BUNIONS
Your mother was wrong. You didn't get bunions from torturing your feet in high fashioned shoes. If pointed-toe, spike-heeled shoes created your bunions, where did your 12-year-old daughter get hers? Why does your mother have them? And where did Grandma get her bunions? From Great Grandma.
The bunion ranks next to the corn and callus as a major cause of foot misery -- discomfort is too mild a word. A bunion is the progressive movement of the great toe toward the second toe with a "bump of bone" forming on the side of the big toe joint, or on top of it There are many causes for bunions: heredity is the major factor, however poor posture and improper shoes certainly play in the picture to a lesser degree. The longer it exists, the more the great toe moves over and the larger the bump becomes. A bunion can be very painful and unattractive, and ultimately cause the great toe to become arthritic, or even dislocated. The crooked great toe and enlarged bump will crowd the lesser toes in a shoe. This can cause the patient to walk improperly and also lead to arch, leg or back pain.
A large percentage of bunions are painless and I advise my patients to leave them alone. Bunions should be surgically removed only when the patient can no longer find shoes to comfortably fit their feet.
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CORNS AND CALLUSES
During your lifetime, you will walk, dance, hop, skip and jump the equivalent of four times around the earth and all on the same two feet. They are made to last, but abuse your feet, and you'll pay with every tortured step.
Corns are an example of avoidable pain. A corn is a circumscribed thickening of the skin that develops because of recurrent friction and pressure. A corn is very similar to a callus, with the exception that a corn is usually found on the toes, whereas a callus is more frequently found beneath the ball of the foot, often associated with a metatarsal bone.
Painful corns on the toes have probably caused more foot pain and misery than any other single problem. The most common cause is a contracted or crooked toe, often referred as a hammer-toe, which will not lie flat in a shoe. Frequently, a bony spur or enlargement will contribute to this problem. Shoes do not cause corns, but they certainly can aggravate them. When the shoe cannot fit comfortably over the toe, the patient suffers the agony of a vise-like squeeze of the skin between the prominent bone spur and shoe, creating the corn. Never try to break in a shoe. As a rule, shoes break in feet. If the shoe fits well except for one small spot, have it stretched.
Sometimes corns can become infected, especially in patients with diabetes, poor circulation or loss of sensation. Conservative treatments with prescription inserts, commonly referred to as "orthotics," may help mechanically control the function of the foot, preventing early diagnosed hammer-toe deformities from rigidly fusing and forming a painful "corn". Over-the-counter medicated remedies should be avoided especially in diabetics.
Surgical treatment is considered only when conservative treatment provides little or no lasting relief, and can be accomplished in an outpatient setting with minimal loss of time off one's feet. Ninety to 100% of corns generally do not recur following appropriate surgery.
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DIABETES
Each year 60,000 Americans discover that they have diabetes. In addition, tens of thousands more have the disease without knowing it. If they are not diagnosed and treated, some may be among the nearly 15,000 people with diabetes who this year will undergo foot, toe, or leg amputations. All of us are likely to have problems with our feet, but diabetics may develop serious problems more quickly and have more complications, especially when circulation or nerves are impaired. When circulation is poor, the tissue in the foot is less able to fight infection. When nerves are impaired, an injury can occur without pain and, as a result may go unnoticed. Even the most trivial injury, if left untreated, can lead to serious complications. The key for the diabetic is to view all foot problems as potentially dangerous and to prevent them or seek podiatric care as soon as they occur. The endocrinologist is another key player in the prevention of diabetic complications.
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PROBLEMS OF JUVENILE DIABETICS
A cut, scrapes, blisters, and puncture wounds are a part of childhood. To prevent such injuries, diabetic children should always wear some kind of footwear. If foreign bodies such as splinters become lodged in the foot, or an infection or puncture wound occurs, the child should be treated promptly by a professional. Ingrown toenails can cause infections, which tend to be especially severe in diabetic children. Athlete's foot is a fungal infection common in young people. If it or other skin rashes are not promptly treated, secondary bacterial infections may develop.
