Weird Sensations in the Ball of Your Foot??????

If you are experiencing burning, tingling and/or numbness to your foot, you might have a neuroma. A neuroma is thickening of nerve tissue. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an inter-metatarsal neuroma. “Inter-metatarsal” describes its location in the ball of the foot between the metatarsal bones (the long bones of the foot).

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Anything that causes compression or irritation to a nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box or high-heeled shoes that cause the toes to be forced into the toe box. Other causes include certain foot deformities, such as bunions, hammertoes, flatfeet, or more flexible feet. Other potential causes include activities that involve repetitive irritation to the ball of the foot, such as running or court sports.

Common symptoms that you might experience if you have a neuroma include:

-Tingling, burning, or numbness
-Pain
-A feeling that something is inside the ball of the foot
-A feeling that there’s something in the shoe or a sock is bunched up

Non-surgical treatment options for this condiiton may include:

-Padding: Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
-Orthotic devices: Custom orthotic devices provide the support needed to reduce pressure and compression on the nerve.
-Activity modifications: Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
-Shoe modifications: Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
-Medications: Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
-Injection therapy: Treatment may include injections of cortisone, local anesthetics or other agents.

Surgery may be considered if symptoms have not responded adequately to non-surgical treatments.

If you would like further information please visit our website, www.drrobertrosenstein.com or give the office a call, 440-946-5858 to schedule a consultation.

Toe Contracting????????

Hammertoes occur when the smaller toes of the foot become bent and prominent. The four smaller toes of the foot are much like the fingers in the hand. Each has three bones (phalanges) which have joints between them (interphalangeal joints). Normally, these bones and joints are straight. A hammertoe occurs when the toes become bent at the first interphalangeal joint, making the toe prominent. This can affect any number of the lesser toes. In some cases, a bursa (rather like a deep blister) is formed over the joint and this can become inflamed (bursitis). With time, hard skin(callous) or corns (condensed areas of callous) can form over the joints or at the tip of the toe.

What Causes Hammertoes?
There are many different causes but commonly it is due to shoes or the way in which the foot works (functions) during walking. If the foot is too mobile and/or the tendons that control toe movement are over active, this causes increased pull on the toes which may result in deformity.

In some instances trauma (either direct injury or overuse from walking or sport) can predispose to hammertoes.

Patients who have other conditions such as diabetes, rheumatoid arthritis and neuromuscular conditions are more likely to develop hammertoes.

What are common symptoms?
Deformity/Prominence of toe
Pain
Redness around the joints
Swelling around the joints
Corn/Callous
Difficulty in shoes with deformity of the shoe upper
Difficulty in walking
Stiffness of the joints of the toe

What can be done to reduce symptoms?
There are several things one can do to try and relieve symptoms:

Wear proper fitting shoes with a deep toe box
Avoid high heels
Use a toe prop to straighten the toe if it is still mobile
Wear a protective pad over the toe
See a podiatrist

How can a podiatrist help?
A podiatrist can offer other options, if simple measures do not reduce symptoms. These include:

Advise on appropriate shoes
Advise on exercises if the toes are still mobile
Instruction on how to properly strap the toe in a corrected position
Providing of a splint or protection
Advise on surgery
Prescribing of custom orthotics

These are unlikely to resolve established deformity, however can help reduce discomfort to the ball of the foot.

How can I cure the deformity?
The only effective way of correcting the deformity is to have surgery.

What does surgery for this deformity entail?
There are a number of different surgeries. However, the most common procedures are:

Tendon transfer
Tendon transfers involve taking the tendon from under the toe and re-routing it to the top of the toe so that the toe is pulled down.

Digital arthroplasty/Digital arthrodesis
Digital arthroplasty and arthrodesis involve the removal of bone from the bent joint to allow correction. An arthroplasty removes half the joint and leaves some mobility whilst an arthrodesis removes the whole joint leaving the toe rigid.

In more severe cases, the tendon on the top of the toe and the joint at the ball of the foot may need to be released to allow the toe to straighten. If there is severe stiffness at this joint, the metatarsal may need to be shortened using a Weil osteotomy.

If you are suffering from hammertoes and would like more information please visit our website for more information, http://www.drrobertrosenstein.com/ or call the office, 440-946-5858, to schedule a consultation.

Stiffness in Your Big Toe??????????

Each day, with every step you take, your big toe bears a tremendous amount of stress, a force equal to about twice your body weight. Most of us don't realize how much we use our big toe. We tend to take it for granted, unless a problem develops. One problem that afflicts the big toe is called hallux rigidus, a condition where movement of the toe is restricted to varying degrees. This disorder can be very troubling and even disabling, since we use the all-important big toe whenever we walk, stoop down, climb up or even stand. If you have pain and/or stiffness in your big toe, you may have this condition.

Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the big toe and with time gets increasingly harder to bend the toe. "Hallux" refers to the big toe, while "rigidus" indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis (a wearing out of the cartilage within the joint that occurs in the foot and other parts of the body).

Early signs and symptoms include pain and stiffness in the big toe during use (walking, standing, bending), difficulty with certain activities (running, squatting) and swelling and inflammation around the joint.

As the disorder gets more serious, additional symptoms may develop, including pain, even during rest, difficulty wearing shoes because bone spurs (overgrowths) develop and limping, in severe cases.

Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis—the kind that results from "wear and tear"—often develops in people who have defects that change the way their foot and big toe functions. In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse, especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury or an inflammatory diseases, such as rheumatoid arthritis or gout.

Treatment for mild or moderate cases of hallux rigidus may include one or more of these strategies. First, shoe modifications: Shoes that have a large toe box should be worn, because they put less pressure on the toe. Stiff or rocker-bottom soles may also be recommended. Second, orthotic devices: Custom may improve the function of your foot. Third, medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to help reduce pain and inflammation. Supplements such as glucosamine-chondroitin sulfate and some vitamins and minerals may also be helpful. Fourth, injection therapy into the affected toe can help to reduce the inflammation and pain. Lastly, physical therapy: Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.

In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery that can be undertaken to treat hallux rigidus. These surgical procedures fall into two categories. The first category of procedures consists of reconstructing and "cleaning up" the joint. The arthritic damage from the joint as well as any accompanying bone spurs are removed, preserving and restoring the normal alignment and function of the joint, as well as reducing or eliminating pain. The second category of procedures consists of more aggressive procedures. These procedures include fusing the joint or removing part or all of the joint and replacing it with an implant, such as is done for the hip or knee.

If you or someone you know is suffering from this condition please visit our website, http://www.drrobertrosenstein.com/ for more information or contact our office, 440-946-5858 to schedule a consultation.

Bump on the Side of Your Small Toe????????????

Tailor’s bunion, also called a bunionette, is a prominence of the fifth metatarsal bone at the base of the little toe. The metatarsals are the five long bones of the foot. The prominence that characterizes a tailor’s bunion occurs at the metatarsal “head,” located at the far end of the bone where it meets the toe. Tailor’s bunions are not as common as bunions, which occur on the inside of the foot, but they are similar in symptoms and causes.

Tailor’s bunion is most frequently caused by an inherited faulty mechanical structure of the foot resulting in the fifth metatarsal bone starting to protrude outward, while the little toe moves inward creating a bump on the outside of the foot that becomes irritated with shoe gear. Another cause for a tailor's bunion is a bony spur (an outgrowth of bone) on the side of the fifth metatarsal head.

Symptoms associated with a tailor’s bunions can include redness, swelling, and pain to the site of the enlargement. These symptoms tend to worsen with shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation.

Treatment for tailor’s bunion typically begins with non-surgical therapies, which may include:

Shoe modifications. Shoes with a wide toe box. Avoid shoes with pointed toes or high heels.

Padding. Pads placed over the area may help reduce pain.

Oral medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.

Injection therapy. Injections of corticosteroid may be used to treat the inflamed tissue around the joint.

Orthotic devices.

Surgery is often considered when pain continues despite the above approaches. Surgery can include many different procedures or combination of procedures based upon x-ray findings, age and activity level.

If you or some one you know is suffering from a tailor's bunion, please do not hesitate to give our office a call for further information or to set-up a consultation, 1-440-946-5858.

Bothersome Bump to Your Big Toe?????

A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework 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 most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.


Most common symptoms, which may occur at the site of a bunion, include pain or soreness, inflammation and/or redness, burning sensation or possible numbness. Symptoms most often occur when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men.

Early treatment for bunion treatment is aimed at easing the pain, not reversing the deformity itself. These treatment options include a change in shoe gear: Wearing shoes that have a wider toe box and forgoing those with pointed toes or high heels, which may only aggravate the condition. Padding over the area of the bunion can help minimize the pain associated with bunions. Medications, such as oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and icing several times a day can help to reduce pain and inflammation associated with the deformity. In some cases, custom orthotic devices may be provided to help reduce pain, control the abnormal biomechanics of your foot and prevent further progression of the deformity.If non-surgical treatments fail to relieve bunion pain and the pain of a bunion interferes with daily activities, it’s time to discuss surgical options to determine if surgery is best for you.

A variety of surgical procedures are available to treat bunions. These procedures are designed to remove the “bump,” correct the changes in the bony structure of the foot and correct soft tissue changes that may also have occurred. The goal of surgery is to reduce and/or eliminate pain.

If you are suffering from a “bump” to your big toe, please do not hesitate giving our office a call for additional information or to schedule a consultation, 440-946-5858.