If you watched the Oscars this weekend you probably saw lots of high heels. Whether it was Jennifer Lawrence falling yet again or Liza Minnelli smiling despite those painful bunions, it was quite an entertaining evening. High heels are here to stay but you should know by now that they cause instability, hammer toes and bunions. I’d like to give you a little advice when it comes to bunions.
A bunion is an abnormal bump that forms at your big toe joint. Bunions are unfortunately a large problem that affects nearly 25% of people between the ages of 18-65. Bunions are generally formed by tight shoes or biomechanical imbalances. The big toe starts to deviate toward the other smaller toes which force the joint to protrude away from the foot. Many women’s shoes actually put the foot right into this position because of the pointed tight toe box. Some statistics show that 85% of women wear shoes that are too tight. In fact, many of the fashionable shoes on the market will only fit if they are a size too small.
That big bump is unfortunately a self-aggravating problem. The more that bump protrudes the more muscular imbalance in the foot and the more it rubs on the shoe. These things will just get worse and worse and more and more painful. If you are in an early stage and your bunion is small then now is the time to act.
First of all, stop feeding the bunion. Wear shoes with larger toe boxes and plenty of room for your toes. There are plenty of comfortable AND fashionable shoes out there. Sometimes simple things like this can stop the bunion from progressing further and keep your feet in proper alignment.
If your shoes aren’t the problem and you have a biomechanical deformity that is causing your bunion, consider taking a trip to your local podiatrists. As podiatrists we are taught to assess the biomechanics of the foot and correct problems with what we call functional orthotics. Functional orthotics work by positioning your foot in the proper position at a precise moment in your gait cycle, allowing proper biomechanics as you walk. By doing this we are able to treat the cause of the bunion to ensure that it doesn’t progress.
There are also some splints on the market that pull your big toe into proper alignment and protect the bump from friction on the shoe. This can help to rebalance the muscles in your foot and alleviate any pain you may have. There are many splints on the market so do some research and find one that fits your needs.
The last resort is surgery. Bunionectomies are common procedures that are usually reserved for those with severe pain or serious malformations that need correction. One thing is for sure, if you start to see changes in your feet then come see your podiatrist as soon as possible. Treatments are most often successful if they are treated early. If you have foot care questions or needs then make an appointment with your local podiatrist at Affiliated Foot and Ankle Care located in Edison and Monroe NJ today.
By Varun Gujral
A callus is an area of the skin with an excess buildup of keratinocytes (cells that produce the keratin which makes up the outer layer of skin). The cells proliferate in response to any excess in pressure or friction. This is your body's natural protective response traumatic stimuli. The most common places for calluses to form are the hands and the feet. I commonly get a callus buildup on my hands when doing pulling exercises at the gym. This can get irritating which is why many heavy lifters use chalk or lifting gloves.
The feet are also a very common place for callus formation. The average active adult will walk over 5000 steps a day which equates to over 2 miles. Every step puts your entire body weight and momentum onto your shoes which in turn transfers that pressure to your feet. That's a lot of pressure and friction every single day. The feet are built to handle this pressure and for most people it's not a problem. However, many people get a buildup of calluses. For the trained eye, these calluses are obvious patterns of wear that indicate problem areas in the foot. Common places for callus formation are the heel, metatarsal heads (the balls of your feet), side of the big toe, and on top of the toes.
Without getting too technical, let's just say that the foot has more going on biomechanically than any other location in your body. With 26 bones in each foot interacting with each other at 33 joints it doesn't take much to throw the system out of wack. The purpose of these joints is to absorb the body weight and propel you along while expending the least amount of energy possible. Your body is remarkably efficient at locomotion.
So what can throw the system out of wack?
· Wearing shoes that interfere with normal motion or don't properly distribute the weight
· Variations in foot structure that can predispose to abnormal weight distribution
· rapid weight gain that puts more stress on the foot than it can handle
· Trauma that alters growth at a young age
· Anything that causes pronation
· Arthritis, pain, or injury which may cause you to alter your gait to alleviate the pain
The list can go on but you get the idea. When you visit your podiatrist, you can bet he'll be looking at your calluses for clues as to what may be happening with your foot. In many cases the reason for callus formation is benign such as a recent change in shoes or increase in activity. In other cases, orthotics may be able to relieve the callus formation and correct a biomechanical abnormality.
If you are curious as to why you have recurrent callus formation, then I encourage you to make an appointment with your local podiatrist at Affiliated Foot and Ankle Care located in Edison and Monroe NJ today. Have a great day and remember to take care of your feet!
By Nrupa Shah
Fungal nails are a plague that you can't get rid of. They can cause your nails to become yellow, brown, and/or black and have you thinking twice before you hit the beach with sandals when it finally warms up. I would like to tell you about my approach to a fungal nail infection.
When a patient walks into the podiatry office with a high suspicion of fungal infection, the first thing to do is take a biopsy. This generally involves cutting away some nail pieces to send to the pathologist. The pathologist will inspect the nail tissue for signs of infection and use a special stain to visualize the fungal organisms. After the biopsy I will trim the nail and clean it up and send the patient home to return in about a week.
