What are bunions?

Bunions are bumps or prominences on the inside of the foot near the great toe joint.  Although we just think of a bunion as the bump on the side of the foot, there is more occurring than just that.  When a bunion develops, the big toe starts to angle or lean towards the second toe.  The large toe joint becomes out of alignment leading to the visible bump.  The medical term for this condition is Hallux Valgus.  Bunions start small and gradually progress with time.  Bunions are not always painful, however, the larger they become the more likely they are to become painful especially with wearing shoes.  Since the big toe drifts over towards the second toe, bunions (hallux valgus) can often lead to the development of hammertoes and calluses.

What are the symptoms of bunions?

• Pain at big toe joint
• Redness noted at the site of the bunion
• Pain with snug shoes/ high heels
• Numbness or burning pain as nerves can become entrapped between the bone and skin
• Stiffness

What causes bunions?

Bunions are typically a result of a person’s foot structure, which is hereditary.  Although genetics are the cause of bunion (hallux valgus), certain risk factors such as wearing ill-fitting, unsupportive shoes may lead to progression and worsening of the deformity.  Bunion deformities are more common in women and over the age of 60.

 

What are treatment options for bunions?

Nonsurgical options will not fix the bunion but will alleviate symptoms and slow progression.  These include:

• Orthotics to provide proper arch support and promote a better gait pattern. These will help slow down the progression of the bunion.
• Supportive shoes with a wider toe box to accommodate the bunion
• Bunion padding/shields/taping
• NSAIDs for acute pain
• Toe separators to take pressure off of the second toe
• Cortisone injections are an option to alleviate acute pain and nerve irritation

If conservative treatment options fail, surgical intervention is the next step.  There are many different types of surgical procedures depending on the severity of the bunion.   Prior to surgery, we will need to take x-rays to help in surgical planning.  Often these surgeries, called bunionectomies, require cutting the bone and realigning it as well as shaving off any prominent bunion.  At Star Foot & Ankle Specialists, we also offer minimally invasive surgery.  Minimally invasive surgery results in minimal scarring and often leads to a quicker recovery.

If you are suffering from bunions click HERE to make an appointment to come see us and find the best treatment plan for you!

Ingrown toenails are one of the most common conditions we see in our office at Star Foot and Ankle Specialists.  Ingrown toenails can be extremely painful and can lead to infection.  We most commonly see ingrown toenails on the big toes, but they can happen to the nails on the remaining toes as well.

Symptoms of an Ingrown Toenail

• Pain near the toenail
• Redness
• Swelling
• Drainage from the side of the nail that is ingrown. This drainage can be clear, bloody, or have pus.  There may also be an associated odor.

Causes of an Ingrown Toenail

• Genetics
• Trauma (dropping something that damages the toenail/repeatedly stubbing the toe)
• Nails being trimmed incorrectly (digging into corners)
• Too narrow of shoes causing pressure to the nails

Treatment of Ingrown Toenails

If you notice signs/symptoms of an ingrown toenail you can ease the symptoms at home by soaking the affected toenail in warm water and Epsom salts.  Please avoid attempting “bathroom surgery” and attempting to dig it out yourself.  This often will make the condition worse.  It is important to make an appointment as soon as you can with a podiatrist to treat the ingrown toenail so it does not become infected.  Although sometimes the nail can be trimmed at the tip to provide relief, most often the ingrown nail border will need to be removed.  This can be done the same day in office in a relatively quick procedure.  We start by cleaning and numbing the toe with local anesthesia.  Once the toe is numb, we use sterile instruments to remove the affected angry nail border.  We apply topical antibiotic ointment and bandage the toe following the procedure.  There is sometimes mild discomfort/aching to the toe for a few days following.  If the nail is infected, topical or oral antibiotics may be prescribed.

There is a possibility that the ingrowing toenail can return in the future.  We also present the option to permanently remove the ingrown toenail border.  This procedure is the same with the exception of the application of a chemical to destroy the nail root and prevent regrowth.  This procedure tends to cause discomfort for a little longer, usually about a week or so.

Prevention of Ingrown Toenails

• When cutting nails, trim them straight across. Avoid digging into the corners.
• Avoid cutting toenails too short.
• Wear shoes that are not too narrow and cause pressure to the sides of the toes.

If you are experiencing any symptoms of an ingrown toenail, click HERE to schedule an appointment at Star Foot and Ankle Specialists!

 

Toenail fungus, which medically is termed onychomycosis, is a common condition that can cause changes to the thickness and color of a nail.  Fungus, in general, is an organism that likes moist and dark environments, just like how we can find in our shoes!  Wearing shoes, especially when snug, can cause repeated friction and microtrauma which can cause nails to lift up. This lifting of the nail allows fungus to enter and infect the nail.

Toenail fungus symptoms include discoloration and thickening of the nail.  The affected nail may become brittle and separate from the nail bed.  You may notice debris (buildup) underneath the nail.  Sometimes the nail can even have an odor.  The nail may become painful as it continues to thicken, which can be worsened with certain shoes.  Often, we see toenail fungus in combination with Athlete’s Foot (a fungal infection of the skin).

Although anyone can contract toenail fungus, there are certain groups that are more at risk than others including those who are immunocompromised, have diabetes, and are elderly.  People with poor circulation are also more prone to a fungal infection of the toenails.  We also see toenail infections more commonly in those with excessive sweating of the feet and Athlete’s Foot infections.

Without treatment, the toenail fungus will likely spread to other toenails.  There are multiple types of treatment options:

• Oral medications, depending on the medication, offer success rates of up to 76%. These antifungal pills often have predictable and successful results.  Typically, these require about a 12 week course of treatment and improvement to the nail is noticed as it grows out.  As with any oral medication, although uncommon there are risks.  We require routine bloodwork to be done to ensure that there are no side effects particularly on the liver or blood cell count.
• Topical medication includes creams and medicated nail lacquers. Overall, these are not quite as effective as oral medication but are an option if there are contraindications or hesitancy to taking antifungal pills.  Topical medications tend to work better on more mild nail infections.  With use of topical medication, we recommend regular nail trimming.
• Laser therapy is another option for treating toenail fungus. Laser therapy typically involves 4 weekly sessions of 12 minutes of laser exposure, which is relatively painless.  Research has shown to have approximately 67% efficacy rate, with some sources even higher than this.
• Nail Removal is a last choice option for severe nail thickness. This involves a minor procedure in the office where the affected toe is numbed with anesthesia and the nail is removed.  Regardless of the treatment option there is always a chance of recurrence.

There are certain steps that can be taken to help prevent toenail fungus.  These include:

• Changing socks regularly, especially throughout the day if you have sweaty feet
• Avoiding being barefoot in public areas, especially damp areas like showers/saunas/etc
• Ensuring that clean instrumentation is used when cutting nails/getting a pedicure
• If noticing any signs of Athlete’s Foot (fungal skin infection) seek prompt treatment
• Wearing shoes that fit your feet well
• Wearing shoes with material like mesh that breathes well
• Wearing moisture wicking socks
• Having toenails well trimmed
• Seeing a podiatrist in a timely manner when noticing changes in nail color or thickness

If you have any concerns about possible toenail fungus, make an appointment with Star Foot & Ankle Specialists and have Dr. Heredia and Dr. Zellers find the best treatment for you!

Schedule an appointment by clicking here