BUNIONS (550 words)
Q What is a bunion?
A They are bony protusions which form at the bottom outer side of the big toe. In time, a bunion can widen the change the shape of your foot making it difficult to find comfortable shoes.
Q What causes them?
A You may inherit bunions or develop them through pronation of your foot when walking, or wearing high heels. If you suffer from arthritis or gout, you’re more likely to develop one.
Q What is pronation?
A If you walk with excessive pronation you’re at a greater risk of getting bunions. Overpronation is when your foot rolls in excessively when you walk or run. When you start to move forwards, the majority of your weight is transferred to the inner side of your foot instead of the ball of your foot. Your podiatrist may suggest custom made orthotics to correct this.
Q Can Bunions Be Treated Without Surgery?
A Yes. If your bunion is still in its early stages, your podiatrist may suggest bunion pads, custom orthotics, physical therapy and choosing shoes that allow you feet more room but are still supportive.
Q If A Bunion Isn’t Causing Pain, Is Surgery Still Necessary?
A A bunion may interfere with how you manage your daily activities – even if it isn’t painful. If an x-ray of your bunion shows changes due to arthritis or if there is a narrowing of the joint space or if the range of motion to your big toe joint is decreasing, your podiatrist may recommend surgery.
Q My Bunion is painful. What should I do?
A Book a visit to a board-certified podiatrist. They can assess your bunion and how it is impacting your usual activities. They can then suggest the most appropriate treatment. Don’t put off seeing a podiatrist as early treatment may save you from more invasive treatment later on.
Q What Will Happen If I Don’t Seek Treatment?
A If left untreated a bunion will get worse over time and cause other issues. If a bunion rubs inside a shoe, it can cause corns and calluses to form. The bunion may cause the big toe to press against other toes which can lead to ingrown toenails. In severe cases bunions can cause hammer toe or may lead to a loss of mobility in the foot and even a loss of feeling.
Q What Is Bursitis?
A If a bunion is left untreated, the fluid sac covering the joint of the big toe may become inflamed causing severe pain and difficulty in walking.
Q Why Is Bunion Treatment Vital For Diabetics?
A More than 28 million people in the US suffer from diabetes. Half of those will develop neuropathy. This is nerve damage which can cause a loss of feeling to the lower legs and feet. If a bunion is not treated and becomes inflamed, it may cause an ulcer to form. A diabetic person may not detect this until the ulcer becomes infected. The worst case scenario is that it could lead to partial amputation of the foot or full amputation of the foot or lower leg. Diabetes is the main reason for the amputation of lower limbs.
With early treatment, this can be avoided. It’s highly recommended that all diabetics pay regular visits to a podiatrist.
References: American Podiatric Medical Association
HAMMERTOES (520 words)
Q What Are Hammertoes?
A They are toes that have become fixed in a bent position. Any of the smaller toes can develop into a hammertoe but the toe next to the big toe is the one that is usually affected.
Q How Do Hammertoes Develop?
A The tendons and muscles that usually hold the toe straight go out of balance. They allow the underside of the affected toe to tighten up which causes the middle joint of the toe to bend to the extent that it bends upwards.
Q I Have a Toe That Bends upward but it’s Still Flexible. Is it a Hammertoe?
A Yes. When hammertoe starts to develop, the toe is still flexible but if not treated, the tendons and muscles will become more unbalanced until the toe is totally stiff and unable to move. The more stiff it becomes the more painful it will be. Once it gets to this stage it is much harder to treat without surgery.
Q What causes Hammertoes?
A Wearing shoes that are too tight and too narrow is the most common cause. Wearing high heels with pointed toe boxes will squash the toes together and increase the pressure on the ball of the foot. This leads to tissues contracting and tightening.
Q What is a toe box?
A This is the name for the front part of a shoe which contains your toes. It may be rounded, square or pointed. The more pointed the toe box is, the less room your toes have. This lack of room can cause hammertoes, crossover toes (where the second toes crosses over the big toe), corns and calluses.
Q What Is The Treatment For Hammertoes?
A If caught early enough a hammertoe may be treated by non-surgical methods. If you have a toe that has started to bend towards your big toe, it’s important to visit your podiatrist who can assess it and start treatment that could help you to avoid surgery.