If, and when the pathology report comes back positive for fungus, it’s time to consider treatment options. Let's assume we have a relatively healthy patient that wants to be able to wear sandals. There are basically two options that I present the patient with. If only one nail is infected (most commonly the big toe) then I present the patient with the option to remove the nail completely. This is a simple 5-10 minute procedure that requires anesthesia of the toe and some sterile instrumentation to remove the entire nail. The patient will be put on an oral antifungal agent to ensure no fungus survives and the nail will grow back clean and normal. This treatment is aggressive but offers the greatest chance of full nail recovery.
The second option is to leave the infected nail intact and try to treat the infection with lasers, creams, or oral antifungal agents. Lasers and topical creams can work to kill the organism within the nail but should be stacked with an oral antifungal agent that works to kill the fungal organisms on a systemic level. This option can also result in a clean and normal looking nail in some cases. If the fungal infection has been present for years or even decades then a full recovery is very difficult or impossible to achieve.
Oral antifungal agents such as terbinafine have been the gold standard treatment for fungal nails and every treatment regimen should include this medication. Even with this medication, there are some nails that will never return to normal. If you have nails that have recently started to change color or become brittle and oddly shaped then you may have a fungal infection and you have the best chance for recovery if you treat it immediately. Remember, your local podiatrist sees patients with fungal infections on a daily basis.
By Varun Gujral
Yellow, possibly fungal, nails are one of the most common complaints that show up at a podiatry office. There are many misconceptions about fungal nails and I'd like to take you on a quick tour of my approach to ugly, yellow, and often dystrophic nails.
First of all, many patients come in complaining of a fungal infection because their toenails look yellow, chunky, or like they're about to fall off. The misnomer is that all yellow nails are infected which is often not the case. The most common cause of yellow dystrophic nails is actually what we call micro trauma.
Micro Trauma to the nail unit is repetitive banging or force on the nail. This repetitive trauma to the nail will over time cause a callus to form under the nail. Normally when your skin forms a callus the excess skin will eventually be sloughed off. When the callus is under the nail the skin is stuck and pushes up on the nail. This excess skin tissue is what causes the nail to appear yellow and often raises the nail unit up eventually causing the nail to fall off.
So, when a young patient comes in that has recently started training for a marathon, my mind is thinking micro trauma, not infection. The micro trauma generally occurs in athletes, especially runners with tight shoes that don't allow enough space for the toes to slide forward upon impact. Instead the toes are slamming into the forward aspect of the shoe, causing damage. So, I tell my runners to bring in their shoes so I can take a look and see if they are fitting correctly. If they have micro trauma then nine times out of ten their shoes are too small.
The second half of the story is unfortunately, fungus.
Remember that callus which formed under the nail? Well that callus is mostly keratin, the main component of skin. Anyone want to guess what fungal organisms like T. Rubrum like to feed on? That's right, keratin. The micro trauma will cause your nails to become yellow and ugly and can also provide a nice cozy home for fungal organisms to thrive in. Once that fungus gets in there, it can be very difficult to get rid of.
By Nrupa Shah
Ingrown toenails walk tenderly into my office on a daily basis. Treating ingrown toenails is one of the everyday procedures that podiatrists perform on a weekly if not daily basis.
Ingrown toenails are basically sharp edges of nails that grow into the skin at the edges of the nail. The edge of the nail normally only grows outward and away from the skin but this can go awry if you're not careful. So why does this happen?
I've said it before and I'll say it again. Don't wear tight shoes! Your toes need plenty of space so give yourself a big toe box with space above and in front of your toes. Tight shoes force the nails downward and can eventually cause your toenails to become rounded. Believe it or not you can actually predispose yourself or your children to ingrown toenails if the shoes worn are too tight. When your toes are still developing during childhood, you can cause permanently rounded nails that can dig into the skin with any downward pressure. There are also some people with naturally rounded nails that are more likely to develop ingrown toenails.
The actual cause of the ingrown nails is almost always tight shoes and improper nail care. People that don't wear shoes will never (well, I'll say almost never) develop ingrown toenails. When cutting your nails always cut straight across and be careful not to cut them too short, especially on the sides of the nail. You definitely want to stop cutting before the nail attaches to the skin.
Another factor that can increase your risk is weight bearing trauma to the toes. When playing basketball for instance, if you have tight shoes you are constantly slamming your toes into your shoe and the floor which is pushing the skin into the nail. The more you damage the skin the more inflamed it can become and the skin may actually grow and swell up over the nail (if the nail is cut too short).
What does this mean for you? If you commonly get ingrown toenails then take a look at your shoes. They are probably too small. If you live in warm weather you can wear open toes shoes to stop ingrown nails. Be more conservative when cutting your nails and don't cut your nails too often.
Ingrown toenails can develop and get out of control quickly. They often get infected and swollen and very painful. In this case you should make your way to your local podiatrist who is equipped with the tools and expertise necessary to return your nails to normal. Seriously, you can walk in with extreme pain and walk out feeling great. Actor Mark Wahlberg recently underwent a procedure for an ingrown toenail and showed up at the Critics Choice awards that same night. Recovery from these simple procedures is quick and the pain relief is instant.
By Varun Gujral
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