Monday, February 25, 2013

Celebrity's and their Ugly Bunions

What is a bunion? This is a bony bump that forms on the outside edge of the big toe. It is estimated that half of women in America have bunions. In fact, it is so common than even celebrities are not spared from this foot condition.
Victoria Beckham, for instance, has not made it a secret that she has problems with her feet. In the past, she has reportedly stated that the ugliest thing about her were her feet. Her penchant for wearing high heels may have resulted to the development of bunions.  Shoes with high heels are commonly damaging to the toes. Victoria is seldom without her towering heels, which may have led to bunion formation.
Wearing elevated heels regularly is known to put unwarranted pressure on the foot. Thus, it is not surprising that a lot of models, such as Naomi Campbell, develop bunions. Celebrity millionaire Oprah Winfrey is not spared from the infamous bunions. Rumors still circulate whether or not she had bunion removal. Although she wears heels during her television appearances, she is known for kicking her shoes off once she goes off the camera. 
Celebrities may look glamorous in towering stilettos but this puts them at more risk of bunion formation. Aside from frequent use of high heels, another contributing factor to development of bunions is wearing too tight shoes. All the stress exerted on the foot from wearing improper footwear can put increased stress on the big toe joint. The extra strain on high heeled shoes or too tight shoes can hasten the formation of bunions in those who are inclined to develop them.
Genetics also plays a significant role in bunions. If the condition runs in the family, then it is more likely to have them. Sometimes, foot injuries can also be a factor. Other risk factors are certain nerve conditions that affect the foot, rheumatoid arthritis, congenital reasons, or occupational factors, for instance among ballet dancers.
Bunions may or may not cause foot pain. A bunion is seen as an enlargement of the base of the big toe. Later on, it can get larger and then sticks out. The skin over the bump may be tender and reddish. As the bunion gets bigger, the more it hurts to walk. In others, the pain can become chronic and the pressure from the big toe may force the second toe out of alignment.
In diagnosing bunions, the physician will do a thorough physical examination of the foot as well as an x-ray to assess the severity and possibly identify the cause of the bunion.
Although bunions do not always cause problems, they are permanent. The treatment options depend on the size of the bunion and severity of the pain. For smaller bunions, wearing comfortable shoes, using foot pads, and avoiding high heeled shoes can reduce stress on the bunion and decrease pain. Over the counter arch supports or prescription orthotic devices can provide relief. Medications such as acetaminophen, ibuprofen, naproxen, or cortisone injections can be helpful.
Larger bunions can get more painful and only surgical correction can be an effective solution. Often, this includes a bunionectomy which includes removal of the swollen tissue around the big toe joint, straightening the big toe, realignment to straighten the abnormal angle in the big toe joint, and permanently joining the bones of the affected toe joint. 
Old fear of painful bunion surgery is unfounded in our practice as our patients typically take only 1 or 2 days of pain medication in anticipation of agonizing pain that does not exist.   Our secret to painless bunion surgery?   Careful tissue handling and surgical technique by the doctor, quality peri-operative local anesthesia and proper use of steroids and anti-inflammatories during and after surgery. 
Prior to making the first incision the patient's foot / ankle is blocked with local anesthetic such as what a dentist would do prior to drilling teeth.    This initial injection stops the pain response of the body before it even starts.   Then at closure time another injection is given with a 24 hour local anesthetic to decrease post operative sensation or stress of surgery.    Most of the time a mild steroid is given as well as an intravenous strong none steroid anti inflammatory.   All these extra steps are taken to ensure a smooth and painless recovery from bunion surgery. 

Family Foot  and Leg Center, PA
661 Goodlette Road, Suite 103
12250 Tamiami Trail East, Suite 101
1660 Medical BLVD, Suite 302
Naples, FL
239 430 3668 for central scheduling.


Friday, February 8, 2013

Secrets to Neuromas

Neuroma and its Various Treatments

A neuroma or Morton’s neuroma is defined a painful condition that involves the ball of the foot. Commonly, the area between the third and fourth toes is affected. The pain can be felt as sharp burning pain, stinging, or a feeling of numbness. In a small number of patients, the nerve pain can occur between the second and third toes.

