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Published in the Yuma Daily Sun Monday, December 13, 1999

People don't need to suffer from the agony of the feet.

Foot Problems are so common that many people just accept them as "normal" and do not seek medical attention. With proper care, your feet will carry you 115,000 miles or more in your lifetime that is three times around the world! Our feet deserve our full attention and the care of your podiatrist.

Bunions, hammertoes, corns and calluses all occur at least partly in response to abnormal functioning of the feet. For example, incorrect joint and tendon motion can lead to bone deformities, such as bunions and hammertoes, that cause shoes to fit tighter and may result in neuromas, corns and calluses. Treatment varies depending on the type, cause, and severity of the condition.

A bunion is an enlarged bone on the side of the main joint of the big toe. Depending on the severity of the bunion, the big toe is angled mildly or sharply toward the other toes. Causes of bunions include hereditary tendency, foot injury, neuromuscular disorder, congenital deformity (a deformity present at birth) and loose joint movement. Bunions may also develop along with inflammatory joint diseases such as gout, pseudogout and osteoarthritis.

Most bunions form as the bid toe responds to abnormal pressure on the foot joints, such as the foot rolling excessively inward during walking. Over time, this stress may cause the big toe to move toward the other toes, putting pressure on the big toe joint and pushing it outward.

Eventually, the bunion slants the big toe toward and under the second toe raising the second toe to a claw-like position, called a hammertoe.

Self care of these includes wearing roomy, supportive, comfortable shoes and self-adhesive type cushions. Doctor's care may include extra wide or prescription shoes, shoe inserts (prescription custom-made orthotics) and injectable or oral medications.

Surgery is used to remove the bunion or hammertoe and realign the joints. Surgery is typically recommended to relieve pain, restore function and reduce or remove a deformity. The surgeries are outpatient procedures that are done in a hospital, outpatient surgery center or a doctor's office'. Based on the type of surgery, as well as the patient's, age, health, and insurance plan, your doctor will recommend the setting and type of anesthesia to be used. The patient is usually able to walk with special shoes the day of the surgery.

Structural bunions occur when the angle between the first and second toes increases beyond normal. Bone growths may form resulting in soft tissue swelling. Sever bunions occur when the angle between the first and second toe bones is excessive.

Structural bunions can be helped with a metatarsal head osteotomy in which the bone is surgically cut and repositioned. A new fixation device called a cortical bone pin can be used that completely grows into the bone. There is no need to remove screws or wires as was done in the past. Afterward, the patient wears a surgical shoe for about four to six weeks. Severe bunions need to be corrected using a metatarsal base osteotomy. A wedge of bone is removed from the base of the first metatarsal (the large toe), and the bone is repositioned. Metal screws are needed to stabilize the bone, and afterward the foot is in a cast for about six weeks.

Treatment of hammertoes also has several options. Flexible hammertoes may only need soft tissue repositioning, but rigid hammertoes may have several options. In an arthroplasty, a portion of the joint is removed and the toe is straightened. Fusion is done by removing cartilage between the two toe bones and the bones fuse as one longer bone. In some situations, a portion of the bone is removed and replaced with an implant. Afterward, the patient may wear a surgical shoe for several weeks. How soon the patient resumes normal activities depends on the type of foot surgery and the extent of the patient's activity.

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