INGROWN TOE NAILS
Ingrown toe nails are caused when a shoe presses against a nail that has been improperly cut or is too wide and digs into the flesh. Some people have an inherited tendency to nails that have an extreme curvature, and the soft tissue of the toe grows over the nail plate. Unless treated promptly, pain, inflammation and often infection can result.
To avoid getting an ingrown nail, cut the nails straight across, not into the corners. Should you still have a problem, see a podiatrist right away. The offending ingrown portion of nail can be painlessly removed. Soaks and antibiotics may be necessary.
Should the problem continue to recur, a simple office procedure can correct the condition permanently. After a local anesthetic is administered, the affected border (about 1/8th inch of nail) is removed and the growth plate is destroyed. This leaves a normal-appearing nail whcich does not grow in. Many podiatrists use a laser for this purpose. This reduces the healing time and post-operative discomfort is kept to a minimum. No incisions are required. The procedure takes only a few minutes and is painless. Most people can be back to work and participating in sports 1-2 days after the procedure.
HEEL PAIN / PLANTAR FASCIITIS
Plantar Fasciitis is a common foot problem most often seen in men and women between the ages of 30 and 65. It is characterized by pain in the bottom of the heel. Classically, this pain is worse first thing in the morning (for the first few steps) as well as after rest.
The plantar fascia is a thick band of tissue on the bottom of the foot. It is attached to the heel bone. This causes inflammation and hence pain. Continuing with activities, even just walking, further stresses the area and a vicious cycle is set up. The condition progresses rapidly and often will not resolve without treatment.
As the fascia is pulled away from the heel bone, a spur often forms. This heel spur is not responsible for the pain and surgery to remove it is not necessary.
1)people who are overweight, especially if the weight gain is recent
2)middle age and up
3)wearing shoes that offer too little support, especially in the heel and arch areas
4)fallen arches (pronated feet) or high arched feet
5)a change in occupation or activity where more walking/standing is involved
The main goal of TREATMENT is to reduce stress on the plantar fascia. This can be accomplished by wearing good athletic shoes (not loafers, moccassins, or barefoot). Women often feel better when wearing dress shoes with a higher heel.
A special taping applied in a podiatrist’s office takes the tension off the plantar fascia and often results in a rapid and dramatic relief of the symptoms. Heel pads and heel cups can also be helpful. Many patients benefit from the use of orthotic devices (prescription shoe inserts) as a long term management of this condition. In some cases, it may be necessary to include other treatments such as rest, ice, oral medication, a cortisone injection and/or physical therapy modalities.
A new exciting procedure is now available for the small percentage of people who do not respond to conservative treatment. Known as ENDOSCOPIC PLANTAR FASCIOTOMY, this is performed in the office under a local anesthetic. A small opening is made on either side of the heel. A small camera and tools are inserted into this opening. While watching a T.V. monitor, the plantar fascia is lenghtened to relieve the tension. Patients walk immediately and are able to resume normal activities in a short time.
CORNS AND CALLOUSES
If you’ve never suffered from corns or callouses, you’re a very fortunate person! These unwelcome growths are areas of hard, thickened skin, caused by the friction or pressure of an enlarged or irregularly positioned bone in the foot. The body builds up protective tissue at pressure points which can lead to even greater stress and irritation of nerves near the growth.
Corns are small and generally form a core and grow on the toes. Soft corns grow between toes when toe bones rub together. They don’t have roots, as the folklore goes.
Callouses usually grow on the ball of the foot or over a bunion. They’re larger than corns but similar in makeup: both are accumulated layers of dead skin.
We can reduce corn and callous irritation by padding and cushioning affected areas. In some cases larger shoes help. Never use a razor blade or cutting tool to remove a corn or a callous at home since infection could result. Also, avoid commercial acid corn removers, since they can damage healthy skin.
Most professional treatments of corns and callouses consist of debridement, shaving away the dead skin with a specialized instrument. The procedure involves little discomfort. Sometimes we wrap pads on the corns or callouses to lessen pressure. We may recommend orthotics to restore proper foot balance. We also fix corns and callouses permanently using the minimal incision technique, with local anesthetic.
