As the colder weather forces us to wear closed toe shoes, the problems that were ignored over the spring and summer are now becoming vastly apparent. Painful lumps and bumps are now more than just a nuisance. They actually start to limit our daily activities especially during this very busy time of year. I would like to discuss some of the most common foot and ankle problems that usually arise in the winter time and tend to be more aggravated by shoe wear.
The first problem to discuss is ingrown toenails. Unfortunately, patients usually do not seek treatment until the ingrown toenail becomes infected. The best treatment at this point is to remove the infected portion of the toenail. This is done through a five minute procedure in the office under a local anesthetic. There is typically very little if any pain after the procedure.
Bunions and hammertoes also become greatly more symptomatic with closed toe shoe gear. Bunions are essentially a progressive dislocation of your big toe joint and as the big toe starts to drift toward your second toe a large bump on the inside of the big toe joint becomes more problematic with footwear and movement.
Hammertoes are essentially progressive dislocations of bones and joints of each toe. The toe starts to contract and then the toe essentially sits higher and rubs on the inside portion of the shoe. We typically see this affecting the second and fifth toe. There are no sure fire conservative measures to fix these problems but there are many over the counter splints, pads and shoe wear modifications that can be applied to help reduce some of the discomfort caused by bunions and hammertoes. Purchasing a shoe with a wide square toe box can be beneficial. Custom made orthotics can also help reduce pressure to these symptomatic areas. The best treatment for bunions and hammertoes still remains to have the deformities fixed surgically through an outpatient procedure.
Neuromas are another common problem affected by closed toe shoes. The nerve supplying feeling to the toe becomes inflamed and irritated. Most people describe a feeling like walking on a rock or pebble or possibly their sock is wadded up in the shoe. Neuromas can be further irritated by pointed toe shoes or high heels. Obviously, footwear modifications are of great help but most of the time patients have waited too long for shoe gear modifications to be of great help. At this point, non-steroidal anti-inflammatory drugs (NSAID) and trigger point injections of local anesthetic combined with steroid are very helpful. In fact, these methods produce complete resolution of symptoms for the vast majority patients.
Haglund’s Deformity, or spurring to the back of the heel bone, also becomes very problematic this time of year with boots and shoes. These spurs can produce considerable pain during the first few steps following rest. Irritation from shoe wear can also cause irritation. X-rays are generally required to ensure that the spur did not crack or break off. People do very well with NSAID’s, heel lifts and physical therapy. If this course of treatment does not help an MRI is warranted to ensure that the Achilles tendon does not have a partial tear. Unfortunately, many times the spur is the ultimate problem and needs to be removed but conservative therapy can be very helpful as well.
The most important thing to realize is that foot and/or ankle pain is not normal and should be evaluated by a podiatrist sooner rather than later. More often than not patients wait because they think the pain will go away. Our feet are the foundation of our very busy, mobile lifestyles and the better we treat our feet the easier it will be to go through the year pain free.