individual consult a podiatrist for diagnosis and information on treatment options.
Proper foot hygiene is also important. Making sure that you always have clean, dry socks on can be a major deterrent to many different problems including bacterial infections, foot odor, and certain types of fungus. Wet feet are a major cause of many of these problems. If your socks get wet, it is important to change them. Walking around in wet socks may not only lead to various infections, but can irritate the skin and result in a number of various complications. Clean, dry feet are less likely to be affected by fungal and other infections.
As people age, the fat present on your feet begins to deteriorate. The protective nature of this fat keeps the feet healthy by providing a barrier between your bones and the ground. This also aids in giving the skin on the feet a certain amount of elasticity. This is one factor that causes elderly people to develop some serious foot issues. Foot moisturizers can be helpful to avoid certain problems associated with this. However, water-based moisturizers do not work as well for elderly people as they do for the young. Instead, it is more effective to use an emollient instead. An emollient is effective because it binds the water in the foot, keeping it from becoming absorbed too readily which will result in dry skin. Emollients also have a special property called occlusion, which provides a layer of oil on the skin. This layer prevents the foot from drying up and can be very effective in treating dry skin disorders. If you can keep the skin on your feet healthy, this will substantially reduce the number of foot problems you will encounter in old age.
Proper footwear is another way to keep feet healthy. Shoes that fit well and provide proper support help prevent ingrown toenails and fallen arches.
Certain medical conditions such as diabetes or poor blood circulation increase the risk for foot issues. For individuals with any of these conditions it is extremely important to conduct regular foot inspections to make sure that there are no sores or infections present.