Bunions (Hallux Valgus)
A bunion (hallux valgus) is a deformity characterized by lateral deviation of
the great toe, often falsely described as an enlargement of bone or tissue
around the big toe joint (1st metatarsophalangeal joint). Although sometimes
there can be bony growth around the joint (Osteophytosis) as part of the
condition. As the great toe (hallux) turns toward the 2nd toe the tissues
surrounding the joint may become swollen and tender. It is important to note
that this condition usually worsens with time resulting in crowding of the 2nd
toe as seen in the picture below. This often results in deformities of the 2nd
and other toes. There are many factors that contribute towards the formation
of bunions. Often people are blaming choice of shoes and choice of parents!
Treatments range from supportive shoes containing orthoses (special insoles)
to corrective surgery. The surgery can be performed under local nerve block
as a day surgery procedure. There are many different surgical options for
bunions so please make an appointment to discuss all options.
Metatarsalgia (forefoot pain)
Metatarsalgia is a general term used to refer to any painful foot condition
affecting the bony knuckles of the forefoot (Metatarsal heads).
Metatarsalgia commonly affects the 1st and 2nd Metatarsals and can be very
painful. It is not a very helpful term to use since many conditions can be
described as Metatarsalgia. To be able to treat this pain correctly it is
necessary to understand the exact cause. It is usually due to excessive
pressures from bony misalignment or loss of fatty pad tissue. It is commonly
thought that by the age of 50 we have lost 50% of the fatty cushioning
beneath our knuckles. Many elderly complain of feeling like they are walking
on the bones of their feet, and they literally are! Treatments range from
cushioning insoles, orthotic therapy and surgery.
Heel pain (Plantar Fasciopathy, heel spur)
Heel pain can be due to a number of conditions. One of the most common
conditions is sometimes known as Plantar Fasciitis or heel spur syndrome.
Very rarely is the problem due to a heel spur, it is mostly a painful
inflammatory process of the plantar fascia, the connective tissue on the sole
(bottom surface) of the foot. Flat feet, poor shoes and injury can be the trigger
for this problem. Sometimes there is no specific trigger since injury to the
fascia can the result of an accumulation over time of microscopic tears that
never get the chance to heal.
The pain is usually felt on the underside of the foot and is often most intense
with the first steps of the day. Another symptom is that the sufferer has
difficulty bending the foot so that the toes are brought toward the shin
(decreased dorsiflexion of the ankle).
Sever's disease
Sever's disease or calcaneal apophysitis is the most common cause of
heel pain in children and is due to overuse and repetitive microtrauma of
growth plates of the calcaneus in the heel. It is linked with a number of other
similar disorders sometimes referred to as ‘growing pains’. It occurs in
children ages 7 to 15. It is related to Osgood-Schlatter disease which affects
the knee. This problem often settles down when the growth plates mature.
However, can be very painful and limit sports and other activity. Usually an
orthotic (shoe insert) can better align the Achilles tendon to the heel and
reduce excess movement at the growth plate. This can significantly reduce
the painful symptoms.
Hallux Rigidus / Limitus
Degenerative arthritis and stiffness due to bone spurs that affects the 1st toe
joint at the base of the hallux (big toe) is called Hallux rigidus or limitus
(HL). The term ‘rigidus’ means that the toe can no longer bend at the joint.
Limitus means there is a limitation in the ability to bend the toe. However
much literature uses these terms interchangeably.
HL usually comes on from arthritis in the joint from trauma and or overuse
injuries. This arthritis then will lead to limited motion and pain and decreased
function. This becomes a continuous cycle of decreased motion, arthritis,
extra bone formation, jamming of the joint causing much pain. There are
some simple surgical procedures to clean up around the joint to restore
motion. Sometimes the joint has suffered too much damage and needs fusing.
Some relief can be obtained with special orthoses (shoe inserts) and a certain
type of shoe.
Flat feet (Pes Planus)
The term Flat feet (also called pes planus or fallen arches) describes a foot
posture where on weight baring the foot tends to flatten out. There are many
people who could be described as having flat feet but never suffer any
significant pain or problems. However there is a definite link between flat feet
and bunions, morton’s neuromas, shin splints, knee pain and other
biomechanical and postural problems. Children and adults who are
suspected of having flat feet should be checked by a podiatrist to see if there
is risk of developing further problems with time. Treatment often involves
orthoses (insoles) in combination with supportive shoes.
Intoeing (Metatarsus adductus)
Pigeon toe, also called metatarsus varus, metatarsus adductus, in-toe
gait, intoeing, is a condition that causes the toes to point inward when
walking. It can be the result of simple muscle imbalance, or due to underlying
conditions such as a twisted shin bone (tibial torsion), a hip condition (femoral
anteversion) or the long bones of the foot being misaligned. Proper treatment
and advice requires proper assessment of the legs and feet to ascertain
where the deformity is coming from.
Out-toeing
Out-toeing can be due to outwardly rotated hip (femoral retroversion), twisted
shin bone (external tibial torsion) or a foot condition.
It is necessary to evaluate people to see at what level the deformity is coming
from to recommend appropriate treatment.
Sesamoiditis
Sesamoiditis is inflammation of the sesamoid bones. In humans it occurs on
the bottom of the foot, just behind the large toe. There are normally two
sesamoid bones on each foot; sometimes sesamoids can be bipartite, which
means they each comprise two separate pieces. The sesamoids are roughly
the size of jelly beans. In humans the sesamoid bones act as a fulcrum for the
flexor tendons, the tendons which bend the big toe downward.
Usually periostitis (new bone growth) occurs along with sesamoiditis, and the
suspensory ligament may also be affected. Sesamoiditis results in
inflammation, pain, and eventually bone growth.
Achilles Tendonitis
Achilles tendonitis is tendonitis or inflamation of the Achilles tendon,
generally caused by overuse of the affected limb and is more common among
athletes training in under less than ideal conditions.
The Achilles tendon does not have good blood supply or cell activity, so this
injury can be slow to heal.
Shin Splints
Medial tibial stress syndrome, tibial periostitis or shin splints is a
common injury that affects athletes who engage in running sports or basic
activities such as cross country, football, or hiking. This condition is
characterized by pain in the lower part of the leg between the knee and the
ankle. MTSS injuries are caused by repeated trauma to the connective
muscle tissue surrounding the tibia. Ignoring this injury may result in a more
serious condition such as a stress fracture of the bones.