The reason behind this is usually because of an injury, irritation, or pressure. A neuroma is sometimes described as a nerve tumor although this may not always be true. A neuroma is a swelling in the nerve that may bring about permanent nerve damage.

Although the exact cause for neuroma is unknown, there are certain factors that are believed to play a role in its development. These include having flat feet, high foot arches, abnormal positioning of the toes, bunions, and hammertoes. Wearing tight fitting shoes and high heels was also found to be a contributing factor. This may be why more women are affected compared to men.

If you have persistent foot pain of have continuous foot tingling, it is best to see a podiatrist. Helpful information would be the type of pain felt and how much pain is involved. Inform the physician about foot conditions that you have, what type of shoes you usually wear, your work, sports activities, and lifestyle.
In the diagnosis of neuroma, a thorough physical examination is the first step. There is usually tenderness on the involved area upon compression. Sometimes, there is a tingling sensation when the sides of the foot are squeezed. To rule out bone problems, a foot x-ray is often done. Other tests are magnetic resonance imaging or MRI, ultrasound, and electromyography or nerve testing.

There are basic treatments that usually resolve the pain in neuroma. Resting the foot is the simplest. Using foot pads or arch supports can help minimize the pressure on the nerve. These can either be custom made or bought over the counter. Taping the toe area is another way to manage pain. Staying away from high heeled shoes and wearing shoes with wider toe boxes also help.

Taking anti inflammatory medications, other painkillers, or injection of nerve blocking medicines into the toe area may also be suggested. However, painkillers are not to be used for long term management. Cortisone injections and the use of orthotics may be combined to manage the condition.

Another alternative is chemical destruction of the nerve or chemical neurolysis with 4% alcohol with sarapin and phenol can be used. This involves a series of injections using a local anesthetic mixed with an alcohol solution. Repeated exposures to chemicals destroy a part of the nerve which is causing the pain.
In a small percentage of patients, surgery may be needed. This is especially true when the nerve has become damaged permanently. Decompression surgery involves cutting nearby structures to relieve pressure on the nerve thereby alleviating neuroma pain. Sometimes, surgical removal of the nerve may be necessary if other treatments do not provide relief from pain.  As with any surgical procedure, complications can occur such as excessive swelling, infections, healing problems, bleeding, scarring, or continued pain. Regrowth of a more painful neuroma can happen also.

ESWT or extracorporeal shock wave therapy is now also starting to be utilized for neuroma pain that does not respond to the usual methods and an alternative before proceeding to surgery. In this treatment method, powerful but painless energy pulses are used to induce microtrauma to the tissues. In turn, the natural healing process is induced in the area. Studies have shown the potential of ESWT neuroma treatment for persistent pain that is not responsive to the usual management methods. This technique is great for people with previous neuroma surgeries where it is actual scarring that causes the pain. In our practice, Family Foot and Leg Center, PA 80% resolution in 4 wks and 100% resolution in pain after the 5 months for majority of patients who have undergone ESWT for treatment of pain after neuroma surgery.

Our newest addition it the RF ablation therapy. It is heat that is generated by a probe that injures the nerve to the point where it no longer sends pain signals. Pain management doctors have been doing this for the neck and lumbar spine issues. FFLC, has been using this for neuroma management with great success for those that fail the usual treatments as mentioned earlier.

We have minimized greatly the number of patients having to undergo neuroma surgeries. This surgery very unpredictable even in the best of surgical hands.

Family Foot and Leg Center, PA
239 430 3668 for Centralized Scheduling.
3 locations to serve you:
661 Goodlette Road, suite 103 Naples, FL 34102
12250 Tamiami Trail East, Suite 101 Naples, FL 34113
Royal Palm Medical Building
1660 Medical Blvd, Suite #302
Naples, FL 34110

Soon to come:
Fort Myers
3596 Broadway Fort Myers, FL