Advancements in Treatment of Big Toe Arthritis

There has been a great advancements in the treatment of great toe arthritis, also known as hallux limitus and/or hallux ridigus. The terms commonly used refer to the latin term for limited to no motion, which is the main complaint that patients will have when they present for this condition. There is no clear understanding of the cause of hallux limitus/rigidus, but the main understanding is it may be due to trauma or chronic mechanical overload of the joint with abnormal weight bearing. The limited motion in the great toe joint is due to bone spurring and arthritis of the joint which causes jamming and pain.

Presenting symptoms for this include, but are not limited, to stiffness/pain/swelling/limited motion and cracking and/or grinding of the great toe joint.

Patients who present initially with mild complaints are often treated with shoe modifications and orthotics or custom insoles. Patients will often state that this improves their pain because they are not placing as much weight through the great toe region. However, over time, a certain number of patients will get increasing pain as the arthritis gets worse. This diagnosis is made through examination and x-rays of the foot to see the level of arthritis and joint damage to the great toe. It is rare but in some cases of local cartilage damage of possible cartilage lesions of the great toe, an MRI may be performed.

In most cases, surgical treatment of bone spurs and great toe arthritis is necessary. As the arthritis gets worse, the surgery is more difficult and requires more invasive options.

Advancements in surgical options for hallux limitus/rigidus are growing and getting better and better, offering a multitude of treatment options based upon the patient's needs. These procedures can include cheilectomy of bone spur removal, osteotomy for realignment and joint decompression, midfoot fusion for 1st metatarsal repositioning, hemi base implant joint resurfacing and great toe fusion

In general, early cases of spurring with limited joint damage do well with cheilectomy. As the problem proceeds, less cartilage is avaliable to work with, therefore an implant or great toe fusion is required If the 1st metatarsal bone is very loose and seems to be drifting upwards resulting in jamming of the great toe joint, then a fusion of the metatarsal at the base is a good option to realign the first metatarsal and prevent the jamming at the great toe joint.

For more information or to schedule an appointment, please call our office at, 440-946-5858.

Can Your Feet be Trying to Tell You Something?

Fungal Nail
Reason: Trauma or infection to the nail that makes it thickened, discolored, loose or deformed. Often caused by the spread of athlete’s foot, but may also be an indication of conditions such as diabetes or arthritis.
Response: Medications, such as Ker¬alac Gel and Lamasil tablets, have proven effective treatment.

Tendonitis
Reason: Overuse due to increase in physical activity, such as an increase in walking time or distance. May also be caused by wearing worn out or improperly-fitted shoes.
Response: Rest and ice, however in some cases, over-the-counter arch supports or anti-inflam¬matories may be indicated.


Blisters
Reason: Friction from shoes that don’t fit right or are too stiff.
Response: Instruct patients to keep feet dry and wear socks with properly-fitted shoes. Additionally, instruct them never to pop a blister and if painful, to seek medical attention.

Ingrown Toenails
Reason: Improper trimming or too much pressure on feet in tight-fitting shoes, resulting in redness, pain or swelling around the nail. Can also result from poor foot structure, heredity, trauma or foot deformities.
Response: Instruct patients to avoid tight-fitting shoes and socks and inspect nails daily. Additionally, instruct patients to trim nails straight across using toenail clipper.

Bromohydrosis (Foot Odor)
Reason: Increased perspiration from the more than 250,000 sweat glands in the foot due to increased body temperature.
Response: Instruct patients to rub corn starch or spray anti-perspirant directly onto the soles of the feet and spray Lysol into shoes daily. Additionally, instruct patients to keep shoes and socks dry and change shoes regularly.

Bunion (Hallux Abducto-Valgus Deformity)
Reason: A bump at the base of the big toe that is swollen, tender or painful when in the shoe, often caused by misalign¬ment of the joints. Ill-fitting shoes, heredity, trauma, biomedical abnormalities, neuromuscular disorders, inflammatory joint disease, congenital deformities or arthritis can also be culprits.
Response: Instruct patients to avoid pointy and narrow shoes or shoes with stitching or seams that rub bony areas of the foot. If painful, bun¬ions can be surgically removed by a podiatrist.

