Saturday, January 8, 2011
Patients are always asking about Bunions, and Bunion Surgery. Bunion Surgery is an ART. It is not the same for every patient. The more you know, the better your results. So let's start at the beginning...Do I Have a Bunion?
Where does the term "bunion" come from? The term "Bunion" originated in 1718, from E. Anglian dialectic, "bunny", which meant: "lump, swelling". The Podiatric term used to describe a bunion is hallux valgus. Hallux is Latin for great toe, while Valgus describes the change in position of the great toe. Valgus is seen when the great toe begins to move closer to the 2nd toe, as opposed to being straight.
Today "Bunion" is a commonly used term to describe an area around the great (big), toe joint of your foot. This area can appear enlarged, and prominent. Some bunions are just that, bumps on the side of the great toe, without pain or discomfort. Bunions come in all shapes and sizes. Most patients who have symptomatic bunions complain of pain on the medial, or inner aspect of the big toe joint. However, bunions may also cause pain on the top of or underneath the big toe joint, or even under the second toe. Some severe bunions may cause the 2nd toe to become contracted, at times even overlapping the great toe. If you have a bunion you may have pain with shoe pressure, when walking or with any motion. My patients often complain of soreness, and throbbing especially following increased activities or wearing their favorite shoes.
But is a Bunion just a bump? It could be. Some bunions are really the result of such disorders as, Gout, Skin/Soft tissue cysts, Arthritis, or other inflammatory conditions. However: the visible bump may actually reflect a change in the bony structure of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment - producing the bunion's "bump."
Bunions are considered a progressive disorder. They can begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent.
Don't think you need surgery for that bump yet! You should visit your podiatrist for a thorough evaluation.
Next.. different types of Bunions and conservative treatments.

Dr's. Evans and Korponay have treated thousands of patients using Custom Foot Orthotics as an integral part of their treatment plan. Dr. Evans believes, "Many foot problems can be traced to a biomechanic imbalance in the way the foot and leg function. Properly made Custom Foot Orthotics can realign this imbalance for proper foot function and stability."

Patients frequently ask about which sneaker or shoe is best for their custom Orthotics. Dr. Korponay states," basically the shoe or sneaker is just a "box". They function to hold, and protect the foot. The foot motion, such as pronation, that occurs within the shoe is the key."

Dr's.Evans and Korponay agree on some simple rules to consider when purchasing a shoe or sneaker for use with your Custom Orthotics:

* the heel of the Orthotic should fit snugly into the heel area of the shoe

* the Orthotic itself should sit flat within the shoe

* While standing and with the Orthotic in the shoe, observe the medial, inner aspect of the shoe. If you can see the inner edge of the Orthotic pushing out beyond the shoe, it is not a proper fit.

* When choosing a sneaker look for midfoot, medial support. This helps provide stability to the Orthotic.

"Patients often ask if they should be in a cushioned, neutral or stability shoe", Dr. Evans states. " A custom Orthotic is designed to work with your feet. Your shoe should work with the Orthotic" Dr. Evans recommends a biomechanical and gait examination to determine which type of shoe is preferred.

Dr. Gary Evans, a New York City Foot and Ankle Surgeon, teaches his patients that the combination of wearing narrow, pointed-toe shoes at work and pounding their feet on New York City streets or in the gym can cause a Neuroma, a painful nerve disorder of the feet.

Active women, especially those with flat feet, are prone to develope neuromas. A nerve located between the toes becomes enlarged and inflamed and produces a tingling, cramping, burning pain.

Gary Evans, DPM,and James Korponay DPM, who are Board Certified in Foot Surgery, and members of the American College of Foot and Ankle Surgeons agree that the symptoms begin gradually and, left untreated, progressively worsen.

"We see neuromas quite often in our female patients who wear high heels, even if they occaisionally wear a flat shoe or sneaker" says Dr. Korpoany.

Dr. Gary Evans explains that neuromas enlarge as the condition progresses, causing pain and numbness to an area at the base of the toes, or forefoot. Patients often complain it feels as if there is a cramp , or sharp, burning pain in the ball of their foot. The symptoms may go away temporarily by massaging their foot, wearing wider shoes with low heels, and avoiding running and other activities that aggravate the condition.

"Symptoms become more intense as the nerve enlarges and the temporary damage becomes permanent, so it's best to seek treatment if discomfort persisits more than a few days" Dr. Korponay says.

Dr. Evans states that Neuromas can develope in different areas of the foot. The most common is called Morton's Neuroma, which developes at the base of the third and fourth toes. The nerve will thicken and swell from compression and irritation from wearing narrow shoes, high heels and pronation of the foot while running.

