Bunions (hallux valgus)
More than half the women in America have bunions, a common deformity often blamed on wearing tight, narrow shoes. Bunions cause the base of your big toe (Metatarsophalangeal Joint) to enlarge and protrude. The skin over it may be red and tender. Wearing any type of shoe may be painful. This joint flexes with every step you take. The bigger your bunion gets, the more it hurts to walk. Bursitis may set in. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful.
Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. If your bunion gets too severe, it may be difficult to walk. Your pain may become chronic and you may develop arthritis.
Most bunions can be treated without surgery by wearing protective pads to cushion the painful area, and of course, avoiding ill-fitting shoes in the first place.
Bunion surgery, or bunionectomy, realigns the bone, ligaments, tendons and nerves so your big toe can be brought back to its correct position. Many bunion surgeries are performed on a same-day basis (no hospital stay) using an ankle-block anesthesia. A long recovery is common and may include persistent swelling and stiffness.
Claw toe normally is caused by nerve damage from diseases like diabetes or alcoholism, which can weaken tour foot muscles. Having claw toe means your toes “claw,” digging down into the soles of your shoes and creating painful calluses. Claw toe gets worse without treatment and may become a permanent deformity over time.
Common symptoms include:
- Toes bent upward (extension) from the joints at the ball of the foot.
- Toes bent downward (flexion) at the middle joints toward the sole of your shoe.
- Corns on the top of the toe or under the ball of the foot.
Claw toe deformities are easier to repair when detected early, but they harden into place over time. Splint or tape is used to hold your toes in correct position.
Many disorders can affect the joints of the toes, causing pain and preventing the foot from functioning as it should. People of all ages can have toe problems, from inherited to acquired.
Toe deformities in adults are caused mainly by an imbalance of the tendons, causing them to stretch or tighten abnormally. People with abnormally long toes, flat feet, or high arches have a greater tendency to develop toe deformities.
Arthritis is another major cause of discomfort and deformity. Toe deformities also can be aggravated by poorly-fitting footwear, or if a fractured toe heals in a poor position.
The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, overlapping and underlapping toes, and curled toes.
Hallux Limitus (stiff big toe joint)
Hallux Limitus is a condition that results in stiffness of the big toe joint. Hallux Limitus is normally caused by an abnormal alignment of the long bone behind the big toe joint called the first metatarsal bone. Left untreated, Hallux Limitus can cause other joint problems, calluses, and diabetic foot ulcers. Painful bone spurs also can develop on the top of the big toe joint.
Anti-inflammatory medications, cortisone injections and/or shoe inserts are some of the common treatments for stiff big toe. Surgery may be prescribed if spurring around the joint becomes severe.
Hallux Rigidis (rigid big toe)
When you have a stiff big toe, walking can become painful and difficult. An unmovable big toe (Hallux Rigidus) often is the most common form of arthritis in your foot, according to the American Orthopaedic Foot and Ankle Society.
“Wear-and-tear” injuries also can wear down the articular cartilage, causing raw bone ends to rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk.
Symptoms may include:
- Pain in the joint when you are active, especially as you push-off on the toes when you walk.
- Swelling around the joint.
- A bump, like a bunion or callus, that develops on the top of the foot.
- Stiffness in the big toe and an inability to bend it up or down.
Pain relievers and anti-inflammatory medications often help to reduce swelling and ease the pain. Consult us before taking any medication. Applying ice packs or taking contrast baths (which use alternating cold and hot water to reduce inflammation) may also help reduce inflammation and control symptoms for a short period of time.
Invest in a stiff-soled shoe with a rocker or roller bottom design and possibly even a steel shank or metal brace in the sole. This type of shoe supports the foot when you walk and reduces the amount of bend in the big toe. Bone spurs, as well as a portion of the foot bone, may be surgically removed when damage is mild or moderate. The procedure also allows the toe more room to bend.
Hallux Varus is a condition in which the big toe points away from the second toe. It often is one complication from bunion surgery. The condition has been linked to a number of other causes, including congenital deformity, tight or short tendons, and trauma or injury.
Treatment may focus on stretching the abductor hallucis tendon through a specific kind of stretching exercise. Other options include toe splints and surgery, in which a small incision is made on the side of the toe. The toe is then splinted in a neutral or straight position.
Hammertoe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, resembling a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.
Causes of hammertoe include improperly fitting shoes and muscle imbalance.
Treatment for the condition typically involves shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions or non-medicated corn pads may also relieve symptoms.
Intoeing is a condition caused by curving inward of the feet when walking or running. Young children normally outgrow this condition without special shoes.
Overlapping, Underlapping Toes
Underlapping toes usually involve the fourth and fifth toes. (A special form of underlapping toes is called congenital curly toes.) The cause of underlapping toes is unknown. Many experts suspect they are caused by an imbalance in the small muscles of the foot.
At a younger age, or when the toes are fairly flexible, a simple release of the tendon in the bottom of the toe usually helps. If the deformity is rigid, surgery may be required to remove a small portion of the bone in the toe.
Overlapping toes are characterized by one toe lying on top of an adjacent toe. The fifth toe is the most affected digit with overlapping toes. Overlapping toes are believed to originate during pre-natal development.
Passive stretching and adhesive taping is most commonly used to correct overlapping toes in infants, but the deformity usually recurs.
Surgical correction sometimes involves releasing the tendon and the soft tissues around the joint at the base of the fifth toe. In severe cases, a pin may need to be surgically inserted to hold the toe in a straight position. The pin, which exits the tip of the toe, may be left in place for up to three weeks.
Subungal Exotosis (bone spur under toenail)
A Subungual Exostosis is more commonly referred to as a bone spur under toenail. They generally are a result of some form of trauma to the toe, forming a bony irregularity or prominence. They are normally treated by surgical removal. Other small tumors called Osteochondromas and Enchondromas can also form in the bone beneath the toenail as well as in other bones in the body.