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PROBLEMS OF ADULT DIABETICS
Concerns of adult and maturity-onset diabetics are somewhat different from children. Foot problems neglected in youth cause more problems, and can be compounded by circulation disorders and changes in sensation (diabetic neuropathy).
IMPORTANT CARE:

· Have your feet checked professionally at least twice a year.
· Inspect your feet daily.
· Avoid actions that restrict circulation to your feet, such as smoking, sitting with your legs crossed.
· Avoid burns, including excessive sunburn. Do not put feet in hot water or add hot water to bath without testing the water temperature.
· Use of over-the-counter corn cures should be avoided.
· Prevent unnecessary cuts and irritations. Do not walk barefoot or wear rundown shoes.
· When toenails are trimmed, be sure they are straight across.
· Wear shoes that fit.

By following a simple daily routine of foot hygiene, most long-term complications can be avoided.
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FLAT FEET
Flat foot is often misunderstood as fallen arches or broken arches. Actually a flat foot is mainly a structural abnormality of the foot in which the foot bones maintain a low angle, thereby giving an appearance of an absent or low arch area. Frequently a flat foot due to its abnormal structure causes the muscles, tendons and ligaments of the foot to function improperly and overwork itself, therefore giving symptoms to the person. These symptoms may include pain and/or cramping sensation in the arch, leg cramps and increased tendency towards fatigue or tiredness in the foot and leg. In children with abnormal flat feet, there may be additional signs and symptoms besides pain and tiredness of the foot and leg. The child may show clumsiness in walking and running; they may also show an increasing lack of interest or unwillingness to participate in physical activities such as sports, or running and walking for any prolonged length of time. Not every flat foot demonstrates abnormal signs or symptoms, and not every flat foot needs to be treated. However, if symptoms persist, then it will be wise to seek professional help from your podiatrist. If left untreated, the symptomatic flat foot may become progressively more painful and disabling and may lead to the formation of bunions, hammertoes or arthritis of the foot. Through careful examination and x-ray studies, your podiatrist can determine the cause and severity of the flat foot problem and initiate a treatment program aimed at relieving the discomfort and stopping the progression of the abnormality.
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FOOT SURGERY
There are many commonly asked questions regarding corrective surgery about such topics as disability, pain, and cost. Most importantly, we understand the apprehension associated with the prospect of foot surgery. While this apprehension is quite normal, a better understanding of what to expect will frequently help put this concern in proper perspective. Rapid advances in local anesthetic techniques and pain control have made it possible to correct many common foot problems permanently, on an ambulatory or out-patient basis, and with minimal disability and loss of time from work and daily activities. Some common foot problems amenable to this type of care are such things as: ingrown toenails, warts, corns/calluses, hammertoes and bunions. When necessitated because of concurrent medical problems or a need for more comprehensive medical management, arrangements are made for hospitalization and general anesthesia. The fact is, a better understanding of foot function, along with refinements of traditional surgical techniques and instrumentation, have made it possible to permanently alleviate or substantially improve most common foot problems. In regard to health insurance, podiatric medical and surgical foot care services are covered as a part of the benefit package under Medicare, BC/BS, and most every private health insurance program. For a more comprehensive overview of this subject, you may wish to call your particular insurance plan for specific details.
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INGROWN TOENAILS
One of the most common foot problems, ingrown toenails, can occur at anytime -- from infancy to old age. It occurs as a result of the nail edge embedding itself into the skin causing, pain, swelling, redness, and frequently, infection. It can occur on any toe, but most commonly on the great toe. They are painful and tend to recur -- but the cure is quick, painless and permanent with virtually no loss of time from any activity and generally one is able to resume wearing shoes and return to most normal activities immediately.
Over the counter medications are virtually worthless for ingrown toenails and can be dangerous, particularly to individuals with compromised circulation or diabetics. Tight shoes tend to aggravate ingrown nails but certainly do not cause them.
TREATMENT: The only permanent cure for an ingrown toenail involves the removal of the offending spicule of nail, including its root, in addition to addressing any concurrent infection, which may be present. The procedure is generally painless and takes only a few minutes in our office under a local anesthetic.
