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.

AFO

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

www.NaplesPodiatrist.com

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  

Pediatric Flat Foot

Often, I would get a consult for pediatric flat foot / feet deformity from the pediatrician or concerned parent. General rule is that if the child has a flexible flat foot that  can be controlled with a true custom orthotic device such a UCBL (University of California Berkeley Labs) type orthotics and some Achilles stretching exercises then the child would just be monitored over the years.  If despite the conservative treatments above the child still has pain then surgical correction will be discussed.  Not all pediatric flat foot deformities require surgery only a small percentage would actually need corrective surgery.   Please refer to my post below about adult flat foot ,etc below for more information.

Part I

Part II discussion

Secrets 2 Stopping Heel Pain

A common foot complaint is pain in the bottom of the heel. This is often referred to as heel spurs or plantar fasciitis. It commonly is painful the first few steps in the morning or after rest. Heel pain tends to get worse the longer one stands during the day. 

It is caused by subtle changes in foot structure that occurs over time. These changes result in the gradual flattening of the arch. As this occurs a thick ligament (the plantar fascia) that is attached to the bottom of the heel and fans out into the ball of the foot is stretched excessively. This ligament acts as a shock absorber while walking. As the foot flattens it stretches. If it stretches too much it gets inflamed and causes pain. 

Over time the pull of the ligament creates a spur on the heel bone. It is important to realize that it is not the spur that causes the pain and therefore the spur does not need to be removed in most cases. This condition may also cause generalized arch pain called plantar fasciitis. This is an inflammation of the plantar fascial ligament.

A common factor that contributes to this condition is tightness of the calf muscles. Women who wear high heels and people who walk for exercise will often develop this problem because of the tightness that results in the calf muscle as a result of these activities. A non-supportive shoe also contributes to heel pain. Weight gain is another factor in developing heel pain.

Home Treatments for heel pain


Stretch, Stretch, Stretch and Stretch

Calf muscle stretching is very useful. The typical runners stretch by leaning into a wall is helpful. An alternative method of stretching is to stand approximately two feet from a wall. Facing the wall turn your feet inward so you are pigeon toed. Lean forward into the wall keeping your heels on the floor and the knees extended. Also keep your back straight and do not bend at the hips. Hold the stretch for 10 seconds and do the stretch ten times in a row. Do the stretching three times each day. Always stretch the calf muscles following any form of exercise. 

• Our Doctor's Recommended Stretches

Over the Counter Arch Supports

Wear a supportive sport or walking shoe. This can be supplemented with a good over the counter arch support, some of the time a custom made set may be recommended / required. 

Our doctor recommends the new balance sneakers

Oral Anti-inflammatory Medications 

Medications like Advil, Naprosyn or Aleve may be of some benefit. Always read the medications directions and warnings before use and seek the advice of a physician. 


VISIT www.NaplesHeelPain.com



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Professional Care

If the heel pain persists your foot doctor may suggest a cortisone injection, taping the foot to support the arch, night splints to stretch the calf muscles at night while you are sleeping or functional foot orthotics. Professional physical therapy program may also be required.    The Family Foot and Leg Center has the only integrated foot and ankle physical therapy clinic in the area.  We are very proud of our excellent , knowledgeable staff with over 32+ years of experience in physical therapy.  ESWT or shockwave therapy will help patients without the complications of surgery.   On occasion, surgery may be required to cure this condition.  

Greatest Fear in Bunion Surgery Addressed

Greatest fear in bunion surgery comes from hearing stories about the pain and agony of someone who knows   of someone, who heard of someone, etc who had bunion surgery and it was the worse pain ever.

In the past foot surgery can be painful, but that is a thing of the past. 

How we now decrease the discomfort or even eliminate post operative pain is a multi pronged approach. 

1) preoperative IV NSAIDs or oral NSAIDs barring allergies and kidney issues

2) preoperative anesthesia with a nerve block despite the type of other anesthesia used such as Sedation or general anesthesia. 

3) careful incision planning

4) careful soft tissue handling to minimize trauma and collateral soft tissue damage

5) intricate closure of tissue to minimize bleeding

6) post operative long lasting anesthetic that can give up to 8 hours = of numbness.    

7) post operative steroid injection to decrease inflammation 

8) post operative pain medication both narcotics and none narcotics

Most of our patients report a pain scale of  zero to three out of ten (most pain) at their post operative visit. 

Saving Limbs and Lives with Amniotic Stem Cells

Family Foot and Leg Center, P.A.

