by Jack A. Reingold, Podiatrist
When you have problems with your feet, who do you call for help? Many people aren’t aware that podiatrists, also called doctors of podiatric medicine, specialize in the treatment of foot and ankle conditions ranging from common problems such as bunions and hammer toes to sprains, fractures, infections and injuries.
Podiatrists complete undergraduate medical school training as well as graduate school for a doctorate degree in podiatry. We are required to take state and national exams, and must be licensed by the state in which we practice.
Like most other surgical specialties, post-graduate training is required. Most podiatrists today complete three years of foot and ankle surgery training, and many do additional fellowships.
According to the American Podiatric Medical Association, foot disorders are among the most widespread and neglected health problems affecting people in this country, and our rapidly aging population contributes to even more foot problems. Let’s take a look at a few of the most common foot issues and how we treat them.
Pain in the heel or arch is the most common reason we see patients; it is estimated that 15 percent of all new patients have this complaint. Such pain can often be traced to inflammation on the bottom of the foot, a condition known as plantar fasciitis or heel spur syndrome.
Specifically, plantar fasciitis is an inflammation of the connective tissue (plantar fascia) that connects your heel bone to your toes and supports the arch of your foot. The most common cause of plantar fasciitis is faulty foot posture and function (excessive pronation), which means that the foot rolls inward excessively when walking.
This flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation and pain.
- Conservative treatments, such as the use of oral anti-inflammatory medications, small steroid injections, ice packs, stretching exercises, physical therapy, and orthotic devices will provide relief most of the time.
- Orthotics are custom-molded devices placed in your shoes that adjust the angle of your foot when you walk and correct improper foot posture.
- In persistent cases where patients have experienced plantar fasciitis for six months or more and have not found relief with conservative treatments, I have successfully treated the problem with Extracorporeal Shock Wave Treatment (ESWT).
ESWT is a safe and effective treatment for heel pain; clinical studies show a 70 percent success rate. In fact, this new technology has virtually replaced the need for surgery for this condition (“extracorporeal" means "outside of the body”).
During this noninvasive procedure, we direct sonic waves at the area of pain using a device similar to that used in nonsurgical treatment of kidney stones. The strong sound waves penetrate the heel area to stimulate a healing response by the body.
This outpatient procedure is performed without the need for any anesthesia and takes about 30 minutes. There are no known side effects and minimum post-operative discomfort, and individuals can return to limited actives immediately.
A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe. Bunions form when the toe moves out of place; the enlarged joint protrudes and causes friction, pressure and discomfort as it rubs against footwear.
Because the joint flexes every time you take a step, the bigger the bunion gets, the more it hurts to walk. Over time, the movement of the big toe angles in toward the other toes, causing even more irritation or inflammation. Bunions can also lead to other toe deformities, such as a bent or curled toe called hammer toe.
Bunions tend to run in families, usually because of a faulty foot structure; most people who have bunions will have a parent, aunt or grandparent who also had them.
Although inherited foot structure is the main reason for developing bunions, wearing shoes that are too tight, especially around the toes, can aggravate them and make the symptoms more pronounced.
High-heeled shoes with narrow toe boxes are a common culprit. A study by the American Orthopedic Foot and Ankle Society found that 88 percent of women in the U.S. wear shoes that are too small and 55 percent have bunions.
Foot injuries, neuromuscular problems, flat feet and pronated feet also can contribute to their formation.
Because we take eight to ten thousand steps a day, bunions tend to get progressively worse. In theory, orthotics provide stability and should help slow the progression; this is why I suggest orthotics to people with early bunion deformities.
Bunions are bone deformities and do not resolve by themselves. We treat with two goals in mind: one, to relieve pressure and pain, and two, to stop further growth of the bunion. Some of the most commonly used methods to reduce pressure and pain include:
- The use of protective padding, often made from felt material or gel, to eliminate the friction against shoes and help alleviate inflammation and skin problems
- Removal of corns and calluses
- Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth
- Orthotic devices to help stabilize the joint and place the foot in the correct position for walking and standing
- Exercises to maintain joint mobility and prevent stiffness or arthritis
- Splints to help the toes and joint align properly
Depending on the size and severity of the bunion, surgery may be needed to remove the bunion and realign the toe. There are many different surgical approaches for bunion, and the surgeon must take many factors into account, including the patient’s age and lifestyle, the severity of the deformity, and other structural problems, when selecting the proper procedure.
In most cases, this is outpatient surgery performed under local anesthesia. Most patients are able to walk out of the surgery center without a cast or crutches. Return to activity depends on several factors, such as the type of procedure.
Patients often are able to get back to most activities within a month, although participation in athletics can take longer.
This Scripps Health and Wellness information was provided by Jack Reingold, DPM, a board certified podiatrist with Scripps Memorial Hospital La Jolla.