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JOGGING
With jogging as one of the nation's favorite outdoor activities, a few words of advice and caution should be given to the beginning and the serious joggers. Although jogging is a healthy sport, it is not intended for everybody just as skin diving is not intended for everyone. Persons with high blood pressure, diabetes, anemia or any other diagnosed disease, persons taking prescription medications, and persons over age 35 should consult their family physicians regarding their health status before starting on a jogging program. Proper daily warm-up and warm-down exercises before and after jogging are essential to both the novice and the serious jogger. These exercises are intended to limber the muscles and help prevent cramps or injuries to muscle groups.

Just like any other sport, the proper equipment is usually necessary for a better performance. In jogging padding inside the shoe is necessary so as to help absorb the stress in jogging. The training terrain should not be hard and, the clothing should be loose and non-confining and the shoes should be soft and flexible with proper unyielding. The two most preferable types of surfaces are dirt roads and grass. A word of caution: grassy areas sometimes my have small potholes that can cause tripping and falling, so one should be careful when using this kind of surface. In modern day cities, asphalt and concrete are almost unavoidable and if one must jog over these hard surfaces, asphalt is slightly softer and less jarring to the jogger. Like any other sport, jogging can have related injuries. Early signs of trouble may include heel and arch pain, foot and leg fatigue or cramps, or inability to go beyond a certain distance. These are often indications of injury, improper stretching exercises, improper terrain or faulty training methods; such as increasing the running distance too much too soon. If pain and discomfort persist, then professional help from a podiatrist should be sought.
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NERVE PROBLEMS
There are various types of nerve tumors found in the foot. Here we are concerned with the most common type called a neuroma or Morton's neuroma. A neuroma is a benign nerve tumor of the foot, which can be caused by a variety of factors, such as injury, stress to the foot, improper foot function and structural problems, like bunions, which may result in crowding of the feet in shoes. All of these factors generate a frequent irritation to the nerve and can subsequently cause and enlargement of that nerve, thereby forming a neuorma. Frequently, a neuroma causes a burning pain localized to the ball of the feet. This burning sensation may sometimes change to a pins and needles type of feeling that may travel into the toes or back into the rest of the foot. These unpleasant sensations usually occur while the person is walking with shoes and may improve or even subside when the shoes are removed and the painful area massaged. If you should suffer from these symptoms, it is advisable to see your Podiatrist. After a careful examination to determine the cause and severity of the neuroma, your foot specialist will be able to prescribe the proper program of treatment. This may include conservative measures such as injection therapy to calm down the nerve irritation or possibly an orthotic support to relieve or eliminate the stress to the foot. In severe cases in which the neuroma does not respond to conservative treatment, then a simple, relatively painless surgical procedure may be necessary to obtain relief.
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SPORTS INJURIES
Foot and leg injuries are common hazards in sports. Among the most common injuries are shin splints, tendonitis, ankle sprains, stress fractures, and heel and arch pains. These injuries can be brought on by a number of reasons. Frequently, slight changes in the terrain, improper warm-up period and abnormal wear of the shoe can all bring on an injury. If an injury happens to you, the immediate treatment should consist of ice and rest. Ice applied to the area of injury within the initial 24 to 48 hours usually helps prevent excessive swelling. Rest should consist of reducing the amount of sports activities, or in severe cases, staying away from sports until healing is complete. If symptoms of pain in the foot persist, then it is advisable to see a podiatrist. Most athletes are reluctant to seek professional help for fear that they may be told to limit their sports activities. However, with early diagnosis and treatment, chances of complete healing are greatly improved. While no person is guaranteed against injuries, there are a few helpful hints that can decrease your chances of sustaining an injury. Proper warm-up and warm-down exercises, strengthening exercises for muscles and watching out for uneven surfaces or abnormal wear of the shoe can all help. Athletes place special demands on their bodies and their foot and ankle injuries should receive prompt and specialized attention, particularly if they are inhibiting the athlete's physical performance. One of the goals of podiatric medicine is to keep the athlete active in sports, while protecting him from further injury. No injury is too minor or trivial to ignore. An untreated foot injury can potentially lead to long-term inconveniences.
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