A bunion is a prominent bump of the great toe at the outer edge of where it joins the foot. This bump is sensitive to pressure caused by wearing shoes that fit too tight. Shoes that are pointed and too narrow squeeze the great toe causing it to drift toward the little toes. Increasing the width of your shoes is the first step in conservative treatment. If pain persists or shoe fitting is difficult and the bump is quite noticeable, you should discuss this problem with your physician. Some bunions need surgical correction. There are many operations for bunions, often named for the surgeons who developed the procedures: McBride, Keller, Mitchell and Lapidus to name a few. Most surgical procedures not only remove the bump, but correct the cause of the bunion so it does not grow back. Your orthopedic surgeon will discuss with you what procedure, if any, is appropriate. Never consider bunion surgery for cosmetic reasons.

Osteoarthritis, in this area results from the “wear and tear” to joint cartilage (the soft tissue between joints) that comes with age. The result is inflammation, redness, swelling and pain. Injury to the joint may result from swelling caused by inflammatory arthritis (Gout, Rheumatoid Arthritis) or trauma. If left untreated, the great toe may eventually become enlarged from bone spurs. Treatment may include medications by mouth (anti-inflammatory), injections (steroids, cortisone), physical therapy, full length rigid orthotics or shoe modifications to decrease motion. Surgery may be necessary. This may mean cleaning the arthritic joint with removal of bone spurs or ultimately eliminating the painful motion of the joint by fusion.

“Turf Toe” and “Sand Toe” are two euphemisms that describe a stretching or tearing of the capsule or plantar plate of the great toe joint (MTPJ). These structures are the soft tissues that surround the joint.“Turf Toe”is most commonly seen in football players but can occur in any sport. It is caused by overly flexible shoes on a hard playing surface, allowing hyperdorsiflexion (upward) of the joint.“Sand Toe” is caused by a hyperplantarflexion (downward) of the joint. This is commonly seen in beach volleyball players who land from a jump on the top of their toe stretching the dorsal structures (capsule). Treatment for both injuries involve rest, ice, compression and elevation (RICE). An orthotic device or stiffening of the athletic shoe is recommended to help prevent pain and re-injury.

Stubbed toes can be more than just a minor nuisance. If you experience swelling, discoloration or a persistence of pain beyond 2 to 3 days, you may have a fracture or dislocation. Neglecting these injuries, particularly of the great toe, can result in arthritis, loss of motion, deformity and pain. The foot should be immobilized in a splint or a stiff shoe, along with the acute treatment of RICE. Final treatment depends on the severity of the injury, which should be assessed by an orthopedic surgeon with X-ray and physical exam. Complicated injuries may require surgical intervention.

Gout, an inflammatory arthritis that most often affects the great toe joint, is caused by overproduction or under excretion of uric acid. Symptoms include severe pain, erythema (redness) and swelling. Symptoms may be confused with infection. Diagnosis is confirmed with the identification of specific crystals within the joint fluid. Uric acid blood levels may be misleading. Treatment of an acute episode includes rest, ice, elevation and NSAIDs (antiinflammatories). Chronic treatment involves diet modification, allopurinol or colchicine depending on the individual’s underlying cause.

Ingrown toenails often result from trimming the nails too short, particularly at the sides. You should trim your toenails straight across, allowing adequate length to project beyond the skin at the toenail margins. Cuticles should be pushed back and rarely cut.

If you are concerned about your feet and you don’t know who to question, talk to your family physician or most county medical societies are happy to help you identify medical doctors who specialize in the treatment of specific problems, such as the foot. Or you can contact Jupiter Medical Center’s Physician

(Article Courtesy of Kevin B. Newfield, D.O., Orthopaedic Surgeon, is on staff at Jupiter Medical Center.)