Archive for Foot Surgery
Plantar Fibromas
Posted by: | CommentsA plantar fibroma is a fibrous knot (nodule) in the arch of the foot. It is embedded within the plantar fascia, a band of tissue that extends from the heel to the toes on the bottom of the foot. A plantar fibroma can develop in one or both feet, is benign (non-malignant), and usually will not go away or get smaller without treatment. Definitive causes for this condition have not been clearly identified. The characteristic sign of a plantar fibroma is a noticeable lump in the arch that feels firm to the touch. This mass can remain the same size or get larger over time, or additional fibromas may develop.
People who have a plantar fibroma may or may not have pain. When pain does occur, it is often caused by shoes pushing against the lump in the arch, although it can also arise when walking or standing barefoot. To diagnose a plantar fibroma, Dr. Sowell will examine the foot and press on the affected area. Sometimes this can produce pain that extends down to the toes. An MRI or biopsy may be performed to further evaluate the lump and aid in diagnosis.
Non-surgical treatment may help relieve the pain of a plantar fibroma, although it will not make the mass disappear. The foot and ankle surgeon may select one or more of the following non-surgical options:
- Steroid injections. Injecting corticosteroid medication into the mass may help shrink it and thereby relieve the pain that occurs when walking.
- Orthotic devices. If the fibroma is stable, meaning it is not changing in size, custom orthotic devices (shoe inserts) may relieve the pain by distributing the patient’s weight away from the fibroma.
- Physical therapy. The pain is sometimes treated through physical therapy methods that deliver anti-inflammatory medication into the fibroma without the need for injection.
Surgical treatment to remove the fibroma is considered if the patient continues to experience pain following non-surgical approaches. Orthotic devices may be prescribed to provide support to the foot. Due to the high incidence of recurrence with this condition, continued follow-up with Dr. Sowell is recommended.
Hallux Limitus
Posted by: | CommentsThe term Hallux Rigidus describes a limited motion of the big toe joint. The hallux, or big toe, becomes rigid and will no longer move up and down freely. Also known as a dorsal bunion or Hallux Limitius, the condition is most commonly caused by every day wear and tear of the joint and is characterized by an extensive dorsal spurs and arthritic changes in the top half of the joint. As hallux limitus continues to worsen the joint will move less and less. Eventually, we might call it hallux rigidus. Hallux rigidus can be very painful and will often cause patients to change how they walk, leading to more difficulties. Patients with limited motion of their big toes will often have a callus on their big toe as well.
A thorough biomechanical exam will reveal the severity of joint changes and will consider the motion of the first ray of the foot. The first ray includes the metatarsal (see anatomy page) and its motion plays a large role in the motion of the big toe joint. Also, xrays are typically taken to determine the location and severity of the bone spurs on top of the joint and arthritic changes within the joint.
Conservative treatment of hallux limitus might include physical therapy, shoe modifications and often custom made orthotics. With orthotics we can change how the joint and first ray move and possibly avoid surgery. However, if surgery is required the procedure can remove the spurs around the joint that are limiting its motion and may allow a patient to regain much of the range of motion that has been lost.
Morton’s Neuroma
Posted by: | CommentsMorton’s Neuroma is a benign thickening or enlargement of an intermetatarsal plantar nerve. The area of the foot known as “the ball of the foot” is made up of five large joints with very little room in the spaces between the joints. When these joints bump together, the nerve passing between them can become injured and over time will become more tuberous, or thickened. This is often described as a cord-like mass. Patients typically describe this condition as being painful, shooting, electrical and the most common description in my practice is that people say “it feels like there is a hot rock in my foot”.
Typically patients have more pain when weightbearing and wearing shoes and will often relay a history of taking off their shoes and rubbing their feet for relief. Morton’s neuroma can be diagnosed with advanced imaging techniques but is typically a diagnosis made clinically by a physician familiar with the condition.
Orthotics, pads, shoe modifications and corticosteroid injections are widely used to treat Morton’s neuroma. If such interventions fail, patients are commonly offered surgery known as neurectomy, which involves removing the affected piece of nerve tissue. Occassionally neurolytic injections are used to destroy the nerve without surgery.
Hammertoes
Posted by: | CommentsA hammertoe is a change in toe position due to contracture of tendons, laxity of ligaments or arthritic change in joints. These generally progress over time and have many causes and presentations. Hammertoes, one of the most painful foot ailments, can often be traced directly to the wearing of narrow, pointed-toe shoes. Women most often are the victims of hammertoes. Most of the time, female footwear is not much wider at the front than at the heel, and the outline of the normal foot is rounded. The combination of narrow shoe and wide foot, of pointed shoe and rounded foot, causes, predictably enough, painful foot problems such as hammertoes.
Additionally, there are certain foot shapes that are generally unstable while walking. Overtime this instability can cause the toes to flex to provide additional foot support. The toes contracture over an extended period of time can lead to contracture.
