Hammertoes

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




• The way in which your foot loads during walking can place increased stress on the ball of the foot and cause increased toe activity. Orthotics can help to control foot movement.


• 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.

Bothersome Bump to 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.

Sweaty Feet?

Foot sweating is also known as pedal hyperhydrosis. Pedal hyperhydrosis is a medical condition that involves the feet and the excessive sweating of the feet. Foot sweating rarely occurs on its own. More often than not, it appears in conjunction with palmar hyperhydrosis or abnormal hand sweating. If the hands don't sweat profusely but the foot does, the condition is called solitary foot sweating. There are many causes of excessive foot sweating, therefore it is difficult to pin point the exact cause for each individual. It could be caused by an overactive nervous system, stress and anxiety, over-activity of the sweat glands themselves or heredity. It is very common to see family members with similar sweating condition.

Excessive foot sweating exists in many different degrees. Mild forms of foot sweating can be treated with absorbent foot powders, antiperspirants and more frequent changing of shoes and socks. However, more severe forms of foot sweating can lead to other diseases, such as athlete’s foot, bacterial infections, fungal toenails or other skin problems: Therefore, should be evaluated by a foot/ankle specialist for treatment, which may include medications, such as Drysol.

If you have excessive sweating to your feet, please visit the practice website at www.drrobertrosenstein.com for more information or call 440-946-5858 to schedule a consultation.

Sexy High Heels

High heeled shoes create a sexier and more flattering figure. They do this by tilting the hips, accentuating the bust-line and making the legs look longer. However, high heels can cause a great deal of discomfort: High heels can cause calf pain, heel pain, bunions, corns, calluses, ankle sprains, neuromas, hammertoes, pump bumps and pain to the ball of foot.


How do I encourage women to wear more sensible shoes? It's almost impossible. I do tell my well-heeled patients to limit their time spent in heels-never all day, just for a few hours. I also instruct them to buy shoes at the end of the day that fit comfortably across the widest part of the foot and wear gel or silicone insoles for a comfortable cushioning effect as well.

Please do not hesitate to contact the Mentor Office, 440-946-5858 with questions or comments.

Spring is the Season for Ankle Sprains

Spring is sports season for many amateur athletes and weekend warriors in the Cleveland area. It's also ankle sprain season. Ankle sprains are one of the most common sports injuries treated at this time of year due to people emerging from their winter hibernation and getting active again, through playing sports such as basketball, baseball, tennis and/or soccer.

If you injury your ankle prompt medical treatment is required, whether it's your first sprain or fifth. Rest, ice, compression and elevation (R.I.C.E.) can reduce swelling and pain until the ankle can be evaluated and treated. A sprain may not always be a sprain; the ankle could be fractured.

To prevent injury or sprain to your ankle follow the following tips to ensure safe play. First, perform warm-up stretches and exercises before playing sports. Second, wear the right shoes for the sport. For example, don't wear running shoes for sports that involve a lot of side-to-side movement, such as tennis and basketball. Lastly, wear an ankle brace if you're recovering from an injury or have repeatedly sprained your ankle. Follow these tips and enjoy the spring season.

Athlete's foot is a skin infection caused by fungus. A fungal infection may occur on any part of the body: On the foot it is called athlete’s foot or tinea pedis. Fungus commonly attacks the feet because it thrives in a dark, moist, warm environment such as a shoe.

Fungal infections are more common in warm weather when feet tend to sweat more. Fungus thrives in damp areas such as swimming pools, showers, and locker rooms. Athletes commonly have sweaty feet and use the facilities where fungus is commonly found, thus the term "athlete's foot."

Athlete's foot usually produces itchy, dry, scaling skin. It is commonly seen on the soles of the feet and in between the toes. In advanced cases, inflammation, cracks, and blisters may form. The fungus can spread to other areas of the body, including toenails.

Avoiding walking barefoot combined with good foot hygiene can help reduce the spread of the fungus. Feet should be washed every day with soap and water and thoroughly dried, including between the toes. Feet should be kept as dry as possible. If your feet sweat a lot you may need to change your socks during the day. Anti-fungal powders, sprays, and/or creams are often utilized to treat athlete's foot and our office will recommend the best treatment for you, therefore please give us a call, 440-946-5858.

Feet and Fish

What do fish have to do with your feet? Well, have you heard about the latest way to get rid of rough, dead skin (callouses) on your feet? A few salons through out the US have started using tiny little fish called garra rufa or doctor fish to eat the dead skin off of your feet and toes. After the fish are done with your feet a standard pedicure is performed. It sounds like the fish do not have any teeth, so they do not eat living skin. However, with any new treatment, I would advise caution and suggest you follow the 10 tips for a safe salon pedicure provided below.

1. Bring Your Own Instruments

This will help decrease the risk of catching viruses, bacteria and fungus. Things to bring include: nail nipper, cuticle nipper, cuticle pusher and curette cleaner.

2. Ask About Instrument Cleaning

Does the salon sterilize their instruments or do they just disinfect? Sterilization of instruments by autoclaving is the better choice.

3. Ask What Type of Foot Bath is Used

Usually the whirlpool foot bath is either piped or pipe-free. It is thought that pipe-free is better because piped whirlpool foot baths have been found to contain bacteria in their pipes, jets and water filtration systems. The pipe-free whirlpool foot baths can easily be removed for cleaning. If the foot bath uses a liner, make sure that a new liner is being used each time.

4. Ask If Disposable Items Are Used Only Once

Items such as nail files, foot files, buffers and toe separators should be used only once. You may want to consider bringing your own disposable items with you.

5. Make Sure Technician's Hands Are Clean

The nail technician should wash their hands in between clients. If they do not wash their hands, request that they do or that they wear gloves. Be cautious of a technician with fake (artificial) fingernails. It is hard to clean the area between the fake fingernail and the real fingernail.

6. Ask If the Salon and Technician Are Licensed

The salon and technician should both be licensed by the state governing board.

7. Don't Shave Legs 24 Hours Before Appointment

Nicks and cuts from shaving create small openings in the skin where bacteria can enter. If you have any open sores, wait until they heal before getting a pedicure.

8. Tell Technician Your Medical Conditions and Medications

Certain medical conditions and medications can increase the risk of infection. Examples include: Diabetes, lymphedema, PVD, neuropathy, HIV and autoimmune diseases such as lupus. Examples of medications include: chemotherapy agents and blood thinners such as coumadin.

9. Check If the Salon is Clean

The salon itself should be clean and well kept. This is usually a good indicator of how well they take care of their instruments and other salon equipment.

10. You Should Have No Pain

Getting a pedicure at the salon should not be a painful experience. Just like any business, there are good salons and not so good salons. Find a pedicure salon that follows strict sterilization procedures and find a technician who does not cause pain or do you harm.