Named a National Center of Excellence for Advanced Wound Care Technologies
Drs. Kevin Lam, Ramy Fahim and W. Drew Chapman of Family Foot and Leg Center
Naples, FL
239 430 3668

The Use of Amniotic Stem Cells in Wound Healing

Stem cells are a class of undifferentiated or “primitive” cells that are able to divide and differentiate into specialized cells of the body such as skin, bone, muscle cells, blood cells, liver cells, and the like. The two main types are embryonic stem cells and adult stem cells. Embryonic stem cells are derived from the inner cells mass of blastocysts of pre-implantation stage embryos. Adult stem cells are less controversial than embryonic stem cells because their production does not involve the destruction of an embryo.

It is now possible to take stem cells from the amniotic fluid and reprogram them to a more versatile state akin to embryonic stem cells. Using stem cells from amniotic fluid overcomes the ethical opposition to using human embryos as a source of cells.

Amniotic stem cells have a wide range of applications that can be used in research and treatment. A study confirms that the amniotic fluid is a good source of stem cells. This is seen to be more acceptable because this involves no genetic manipulation. Amniotic stem cells can differentiate into various types such as muscle, skin, bone, cartilage, cardiac tissue, nerves, and have a great potential in various medical applications.

Wound healing is a major health problem. Chronic wounds such as a leg ulcer, a foot wound caused by diabetes, and other slow healing wounds have a biological or physiological cause for not healing. Among diabetics, for instance, it is estimated that 15 percent of these patients will develop an open foot sore or diabetic foot ulcer. These chronic wounds have been difficult to cure.

Today, the use of stem cell therapy along in combination with medications and proper wound care can help encourage better wound healing. Stem cell rich materials injected into the area can allow for effective wound healing that otherwise can take considerably longer to heal or may not have healed otherwise. Amniotic stem cell treatments are now revolutionizing chronic wound treatments. Recent studies show that stem cell therapy can dramatically improve the condition of chronic and deeper wounds which would otherwise require more lengthy and expensive rehabilitation.

The healing activity of stem cells is due to their ability to separate into the different component cells of injured tissues as well as release growth factors that may encourage the formation of new blood vessels in the patient. It has been evident that these cells have the ability to multiply, integrate with the host tissue, and replace the damaged cells. Using amniotic stem cells in wound healing have sped up the rate of recovery and the results have been outstanding, saving limbs / lives. 

Post Moh's surgery for skin cancer.   Cancer free, now it is toe saving time. High risk for amputation skin cancer skillfully removed by Mohs surgeon now the challenge.   Day 0

Toe Saving Time after amniotic injection and matrix graft Day 14

Toe Saving time  Day 21

Complete healing at Day 45

Pain in the Ankle / Subtalar Joint On Uneven Surfaces

When patients presents with this complaint a full radiograph of the ankle / foot is required to help.   Surprisingly the pain is usually not in the ankle joint, but rather a very little talked about joint called the subtalar joint.   This joint is below the ankle joint in the foot.  Testing for this is involves moving the foot in and out by grabbing the heel, called an inversion / eversion stress test.   Clinical exam will review pain in the outside of the foot right underneath the small ankle bone, fibula.       Subjective complaints from the patient can be burning, shooting pain and stiffness in the morning with difficulty with uneven surfaces.

Case below is a 72 year old RN presents for second opinion on her ankle pain.  She has been to other doctors to no avail. Xray below was taken.

Symptoms: Pain in the lateral foot below the ankle joint. Pain on uneven surfaces, stiffness and pain in the morning.   Manual test shows pain upon inversion and eversion of the isolated joint.  Patient did get immediate relief with 1% lidocaine into the subtalar joint.   

Preop Xray below. 

FFLC patient preop: note the malalignment on this view.  MRI confirmed swelling  and ligament  injury in the subtalar joint

Above shows the post operative Xray of a healed subtalar joint fusion. Noted the joint is realigned now and that there is a boney bridge present. No pain per the patient and able to go about her activities as an RN at full duty. 

Post operative protocol: 

8 wks of none weight bearing in a cast.  Then a cam boot for 8 wks with aggressive physical therapy. 

Discussion: Degenerative joint disease of the subtalar joint can be treated with NSAIDS such as motrin, aleve, etc.  Injection therapy with corticosteroids may be of help, but  a dislocation as presented in this case requires a subtalar joint fusion or the pain and instability will continue on a daily basis.

Below is a poem from a subtalar joint fusion patient.

Dr. Kevin Lam
Family Foot and Leg Center, PA
Naples, FL
239 430 3668
www.NaplesPodiatrist.com

AFO