Health Leader, What's Afoot?

STORY BY

Imelda Gott

Final of a Two-Part Series

Covering:
Bunions • Hammer, Mallet, Claw Toes • Corns and calluses • Warts • Ingrown Toenails

In Part One, we discussed internal foot disorders. Today, we look at the external—those foot problems that “rub you the wrong way.”

Luckily doctors agree that many pedestrian conditions can be treated at home.

Foot ailments such as bunions, hammertoes, calluses, bunionettes, and Morton’s neuromas are commonly caused by pressure on the forefoot. Toes crumple up like crepe paper, and it feels like torture.

Thomas Clanton, M.D., professor in the Department of Othorpedic Surgery at The University of Texas Medical School at Houston and co-medical director of the Roger Clemens Institute for Sports Medicine & Human Performance, explains, “Shoes that are very narrow through the forefront put a lot of pressure on the toes, and the boney prominence can create irritation.” The irritation, making red patches on the skin, causes the body to create more skin to try to pad the area. With the build-up comes pain.

Just an Ugly Bump—the Bunion

“Bunions are the most common foot problem, particularly in women. Bunion means bump. It can be on the side of the foot, which is more common, or on the big toe, a dorsal bunion, where the big toe connects to the foot,” explains Clanton.

“It isn't the mountain ahead that wears you out, it's the grain of sand in your shoe.”

— Robert Service,
poet

The causes are a combination of heredity and tiny-toed shoe styles. Some bunions are related to an inherited anatomical problem corrected with surgery. Bunionettes, smaller bunions on the outside of the foot, are almost always related to choice of foot wear.

Try This

Pick roomy footwear.
Have a shoe shop stretch the leather of problem-causing shoes.
Buff the bunion with a pumice stone.
Add a cushioned insole (when shoe shopping, take in consideration more room in the shoe to accommodate the extra material.)

Clanton, who has performed hundreds of bunion surgeries in his 22 years, says, “If these don’t work, then surgery becomes the preferable option to straighten the toe and get rid of the bump.” For a bump on the side of the foot, the procedure is to shave it off. If the muscles are imbalanced and the joint is out of place, the imbalance is surgically corrected.

Thick-Skinned Problems:
Corns and Calluses

Dr. Michael Altman, assistant professor of Family Practice and Community Medicine at The UT Medical School at Houston, with a sub-specialty in Sports Medicine explains, “Corn and callus are the same, just thickened dead skin. If they are small, we recommend that patients get those little over-the-counter donuts.” This eliminates contact with the corn. For calluses, Altman suggests felt padding over the callus and between or under the toes to spread them.

If “drug-store” solutions don’t work, Altman says the callus can be shaved off. “We try to make sure they don’t have another problem.” He says if the callus or corn comes back, there may be a bone problem. Surgery is considered only if there is a large piece of calcium or bone causing the callus.

On Your Toes:
Hammers, Mallets and Claws

Toes that don’t extend properly may be caused by that same tight “toe box” implicated in so many other foot crimes, or they may be due to injuries or disease. Resulting corns may benefit from over-the-counter “donuts” or pads and proper fitting of shoes. In some cases, surgery may be required to correct the toe structure.

In hammertoes, a bending of the second, third or fourth toe where the second joint in the toe points upward causes the toe to bend downward. Clanton’s senior research nurse, Thea Troetscher, RN, says, “While it is held in the orthopaedic community that this condition is primarily hereditary, it is also known to be irritated or exacerbated by improperly fitted shoes.”

In the mallet toe, the bending occurs in the end joint at the base of the nail. The cause is usually poorly fitting shoes or an injury such as a stubbed toe that damages the attachment of the tendon to the bone. Claw toes, where the toes bend upward, may have the same causes. Clanton points out, “More commonly, there is a muscle imbalance around the toe where tendons are tight. If this happens on both feet, it may be related to one of the muscular diseases,” although he notes that this is uncommon.

Warts and All

A common virus causes warts. Altman laments, “Unfortunately, there is no good cure for warts that occur on the feet. They often come back.” He often suggests that his patients try a home remedy first. For patients who would rather not deal with warts themselves, Altman’s approach is to spray the area with liquid nitrogen or shave off the wart under local anesthetic.

To walk a little easier:

Try out insoles and heel cups for comfort
Buy your shoes at the end of the day
Wear shoes that are appropriate to your job or sport
Take care with home pedicures to avoid ingrown toenails.

While home remedies often relieve pain, see a physician if problems persist or if there is inflammation.

Home Wart Remedy

Altman suggests the following process to his patients with warts:

Soak your feet in warm water.
Cut off a small piece of tape embedded with aspirin-impregnated tape called salicylate plaster, just large enough to cover the wart, available over the counter.
Place the tape over the wart in the evening, and remove upon awaking the next morning.
Repeat this process until a plug of skin infected with the wart comes off. You may gently scrape it off with a clean, dull butter knife.

How to Avoid Ingrown Toenails

Ingrown toenails result from two basic causes: poorly fitting shoes or improper pedicures. “When you trim your big toenail nice and round like your fingers, the corner where you’re trimming has to pass through a naturally-made ridge. When you trim that nail into an oval, you’re not allowing the nail to pass through that ridge, so it gets stuck in the path of the ridge. We try to get our patients to trim the great toe (big toe) straight across that natural ridge,” says Altman.

Make sure that when you trim the nail that you have allowed the inner corner of the nail to go a little beyond the edge of the toe. Use a file or emery board to soften the corner of the nail base.

Home Treatment

If you have an ingrown toenail, and sure that there is no infection, “just sore, but not swollen or red,” Altman suggests this treatment:

Take a little piece of cotton and roll it up like a tiny cigar and place it between the tender rolled edge of skin and the nail.
Cut a little cotton wedge that is the length of the skin that has rolled over the nail.
Soak the foot in warm water, to make it a little easier to put the cotton wedge between the nail and nail plate.
Place the cotton wedge under the edge of the nail, so that the skin stretches out and allows for the nail to pass through.
Let it grow out, then cut the nail straight across.
If this process doesn’t work, then make an appointment with a physician.

Both Altman and Clanton agree that it is not necessary to remove the entire nail. A small section of the nail can be removed with a nerve block. Usually, the nail will grow back without a problem.

Keep In Step With Healthy Feet

For more information about healthy feet and proper shoes, visit the American Orthopaedic Foot & Ankle Society Web site:http://www.aofas.org

UPDATED: 08-14-2003