BUNIONS and BUNIONETTES
Bunions are a common complaint in our office and an often-misunderstood condition. Many years ago, bunions were hard to treat and required a lengthy hospital stay. A bunion is an unsightly, protruding bony bump at the base of the big toe, where the large toe angles to the smaller toes. The skin over the bunion can become swollen, irritated and/or infected due to irritation from shoes. Bunions can be associated with bursitis or arthritic changes in the joint, and may also exist along with hammertoes. Bunions are a result of heredity, foot type and muscular imbalance and shoe gear. Although the role of shoes in the development of bunions is still not completely understood, it is well known that shoes will aggravate a bunion or make a bunion that did not hurt, suddenly become painful. In addition, trauma, arthritis and certain neurological conditions can cause bunions. There are several treatment options that will treat the symptoms of a painful bunion. Some of these treatments include round toe shoes, molded shoes, paddings, splints, shoe inserts, injections, physical therapy and anti-inflammatory medications. However, these treatments will not get rid of the bunion. If a bunion is not painful, it does not need to be treated. Surgical intervention is the only method of getting rid of a bunion. There are multiple corrective procedures available. The best surgical procedure for each individual case is based on an assessment of the severity of the deformity, the amount of the arthritic/degenerative changes present, the age of the patient, the patient’s activity level and a thorough evaluation of X-rays and special angular measurements. The procedures involve removal of the painful bump, realignment of the large toe and straightening/realignment of the 1st metatarsal bone. Patients may require the insertion of pins, screws, or wire to aid the bone in healing and to maintain correct postoperative alignment. A tailor’s bunion is a small bunion at the base of the little toe. This condition is also known as a Bunionette. The same methods of conservative and surgical treatment of Bunions are performed for Tailor’s Bunions. Bunions and Bunionettes are progressive deformities and, if painful, will probably continually worsen over time. Surgery is performed on an outpatient basis at a hospital or surgical center. The surgery is usually performed under local anesthesia, with some sedation. Surgery performed as an outpatient provides patients with high quality medical care, without the inconvenience, complications, and expense of an overnight hospital stay. At our office, the decision to have surgery is always left to the patient. With proper explanation, our patient will understand his/her foot problem allowing intelligent, informed decisions to be made. At our office, patients are encouraged to ask questions. If you would like more information, please speak to the doctor or staff.
Care of the Diabetic Foot
Fungal infections of the nail, or onychomycosis, are often ignored because the infection can be present for years without causing and pain. The disease is characterized by a progressive change in a toenail’s quality and color, which is often ugly and embarrassing. In reality, the condition is an infection underneath the surface of the nail that may be cause by fungi, yeasts or molds. When the tiny organisms take hold, the nail often becomes darker in color and foul smelling. Debris may collect beneath the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails. If ignored, the infection can spread and possibly impair one’s ability to work or even walk. This happens because the resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Onychomycosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate. Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. Injury to the nail bed may make it more susceptible to all types of infections, including fungal infection. Those who suffer from chronic disease, such as diabetes, circulatory problems, or immune-deficiency, are especially prone to fungal nails. Other contributing factors may be a history of athlete’s foot and excessive perspiration. Treatment of Fungal Nails Treatment may vary, depending on the nature and severity of the infection. A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of a liquid antifungal agent. However, even the best over-the-counter treatments may not prevent a fungal infection from coming back. A podiatric physician can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail. Newer oral antifungal, approved by the Food and Drug Administration is the most effective treatment. They offer a short treatment regimen of approximately three months and improve effectiveness. Podiatrists may also prescribe a topical treatment for onychomycosis, which can be an effective treatment modality for fungal nails. In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail. Trying to solve the infection without the qualified help of a podiatric physician can lead to more problems. With new technical advanced in combination with simple preventive measures, the treatment of this lightly regarded health problem can often be successful.