Q What non-surgical treatment is available?
A Changing your type of footwear is the first option. Choose shoes that have enough room to allow you to stretch your toes comfortably. You also need the ball of your foot to be properly cushioned. Your podiatrist may recommend pads that will stop the bent toe joint rubbing in your shoe. This would also help to prevent corns and calluses developing. They may also suggest custom made orthotics to support the structure of your foot.
Q Would Exercises Help?
A Yes. This is especially helpful if your affected toe has not become rigid yet. Stretching your toes can help the tightened muscles and tendons in the hammertoe to relax while building up strength in the non affected toes. Try spreading your toes, pointing them and bending your feet. Put some marbles on the floor and try and pick them up with your toes.
Q Will I Need Surgery to Correct Hammertoes?
A If your podiatrist finds that the affected toe is too rigid to benefit from exercise or orthotics, they may recommend surgery to release the tightened tendons and restore movement to the toe.
Reference: American Academy of Orthopaedic Surgeons
DIABETIC AND PERIPHERAL NEUROPATHY (500 words)
Q What is Peripheral Neuropathy?
A It’s damage to the peripheral nerves. ‘Peripheral’ simply means the extremities of your body so your most peripheral nerves are in your fingers and toes. Peripheral may also refer to hands and feet.
Q What Are the Symptoms of Peripheral Neuropathy?
A When nerves are damaged they won’t work properly so peripheral neuropathy can lead to less feelings in the toes and fingers. It may also feel like burning, numbness, tingling, shooting or stabbing pains. If the damage is severe, the person may have difficulty moving their feet, hands, toes or fingers.
Q What Causes Peripheral Neuropathy?
A The most common cause in the US is diabetes. Tingling, pain, or numbness in the hands and/or feet is one of the symptoms of Type 2 diabetes . It’s estimated that 60 to 70% of people with diabetes will develop some form of neuropathy .
Q Is Diabetes The Only Cause Of Peripheral Neuropathy?
A No. Other causes may include –
Some medications including some forms of chemotherapy.
Genetics – if your family history includes peripheral neuropathy, you may be at risk.
Getting older – the older you get, the more at risk you are of developing it.
Suffering from Arthritis – certain types may cause peripheral neuropathy.
Alcoholism – in this case it is called Alcoholic Neuropathy. Up to half of all long-term heavy alcohol drinkers will go on to develop this .
Neurological disorders – some neurological disorders such as spina bifida and fibromyalgia may include peripheral neuropathy.
Multiple Sclerosis – Numbness of the face, body or extremities (arms and legs) is one of the most common symptoms of MS.The numbness may be mild or it may be so severe that it prevents use of the affected part of the body. 
Injury – trauma to the peripheral nerves may also cause peripheral neuropathy.
Q Why Are Regular Foot Inspections Vital?
A If you have peripheral neuropathy and / or diabetes, it is crucial that you make regular visits to a podiatrist who can assess your feet and toes properly. In between appointments, make sure that you examine your feet regularly. If you have decreased sensation, you could easily damage your foot without noticing. If that wound becomes infected it can cause enormous problems. Check your feet and toes for any corns, calluses, swellings, protrusions, bent toes, blisters, puncture wounds, scrapes, abrasions or cuts. Seek appropriate medical attention immediately if you’re worried about anything.
If you aren’t able to check your own feet in between podiatrist appointments, get a family member, friend or home helper to do it for you.
Q Can I prevent peripheral neuropathy?
A Not always but you may be able to control the degree of it. Peripheral neuropathy usually corresponds to how well you have your blood sugar controlled. If you keep your diabetes well controlled, you should have improved sensation in your extremities which would alert you to any issue developing with your feet and toes.
FUNGAL TOENAIL INFECTION (467 words)
Q What is it and who gets it?
A The medical name for fungal toenail infection is onychomycosis. It causes half of all nail disorders, is the most common nail disease in adults and is increasing. It’s common in diabetics, anyone with a suppressed immune system (such as people undergoing chemotherapy or HIV treatment), people wearing shoes that cover the toes and older people. Adults are 30 times more at risk of getting it than children and it’s estimated that around 90% of elderly people suffer from it.
Q What are the symptoms?