The tip of a hammertoe can strike the ground with a thud at every step and become flat and squat. A hard corn can form on top, and a distal corn can form at the hammering portion. The nail might split or grow inward. A corn or callused nail groove might develop where the flesh is caught between the nail and the toe bone or where the toe is angulated. A soft corn can prove especially annoying when it is between the hammertoe and the adjacent toe that is overlapped. Although any toe may be affected, the second toe suffers most often. It is longer than the other toes and therefore more likely to be deformed by small footgear. The effects of a hammertoe are not limited to the toe. The toe bones, forced back against the metatarsals, exert pressure against the center of the foot. The ball of the foot suffers, calluses form, and muscular cramps develop.
Wearing tight-fitting stockings, short footgear, tapered-toe shoes, pointed-toe shoes, tight leotards, or really snug pantyhose for long periods of time can produce a hammertoe. Because these articles of apparel are necessarily worn on each foot, there can be two hammertoes, one on each foot.
Surgery is sometimes required for this condition. There are many techniques that can be used to correct hammertoes and often times it is fairly simple. Patients almost always walk after surgery and minimal incision techniques greatly reduce discomfort and healing times.
Fractures
Posted by: | CommentsA podiatrist, like myself, is trained to handle almost all conditions concerning the foot. Not a week goes by in my office that someone does not come in with some sort of broken bone. If you feel you have broken a bone in your foot please seek medical attention immediately. Although it is true that some fractures do not require much care, it is also true that patients who put off the care of a fracture could have trouble getting the fracture to heal. The process is usually as simple as getting xrays (in office), diagnosis and treatment for the particular type of fracture present. Treatments range from splinting, protective shoe, walking cast and sometimes surgery. Yes, sometimes a fracture requires fixation using screw, pins and plates!
Signs of a possible broken bone in the foot are:
-Pain when walking.
-Bruising.
-Swelling.
-A change in foot or toe shape.
Occasionally, I have a patient come into my office with some of these signs but with no history of an injury or fall. Many times x-ray reveals that they have a fracture in their foot and they were not suffering with much pain. This particularly happens in patients with weak bones or osteoporosis. Please take these signs seriously and hopefully we can get you on the road to recovery as quickly as possible.
Bunions
Posted by: | CommentsA bunion is a bony lump on the side of your foot, which develops when your big toe starts to angle towards your second toe. The bunion eventually causes discomfort and pain. The skin over the lump can become red, blistered or infected. A fluid-filled space called a bursa may also develop under your skin in this area and this can be painful if it becomes inflamed. This is called bursitis. You can also get a bunion deformity concerning your little toe this is often called a “tailor’s bunion”. Bunions are typically progressive and usually get worse over time. Symptoms include pain, stiffness, redness, difficulty walking and difficulty wearing shoes.
A bunion occurs as a result of a problem with your big toe known as hallux valgus. Hallux means the big toe and valgus means that it’s pointing outwards towards the other toes. In hallux valgus the bone in your foot at the base of your big toe, called the first metatarsal, moves out at the side of your foot. Your big toe angles towards your other toes. There is evidence that people can inherit a tendency to develop bunions. However, it doesn’t always follow that if your parents or grandparents have bunions, you will have them too.
A good understanding of foot biomechanics is required if you wish to address the cause of the bunion. The anatomy involved can be quite complex and if the forces that are causing the bunion can be reversed it is possible to keep the bunion from worsening. Proper shoe gear and arch control also plays an important role.
The best conservative care will not reverse a bunion. If you have severe pain or discomfort from a bunion, you will typically need to have an operation to correct it. Dr. Sowell is a podiatrist who is specifically trained to treat the bones and joints in the foot. There are over 130 different operations that can be carried out to treat bunions. Most of these procedures will aim to narrow your foot by straightening out your big toe joint as much as possible. An operation won’t return your foot back to normal, but most people find that surgery reduces their symptoms and improves the shape of their foot. The operation you have will depend on how severe your bunion is and whether or not you have arthritis.
One of the most common operations is called a metatarsal osteotomy. Your surgeon will cut one or more of the bones in your foot and then reset them so they are in line. He or she will also cut away the part of your big toe joint that is sticking out. Your surgeon may also correct the ligaments and tendons inside your foot by making them looser or tighter.
Another simpler operation that you may have is called an exostectomy (also sometimes called bunionectomy). In this procedure, your surgeon shaves off the part of the bone that is sticking out (ie the bunion). However, the bones aren’t straightened out. As this operation doesn’t correct the position of the bones, your bunion is more likely to return.
As with all surgery there are risks associated with these procedures. It’s likely that you will find the condition is much improved, but you may still have some pain and your big toe may feel stiffer. It’s also possible that in time the bunion will develop again.