MINIMAL INCISION FOOT SURGERY
It has now been more than 25 years since Minimal Incision Surgery (MIS) was introduced in the United States and Canada. More and more Canadian podiatrists are learning the skills required to offer their patients an alternative to hospitalization when surgery is indicated to treat a foot disorder.
MIS is part of a growing trend in the medical community to adopt surgical procedures that result in less tissue dissection and trauma. Procedures involving the knee, spine, cranium and abdomen are now frequently accomplished through much smaller openings in the skin.
MIS is performed in the podiatrist’s office under local anesthetic. A small incision is made in the patient’s skin and specially designed instruements are inserted into the opening. These instrumenst include mini-blades to cut soft tissue, chisels to free soft tissue from bony prominences, bone rasps to redue the bony prominences and rotary burrs to both remodel and cut the bone. Tourniquets are not necessary. Irrigation is used to flush the small bone particles out through the incision both during and at the conclusion of surgery. The use of intra-operative x-ray allows the practitioner to visualize the bones of the foot during the procedure.
Podiatric conditions that can be treated with minimal incision surgery:
Corns are caused by excessive pressure or friction on the skin. In many cases, appropriate shoe wear, periodic shaving of the corn, and the use of corn pads are sufficiently effective treatments. Recurrent, painful corns, however, are often the result of bone enlargement or a bone spur which pinches the skin against the shoe. Soft corns result when two bony prominences rub against each other and pinch the skin between the toes. MIS is an excellent means of eliminating the corn permanently. Through a small incision made just adjacent to the corn, the soft tissue is separated from the bony prominence and the prominence is removed. Often the patient is able to walk out of the office in their own shoes and return to normal activities in a short period of time.
Callouses are a thickening of the skin in an area, most often on the ball of the foot, exposed to persistent and abnormal friction. Diffuse callouses are frequently the result of abnormal foot mechanics and are often treated effectively with orthotic devices and appropriate shoe gear. Deep-rooted callouses are usually structural in nature, often the result of a long or dropped metatarsal.
Periodic shaving of the callous, the use of callous pads and orthotic devices can help to ease the severity of these lesions. Recurrent painful callouses under one of the metatarsal heads often respond well to minimal incision surgery.
A small incision is made on the top of the foot and the bone is divided and raised in order to move it to a better position. The underlying condidtion has been corrected and the patient remains ambulatory with a reduced amount of discomfort and disability.
The joint at the base of the great toe is the most complex in the front of the foot. Here the bones, tendons, and ligaments work together to transmit and distribute the body’s weight, especially during movement. Should this joint become abnormally stressed over an extended period of time, a bunion deformity may result. The bunion results in an enlargement of the big toe joint. The big toe starts moving towards the second toe. This crowding puts pressure on the joint, pushing it outward. The movement of the joint in this outward direction starts the formation of a bunion. As the deformity progresses, arthritis may damage the joint space.
The underlying cause is usually an inherited weakness in the bone structure of the foot. Bunions are not caused by improper shoe gear but are certainly aggravated by them, which makes them much more common in women. It is important that the bunion be recognized early and evaluated by a foot specialist. Treatment includes proper footwaer and prescription orthotic devices to help control the underlying foot imbalance. Bunion guards can be helpful in reducing the discomfort of a bursitis or preventing inflammation from developing.
Undoubtedly, the most exciting application of minimal incision surgery is in the treatment of bunions. The enlarged bone behind the joint can be remodelled. Using rotary burrs, the big toe bone and/or metatarsal bone can be cut and re-positioned in a better allignment. Soft tissue surgery can also be performed with this technique.
The advantages of minimal incision surgery to the patient are many: local anesthesia is much safer than general anesthesia and the small incision means less trauma to the tissue and hence faster healing with less postoperative discomfort. The potention for a serious hospital-based infection is eliminated. Casts, crutches and internal fixation are usually unnecesary. The patient walks out of the office and is able to remain ambulatory with minimal disability and a more rapid return to normal activity.
In this era of preoccupation with the high costs of health care, reduced O.R. time and fewer hospital beds, office-based minimal incision surgery allows for better use of hospital facilities while benefiting the patient who is undergoing foot surgery.