Bunions (Hallux Valgus)
Hallux valgus, often referred to as “a bunion,” is a deformity of the big toe. The toe tilts over towards the smaller toes and a bony lump appears on the inside of the foot.
Sometimes a soft fluid swelling develops over the bony lump. The bony lump is the end of the “knuckle-bone” of the big toe (the first metatarsal bone) which becomes exposed as the toe tilts out of place.
What problems does it cause?
The main problem is usually the pressure of the shoe over the bony prominence, which causes discomfort or pain. Sometimes the skin over the lump becomes red, blistered or infected. The foot may become so broad that it is difficult to get wide enough shoes.
The big toe sometimes tilts over so much that it rubs on the second toe, or pushes it up out of place so it presses on the shoe. Also, the big toe does not work as well with a bunion, and the other toes have to take more of the weight of the body as you walk. This can cause pain under the ball of the foot (“metatarsalgia”). Sometimes arthritis develops in the deformed joint, causing pain in the joint.
What is hallux rigidus?
Hallux rigidus is arthritis of the main joint of the big toe in the ball of the foot. It is a wearing out of the joint surfaces. It is called “hallux rigidus” because its main feature is stiffness (“rigidus”) of the big toe (“hallux”).
What problems does it cause?
The commonest problem is pain in the big toe joint. In some people the pain is present whenever they walk or even at rest, but in others it only occurs when they turn the big toe up as far as it will go.
Stiffness is also a common problem. The ability to turn the big toe upwards is lost, although it can usually be turned downwards. Sometimes it gets so stiff it points downwards and cannot be laid flat on the floor.
A bony bump (“osteophyte” or “dorsal bunion”) may develop on top of the joint. This is your body’s natural response to the worn joint. The bump may rub on the shoes. In some people this is their only problem.
Because of the painful big toe some people tend to walk on the side of the foot. This may produce pain in the ball of the foot or down its outside border.
Sometimes the joint wears down more on the outer side, towards the lesser toes, than on the inner side. This may make the toe tilt towards the second toe, and the toes may rub together.
This condition describes a contracture of the toes as a result of muscle imbalance within the foot. This contracture can result in rigidity of toes and corns can develop on the tops of toes.
Callus on the ball of the foot can also result as the joint becomes more exposed.
A neuroma is the swelling of a nerve that is a result of a compression or trauma usually in the ball of the foot.
The most common cause of neuroma in ball of the foot is the abnormal movement of the long bones behind the toes, most commonly between the third and fourth toes.
A small nerve passes between the spaces of these bones splitting at the base of the toe. It is in this area the nerve gets pinched and swells, forming the neuroma.
Symptoms include burning pain, tingling, and numbness in one or two of the toes. A popping sensation can often be felt when walking. Pain is intermittent and is aggravated by anything that results in further pinching of the nerve.
A puncture wound or laceration that injures a nerve can also cause a neuroma. These are called traumatic Neuromas. Neuromas can also result following a surgery that may result in the cutting of a nerve.
Gout is caused by abnormal metabolism of substances called purines that result in accumulation of uric acid in the blood stream and formation of crystalline deposits in joints or soft tissues. Gout occurs most frequently in men.
When this happens, there is a sudden onset of extreme pain with associated swelling, redness, and increased warmth to the skin or joint resembling an infection.
Classic gout occurs in the big toe joint. It also commonly occurs in the knee joint. It is rarely seen in more than one joint at a time.
Other areas that gout may present itself are the tops of the foot, the heel and the ankle joint.
Factors that contribute to the onset of gout are alcohol, red meats, aspirin and certain medications for high blood pressure.
Typically the onset of gout is sudden and intense. Frequently, the patient will go to bed feeling fine and wake up the next morning in excruciating pain. The attacks can become recurrent and over time cause permanent damage to the affected joint (arthritis).
What is Plantar Fasciitis?
Plantar fasciitis is a painful condition often caused by overuse of the long arch structures of the foot. This overuse can result in heel spur development or degeneration of fibres close to the attachments to the heel.
Pain is usually on the inside and under the heel and is often at its worst first thing in the morning.
Runners, jumpers and dancers are particularly at risk as well as those whose footwear provides inadequate support especially around the arch.
Obesity can increase the likelihood of developing this condition.
Another type of arthritis is rheumatoid arthritis. It can develop at any age and there is no known cause for this condition. Rheumatoid arthritis is the most crippling form of the disease that can affect people of all ages. It can cause severe deformities of the joints with associated fatigue of the entire body. People who suffer from rheumatoid arthritis often develop severe forefoot problems such as bunions, hammer toes, claw toes, and others.
There are many causes of arthritis. Heredity plays a major role. However, arthritic symptoms can develop due to many other factors. Some of these include bacterial and viral infections, prescription and illegal drugs, traumatic injuries, and bowel disorders such as ileitis and colitis.
Forefoot problems such as hammer toes, claw toes, mallet toes, and bunions often develop as a result of arthritis, particularly Rheumatoid arthritis. Problems can also develop in the heel and ankle area due to the erosion of the involved joints.
Arthritis is a disease characterized by the inflammation of the cartilage and lining of the body’s joints. Inflammation causes redness, warmth, pain and swelling. The primary targets for arthritis are people over the age of 50. Arthritis is a major cause of foot pain because each foot has 33 joints that can become affected by the disease.
There are many different types of arthritis. The most common type is called osteoarthritis. Osteoarthritis causes excessive strain and the wearing away of cartilage in the joints of the foot. Movement becomes very difficult and painful. The pain and swelling worsens while standing or walking, and stiffness usually occurs after periods of rest.
High Arched Feet (pes cavus)
Pes cavus describes a foot that has an abnormally high arch profile. This foot type tends to be quite rigid with associated retracted toes and inward pointing rear-foot.
A more mobile type of cavus is often seen with its own distinct associated dysfunctions.
Often there is no clear cause of this foot type although neuromuscular dysfunction and familial predisposition are often factors.
Flat Feet – Adult
Adult acquired flat feet describes a progressive, often painful deformity that results from the gradual stretch of ligaments that support the arch of the foot.
Pain, inflammation and swelling can occur around the inside of the ankle and this can further weaken the soft tissue flattening the foot further.
Pain occurs because tendons and ligaments have been damaged. Once this damage has occurred the condition can only worsen and podiatric interventions are necessary.
This type of condition affects women more commonly, especially in middle to old age. Other contributing factors include diabetic neuropathy, obesity and hypertension.