Heel pain is one of the most frequently treated ailments in our office. Although heel pain can be caused by many different disorders, such as arthritis, collagen diseases, overuse, trauma, etc. The overwhelming majority of heel pain is caused by plantar fasciitis. This painful heel is usually called “heel spur syndrome”. Plantar fasciitis/heel spur syndrome is an inflammation of a thick band of tissue at the bottom of the foot called the plantar fascia. The inflammation of the plantar fascia, at its origin at the heel bone (calcaneus), causes the classic symptoms of pain at the bottom and/or side of the heel. This is most painful upon arising in the morning or when standing after rest, and the stretching inflames the painful area even more. The pain can exist with or without a “heel spur”. The pain is caused by the stretching and inflammation of the plantar fascia, and not by the bone spur. The spur is the result of the pulling of the fascia at the heel bone, resulting in proliferation of the bone, often referred to as “heel spur”. Many patients are seen with severe, acute heel pain, and they do not have any heel spur on Xray. In addition, often heel spurs of all sizes are seen on X-rays of patients that do not have any heel pain. As a general rule, THE PRESENCE OF A HEEL SPUR IS NO INDICATION OF THE AMOUNT OF PAIN THAT EXISTS. THE PAIN IS USUALLY NOT FROM THE HEEL SPUR, BUT IS FROM THE STRETCHING AND INFLAMMATION OF THE PLANTAR FASCIA. Therefore, treatment is directed at decreasing the bulk of the plantar fascia, and supporting the fascia during weight bearing to decrease the inflammation. Most of the common treatment options are as follows: Anti-inflammatory medication taken by mouth. These medications treat symptoms of the pain and inflammation, but do not treat the cause of the pain. Patients with ulcers or who are allergic to Aspirin like medications cannot take these medications. Heel cushions with or without cut out areas or Heel Cups. It has been our experience that heel cushions are of very little value unless a bruise caused the heel pain. Plantar fasciitis cannot be supported in the arch with the use of heel cushions. Physical therapy using whirlpool, ultrasound, electrical stimulation, Iontophoresis, or stretching is often very effective and treats the symptoms (pain and inflammation) as well as the cause (stretching the tightness of the plantar fascia and Achilles tendon). Taping/strapping of the foot often provides dramatic relief for the patients, because the taping addresses the cause of the problem by supporting the plantar fascia. Orthoses, often known as orthotics or custom-made arch supports, are inserts for your shoes that mechanically correct the foot, as well as support the plantar fascia, therefore reducing the discomfort. Orthoses are available in many varieties from over the counter to custom made. Although orthotics are expensive, they usually last 10-15 years before your foot prescription changes. Injections of a mixtue of local anesthetic and Cortisone are used to locally and directly reduce pain and inflammation. Although results are usually very good with injections, once again, the cause of the problem is not being addressed. It is generally accepted that no more than 3 injections should be given during a year. Soft tissue wraps such as fabrifoam Pronation Spring Control, support the plantar fascia and are often a simple and cost effective way to decrease symptoms. Casting, placing the foot and lower leg in a cast for several weeks, allows the tissue to slowly stretch and the inflammation to subside. The majority of cases respond to other methods of treatment, and casting is seldom necessary. Night splints are a relatively new method. These devices are worn at bedtime or at rest. They place a constant passive stretch on the plantar fascia, in order to prevent tightness and to promote stretching without inflammation. Surgery is utilized when conservative measures have not been successful or when the patient and the Doctor have decided that surgery is in their best interest. Newer techniques have drastically changed the way surgery is performed and usually decrease the post-operative discomfort and recovery period. A method called Endoscopic Plantar Fasciotomy involves surgically releasing a portion of the tight plantar fascia using an endoscope through two ½ inch incisions. The scope allows for accurate placement with monitoring of the procedure and visualization of the tissues on a television screen. This reduces trauma and post-operative discomfort. This high tech procedure and small incision usually allows for a quicker recovery. However, it must be stressed, that over 95% of patients in our office DO NOT REQUIRE SURGERY, and have symptoms relieved with conservative care. Another new method that is performed is shockwave therapy
Warts, Athlete's Feet and Ingrown Nails
WARTS Warts are caused by a virus and can recur. Plantar warts are often mistaken for corns and calluses on the bottom of the foot. Warts have a spongy appearance with little black, brown, or red spots indicative of blood vessels feeding them. There are many ways to treat these benign (non-cancerous skin lesions). There is no best way. Each method of treatment has advantages and disadvantages. Sometimes it becomes necessary to use a combination of treatments. Warts can spread and they are usually very difficult to get rid of them without professional attention and care. ATHLETE’S FEET Athlete’s foot is a skin infection caused by a fungus, usually occurring between the toes or on the soles of the feet. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment, which encourages fungus growth. The warmth and dampness include areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi. Not all foot rashes are athlete’s foot. The doctor will determine if the fungus is the cause of the problem, and develop a specific treatment plan to resolve it. INGROWN NAILS Ingrown nails, the most common nail impairment, are nails whose corners or sides dig painfully into the soft tissue of nail grooves, often leading to irritation, redness, and swelling. Usually, toenails grow straight out. Sometimes, however, one or both corners or sides curve and grown in to the flesh. The big toe is usually the victim of this condition, but other toes can become affected. Ingrown toenail surgery is usually performed with local anesthesia. Removal of a portion of the nail, removal of the entire toenail, and removal of the infected tissue is performed depending on the severity of the condition.
Nova Family PodiatryBernard A. Novabilski, P.C. 3125 Ridge Pike, Suite BEagleville, Pa 19403
Tel: (610) 631-3338Fax: (610) 631-0313
Monday: 9:00 AM to 7:00 PM Tuesday: 9:00 AM to 4:00 PM Wednesday: 8:30 AM to 7:00 PM Thursday: 9:00 AM to 4:00 PM Friday: 9:00 AM to NOON Friday: 9:00 AM to 3:00 PM(Nursing Home) (Assisted Living) Saturday: By Appointment