The Foot of Your Foot: The Great Toe

Lately, we have had quite a few of our patient’s over the age of forty complaining of pain in the big toe joint. Typically, forty is the age when early arthritis symptoms tend to manifest and, in the foot, we see the great toe joint as the most common. This is due to the mechanical load and the important role it plays in every step we take. When we walk, our big toe joint bends up to an impressive 75 degrees just before the foot leaves the ground. But, sometimes, due to unusual wearing and tearing of the cartilage in the toe joint, the toe becomes stiff and starts to hurt. This is called Hallux Limitus.

Hallux Limitus is a progressive arthritic condition that limits the motion and function of the big toe. Symptoms of this condition come on slowly. You may only notice a mild, temporary pain when you are in motion or when you move the big toe joint. Eventually, the pain may worsen and in some cases dorsal bunions or bone spurs may develop and cause additional pain. The big toe is extremely important for proper foot/ankle/knee/hip and even low back bio-mechanics so it is important you don’t go untreated.

Symptoms of Hallux Limitus are based on the stage in which you are in. Your symptoms may or may not include: Pain while active or when you move the big toe joint, stiffness in the big toe, increased pain or aches in cold or damp temperatures, difficulty bending big toe up and down, difficulty wearing shoes, especially high heels, and development of bone growths (bunions, bone spurs).

It’s important to know that these symptoms signify the early stages of this condition. Each of these symptoms will slowly worsen until you’ve reached a point of no movement within the big toe joint. Hallux Limitus is caused by one of four things: Genetics, injury, a long first metatarsal bone (or short second metatarsal), or an elevated first metatarsal bone.

Hallux Limitus is a progressive condition that can lead to further problems, including complete loss of motion in the big toe joint. It’s best to see your podiatrist in the early stages or before bone growths develop. Your doctor will begin with a physical examination so he or she can determine the range of motion within the joint. Imaging tests such as x-rays and MRIs are often used to determine whether arthritis is present, to see how much the joint has narrowed, and to evaluate the foots overall health.

Treatment options include:

• A Morton’s extension can be used to relieve pain. These durable semi-rigid medical devices can be found in podiatry offices, and they are designed to provide support and shift weight away from the big toe to reduce pain.
• Accommodative cushions made of foam work for Hallux Limitus, since it pads the big toe joint and protects it from painful shoe pressure.
• Turf toe plates limit the range of motion of the great toe joint, which makes this product ideal for treating both Hallux Limitus and Hallux Rigidus.
• Athletic or running shoes made especially for over-pronators (flat feet) can provide support. They are less flexible than conventional running shoes, which enables them to limit the motion of the joint.

If you believe you may have Hallux Limitus and you live in the Greater Dayton/Springfield area, give Community Foot Specialists a call. Your feet will be in good hands! 937-426-9500

Bunions

 Bunions, also called Hallux Abducto Valgus (HAV), are a deformity characterized by a lateral deviation of the great toe (hallux) with a subsequent medial prominence ("bump".) The medial prominence is from the underlying deviated prominent bone (not a growth), and sometimes can form an overlying bursitis which may add to the prominence (usually very painful and red.) Bunions form when your big toe pushes up against your other toes, forcing your big toe joint in the opposite direction. Over time, the abnormal position enlarges your big toe joint, further crowding your other toes and causing pain.

The main causes of bunions can be from genetics, tightly fitted shoes, or foot injuries. Bunions are more common in women. Bunions may be associated with various forms of arthritis, including inflammatory or degenerative forms, causing the protective cartilage that covers your big toe joint to deteriorate. An occupation that puts extra stress on your feet or one that requires you to wear pointed shoes also can be a cause. Bunions can not only affect the inner foot but also the outside of the foot at the base of the little toe.

Here are some treatment options for your bunions one is to have well-fitting wide enough shoes to give your feet more room. Another way is to have some padding to alleviate shoe pressure on "the bump." You can take oral or topical anti-inflammatory treatments to alleviate pain associated with the inflammation and bursitis. You can purchase orthotics to help control contributing biomechanical forces to reduce the rate of progression (especially important in kids). If none of these work you may consider surgery to correct the underlying deformity/deformities (important to also correct any contributing biomechanical forces at the time).

Bunions can be very painful and discomforting. Ways to prevent bunions are choosing footwear that fits correctly, especially low heeled shoes with plenty of space for the toes, is one of the main ways that bunions can be prevented. Getting orthotics if your prone to flat-footedness- this can prevent or delay bunions. If you think or know you have bunions get them checked out by your doctor or a specialist. 

Feeling the Pinch this Autumn? Bunions May Be to Blame

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With the curtain closed on summer and sandal season, fall is the season during which Community Foot Specialists sees an upswing in patients whose feet are feeling the pinch in their closed-toe footwear. This seasonal phenomenon seems to focus on women, although there are men who have this issue. The common culprit? Painful bunions that were given room to breathe during sandal season, but now face close quarters of a fall boot or shoe.

Bunions are abnormalities that form on the joint at the base of the big toe in the form of a bony bump. They occur when the big toe pushes against the other toes, which force the big toe joint in the opposite direction. As time passes, the abnormal positioning of the toe enlarges the joint. This further crowds the toes of the foot and causes pain and discomfort.

Bunions can occur for a variety of reasons. One of the most common causes is tight shoes, although they can also come about as a result of an inherited structural or mechanical defect, a stress to the foot, or a medical condition.

To help avoid bunions, don’t wear pointed shoes. Choose footwear with a wide foot box to give all of your toes plenty of room. If bunions become so painful that they impede daily activities, the American College of Foot and Ankle Surgeons recommends discussing surgical options with your podiatrist. However, please note that Community Foot Specialists firmly believes in exhausting the most conservative foot care treatment options first before considering surgery.

Community Foot Specialists can be reached at 937-426-9500. Or you may visit our website to request an appointment, view common conditions we treat, or get any other info you might need.

Question of the Month: I'm a diabetic, do I need diabetic shoes?

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Question of the Month!

By: Dr. Thomas

Q: "I'm a diabetic, do I need diabetic shoes?"

A: That depends. Diabetics who are well controlled with their blood sugar, do not have toe deformities such as bunions or hammertoes, intact circulation to their feet as well as intact sensation or feeling in their feet, are at low risk and do not need diabetic shoes. Diabetic shoes are considered to be a necessity for those diabetics who have an at risk foot or a foot that could be in danger of developing a wound in an otherwise normal everyday shoe. These shoes are designed with extra depth to accommodate the foam inserts which are used to reduce chances of a foot ulcer on the bottom of the foot. Some patients may be interested in these shoes for the simple fact they believe they can get free shoes and the insurance will sometimes "pay for them". This is not the purpose of diabetic shoes. To determine if the diabetic patient is eligible for shoes, the podiatric doctor will perform a comprehensive diabetic foot exam first to check to see if the feet are at high risk for developing problems such as ulcerations. If the need is determined, then your doctor will do all steps necessary to see that the patient gets those shoes and that they are fit correctly.