A Onychomycosis will thicken toenails, cause them to discolour to a yellowish tinge, disfigure them and cause them to split. This can make it very difficult for someone to trim their nails. If the infection isn’t treated, the toenails can grow so thick that they press inside shoes which can cause great pain and may also encourage corns and calluses. The thickening may cause pain on standing, walking and wearing shoes.
It can also cause pricking, tingling or ‘creeping’ pains and a loss of agility. In severe cases, sufferers may lose self esteem and acute embarrassment can lead to social issues.
Q What Causes It?
A Onychomycosis is caused by three organisms:
Dermatophytes – the most common cause – fungi that feed on nail tissue and infect hair, skin and nails
Yeasts – the most common is candida
Non dermatophyte molds
All of them cause very similar results so the only way to find out which one is causing the infection is to send nail clippings for laboratory tests. The results will dictate what treatment is received.
Q Are there medications to cure it?
A Yes. New oral medicines have proven very effective. They travel around the body and start working on the infected nail within a few days. However, the rate of recurrence is high, even with newer medicines. Treatment is expensive, has certain risks, and recurrence is possible.
Oral antifungal medications – terbinafine (lamasil) and itraconazole (Sporanox capsules) are taken for around 3 months but must not be taken if the person has heart failure of liver disease. Doctors should take a blood test to check that liver function is normal before prescribing these.
Fluconazole (Diflucan) has not been approved by the Food and Drug Administration (FDA) but some Doctors use it instead of terbinafine and itraconazole.
Side effects: the most common for all oral meds for fungal nail treatment are nausea and stomach pains.
Topical treatments (applied to the skin and nail area) have limited value on their own because they can’t penetrate the thickened nail. However, they may be helpful if used with an oral medication.
Surgery involves surgically or chemically removing the nail. Surgery should always be accompanied by oral medications.
Laser Treatment – one of the newest treatments available.
TARSAL TUNNEL SYNDROME (478 words)
Q What Is Tarsal Tunnel Syndrome?
A It is shooting pains and /or numbness and/or tingling or burning sensations in the foot.
Q What causes it?
A To answer that, let’s take a quick look at where the tarsal tunnel is and what it does.
First, think about the bump on the inside of your ankle (medical name – medial malleolus).
Now imagine a band of ligaments stretching from that bmp inside your ankle to your heel.
[a ligament is a short band of strong but bendy tissue full of fibres that connects two bones or cartilages or holds a joint together.]
The tarsal tunnel runs under this band of ligaments and is a canal for the nerves, arteries and tendons to travel from your leg down into your foot. These give your foot movement and make it flexible.
One of the nerves that runs through the tarsal tunnel is the tibial nerve, which allows you to have feeling on the sole of your foot. If it becomes pinched, it alters the sensations that you feel.
Q What Can Cause The Tibial Nerve To Get Pinched?
A If you have flat feet or fallen arches, this can strain or press on the nerve. If you sprain your ankle and it becomes swollen, the nerve will become compressed. Arthritis and diabetes can both cause swelling and consequent nerve compression. If your ankle has anything abnormal or enlarged in it, that may compress the nerve – for instance, a swollen tendon, a varicose vein, a bone spur or ganglion.
Q How Is Tarsal Tunnel Syndrome Diagnosed?
A You may have a full medical examination and a full medical history, imaging (x-rays, CT or MRI scans) and electrical testing (this could be and EMG or nerve conduction study)
EMG – electromyography (also called a myogram). This is a test to find neuromuscular abnormalities. It measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle.
Nerve conduction study – This nerve conduction velocity (NCV) testis also called an EneG or electroneurography, It measures how fast electrical impulses move through a nerve. The results are used to determine the amount of damage that has occurred to the nerve.
Once this test (or tests) have been completed, the Doctor will be able to tell how severe the tarsal tunnel syndrome is and then formulate a treatment plan which may or may not include surgery.
Q What Non Surgical Treatments Are Available?
A You may be given anti inflammatory medications. Steroid injections into the tarsal tunnel may be used to reduce pressure and swelling. You may be asked to wear some form of orthotic device such as a foot splint to reduce pressure and limit movement that may be causing nerve compression.
Surgery may be recommended if your nerve is severely compressed or in danger of further damage.
Reference: John Hopkins Medicine