Plantar Fasciitis
Reason: Excessive weight gain resulting in pain on the bottom of the heel or in the arch. May also be caused by bony overgrowth on the heel, muscle imbalance, high or low arched feet, improper shoe gear, exces¬sive activity or trauma.
Response: Instruct patients to exercise, stretch their feet daily and wear strong, supportive shoes that don’t put undue stress on the ball or heel. If these measures are unsuccessful in relieving pain refer to a podiatrist for further examination and treatment.

If you are experiencing any of the above conditions, please do not hesitate to call and/or schedule an appointment at our office, 440-946-5858.

Keep Your Feet Safe at the Gym in the New Year

In the New Year, don’t forget to keep your feet in tip-top shape while following through with your resolutions to get fit. Follow the tips provided below to ensure heatlhy feet and maintenance of your resolutions:

Start new workouts gradually— Increase your stamina and the length of your workouts gradually to avoid overuse injuries such as stress fractures or tendon strains and sprains. Stretching your muscles before and after workouts also helps prevent these types of injuries. If you do feel you’ve sprained your ankle, be sure to seek treatment right away: Untreated or repeated ankle sprains may lead to chronic ankle instability, a condition that causes persistent pain and a ‘giving way’ of the ankle.

Wear the right shoe and sock— Wear well-fitting athletic shoes designed for the exercise or sport. Shoes that don’t support the arch of the foot and provide cushion for the heel can cause heel pain (plantar fasciitis). Shoes that are too small can also cause a neuroma, or a thickening of the nerve tissue, in the foot and may require injections, medication or physical therapy. Wearing cotton or non-slip socks are also key to help avoid painful blisters, which can become infected and cause more serious issues.

Use good technique— Improper exercise techniques can result in injury to the tendons or ligaments in your feet and ankles. Incorrect posture or misuse of exercise equipment can cause decreased stabilization in the foot and ankle, leading to joint sprains and muscle strains.

Gym Safety- Protect yourself from bacteria—Sweaty shoes, public showers, exercise equipment and the pool deck at the gym are breeding grounds for fungus, viruses and bacteria, including drug-resistant strains like MRSA (methicillin-resistant Staphylococcus aureus) which has become increasingly more common. Never go barefoot while in public areas; water shoes can provide a great barrier between your feet and the wet surfaces. “It’s also best to cover cuts and cracks in the skin or ingrown toenails since these minor tears in the skin’s surface can act as entry points for bacteria. If you have a cut or scrape that becomes red or swollen and is not healing in a timely manner, don’t hesitate to call our office for an appointment.

Above all, it’s important to listen to your body. If you experience an injury or pain, call our office at 440-946-5858 for an evaluation immediately!

Snow and Ice Can be Dangerous for Many Women

As a female, I too, like to wear fashionable shoes or boots, however with the onset of snow and ice after the 1st big snow storm hitting Northeastern Ohio it can be very dangerous. The treacherous snow and icy conditions we endure, can lead to falls, which are not only embarrassing but can result in a number of injuries. If your ankle rolls inward or outward, a bone can be broken or if your ankle twists, ligaments can be stretched or torn causing an ankle sprain. If this does happen to you, collect your belongings, brush off your designer duds and get somewhere where you can immediately begin “R.I.C.E.” therapy– rest, ice, compression and elevation – to help reduce swelling, pain and further injury. Then pick up your phone and call my practice in Mentor to be seen, 440-946-5858. If treatment is delayed long-term complications, such as chronic ankle instability and pain, arthritis, or deformity can develop.

Also, please do not believe the misnomer, if you can walk on it, it is not broken. If you develop pain, swelling, or bruising this is an indication of a serious injury requiring medication attention, so please don't hestiate and come into the office for evaluation.