Treatment options for Morton's Neuroma depend on how far the condition has progressed. Gary Evans, DPM and James Korpornay, DPM, both advocate immediate conservative care. Which could include special padding and strapping of the foot, local steriod injections,and local alchohol injections.

In severe cases, surgery might be the best option. When necessary, Dr. Evans explains, "surgery has a very high success rate."

Runners: Fit feet for Running
(NYC,New York - 10/10/09) Both long-distance runners and casual joggers can improve their performance by keeping their feet in top condition and taking steps to control foot problems common in runners, according to Dr. Gary Evans & Dr. James Korponay, foot and ankle surgeons.
"The human foot is a biological masterpiece that amazingly endures the stresses of daily activity," says Gary Evans, DPM, FACFAS, a member of the American College of Foot and Ankle Surgeons (ACFAS). "For runners, the feet are more vulnerable to injury than any other part of the body, and these athletes should be on the alert for signs of foot problems that can slow them down if not treated promptly."
Dr. Evans and Dr. Korponay agree that the most common complaint from runners is heel pain. This condition, also called plantar fasciitis, is frequently caused by inflammation of the ligament that holds up the arch.
"In athletes, heel pain can result from faulty mechanics and overpronation in which pressure is unequally applied to the inside of the foot. It also can be caused by wearing running shoes that are worn out or too soft," Dr. Korponay explains.
At the first sign of heel pain, Drs. Evans and Korponay recommend runners do stretching exercises, wear sturdier shoes and use arch supports. In some cases, icing and anti-inflammatory drugs, such as ibuprofen, are helpful. Should heel pain continue, custom orthotics, injections and physical therapy might be required. Surgery normally isn't considered unless heel pain persists for more than a year and conservative treatment has failed to bring relief.
Neuromas and tendonitis are other common foot problems that affect runners. A neuroma is a pinched nerve between the toes that can cause pain, numbness and a burning sensation in the ball of the foot. Overly flexible shoes often are the cause and padding, orthotics or injections usually are effective. Sometimes surgery is the answer if pain between the toes continues for more than six months.
Serious runners can be sidelined with tendonitis if they ignore the warning signs of this overuse-related condition.
"There are several forms of tendonitis that affect the Achilles and other areas, and all are treated with rest, icing, stretching and anti-inflammatory medications, and sometimes with orthotics and physical therapy." Dr. Korponay says. "Over-zealous training usually causes tendonitis, especially among beginners who try to do too much too soon."
A common myth among athletes, according to Dr. Korponay, is that it's not possible to walk or run if a bone in the foot is fractured.
"I often hear surprised patients say 'It can't be broken, I can walk on it,'" he says. "That's dead wrong, especially with stress fractures when pain and swelling might not occur for a few days."
If a fracture or sprain is suspected, Dr. Evans advises runners to remember the word RICE as an abbreviation for Rest-Ice-Compression-Elevation.
"If pain and swelling continues after following the RICE procedure for three or four days, you should see a foot and ankle surgeon for an x-ray and proper diagnosis."
Other common foot ailments runners should watch for are:
Athlete's Foot: This fungal skin disorder causes dry, cracking skin between the toes, itching, inflammation and blisters. It can be prevented and controlled by washing the feet regularly and carefully drying between the toes; switching running shoes every other day to allow them to dry; wearing socks made with synthetic material instead of cotton; and applying over-the-counter ointments.
Toenail Problems: Ingrown nails can cause inflammation and possible infection and usually are treated by cutting the corner of the nail with sterile clippers. Black toenails happen when a blood blister forms under the nail from trauma, and it's best to let the nail fall off by itself. Fungal toenails are yellow, brown or black and sometimes are irregularly shaped and thick. They are best treated with oral anti-fungal medications.
Foot Odor: There are more than 250,000 sweat glands in the foot and daily hygene plus regular changing of shoes and socks are best for controlling sweat and odor. Runners should avoid wearing cotton socks and running without socks. Foot powders, aerosols antiperspirants and vinegar soaks also are helpful.
Blisters, corns and calluses: Never pop blisters unless they are larger than a quarter or are painful or swollen. Use a sterile instrument to lance the corner, leave the top as a biological dressing, wash, apply antibiotic ointment, and cover with a Band-aid. Corns and calluses are caused by repeated friction, and should be treated by aseptically trimming the dead skin and eliminating the underlying cause.

Most importantly, never ignore foot pain. Dr. Evans explains that today we have many new treatments to get you running as quickly as possible.