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Bunions (Hallux Abducto Valgus)

A bunion is a bony prominence on the head of the 1st metatarsal with or without lateral deviation of the big toe. The pronatory forces surrounding the metatarsal also puts excessive pressure to the surrounding soft tissue structures which may lead to redness, swelling, pain and decreased joint range of motion.

Bunions may cause:
Inflammation or redness Sharp to throbbing pain or soreness with shoe pressure and walking Calluses Decreased or absent range of motion of the big toe joint Burning and numb sensations.

What causes bunions?
Heredity is the main culprit.  But other contributing factors may involve:

Wearing tight narrow pointed shoes.
Being on your feet with excessive stress to the feet.
Foot injuries.
Neuromuscular disorders.
Certain foot types (flat feet, low arches, etc.).
Over pronators.

What do I do if I think I have a bunion?
Consult a podiatrist.  X-rays may be necessary to evaluate the extent of the bunion.  Try wearing wider shoes.  Stretching and strengthening exercises and orthotics may be warranted. 

How to Ease Bunion Pain

Shoe Gear Changes:

Limit pointed toe high heels and wear something more comfortable.


Place bunion pads to reduce the pressure

Activity Modifications:

Minimize situations which require prolonged standing or excessive stress to the feet.


Ibuprofen, Advil, or Aleve may be recommended to reduce pain and inflammation.


Apply ice packs 2-3 times a day for 10minutes to reduce pain and swelling.


Massage and stretch and strengthen the 1st metatarsophalangeal joint 3 times a day.

Over the counter arch support devices:

Superfeet, Spenco Insoles, and other insoles.

Make an Appointment with a Foot and Ankle Specialist Who May Provide:

Custom orthotics.  Non-invasive laser therapy.  Corrective bunion surgery.

If your bunions are interfering with daily activities and is getting worse and more painful and not improving with conservative care, it may be time to discuss surgical options.  This may involve removing the bump and/or realigning the 1st metatarsal bone.

What can I expect after bunion surgery?
Recovery time may take several weeks.  Weight bearing is encouraged as tolerated.  During this period pain medication prescribed and ice to the area may help alleviate any discomfort or pain.  The first dressing change occurs after one week.  Sutures are removed around three weeks.  Keep foot dry until two days after the sutures are removed.  Begin range of motion exercises after the fourth week.  You may wear tennis shoes starting the fourth week as tolerated and regular dress shoes after three months as tolerated.  Back to Top


Ingrown Toenail (Onychocryptosis)

An ingrown nail occurs when a portion of the nail border cuts into the skin fold of the toe. Pain may range from slight discomfort to severe throbbing pain. Infection may or may not be present. Shoe gear can also create pressure on the area causing pain. There may be a cycle of improvement and worsening of the problem.

In mild cases, antibiotic and/or soaking in warm Epsom salt water will provide some relief.  If the skin becomes red, swollen, infected and painful it is time to seek professional treatment.

In mild cases, we will trim the offending corner of the nail and show you how to properly trim the nail to prevent future problems.  In moderate cases, the toe is properly anesthetized and the offending nail border is removed to allow the skin to heal and allow the new nail to grow back in.  In severe cases the entire nail is removed.  If this is a chronic problem phenol matrixectomy or surgical matrixectomy may be performed.  With both methods the toe is properly anesthetized and the offending nail border is removed.  In the case of the phenol matrixectomy a chemical is then used to permanently remove a portion of the nail root.  In the case of the surgical technique, the offending corner of the nail root is excised with a scalpel and no chemical is used.  One or two stitches are used to close the small incision.  Recovery from these procedures is short lasting a day or two.  However, there will be some clear drainage fluid for about 3-4 weeks.

Proper trimming of the nails on a monthly basis is recommended.  Nails that are too long can hit the end of the shoe causing retrograde pressure.  Trim the nail from one side completely to the other side with slight curvature to the corners.  If the nail is trimmed properly it may prevent future ingrown nails.  If in doubt get it checked out.  Back to Top



A hammertoe is an abnormal curling of one or more of the toes. As the toe deformity progresses it may rub against your shoe creating a painful corn. Constant shoe pressure to the contracted joint may lead to bursitis or capsulitis demonstrated by a toe that is red, swollen, stiff and painful.

Hammertoes in most cases may be asymptomatic.  In some cases hammertoe pain is activity or shoe related.

A hammertoe is diagnosed clinically.  X-rays can be used to identify the specific toe contractures.  In suspected cases, blood tests may be necessary to rule out systemic causes.

Find proper fitting shoes with enough room for toes.  Purchasing shoes at the end of the work day may help.  Wearing well fitted, comfortable, roomy shoes that will not irritate contracted toes.  High heeled shoes should be minimally worn. Walking shoes will help accommodate the contracted toes. Trimming corns on your own might be helpful but you are running the risk of cutting yourself and possibly creating a source of infection. Non-medicated corn pads are recommended to allow relief from rubbing shoes.

After either conservative treatment or surgery, follow our doctor’s orders, which may include advice regarding proper footgear, minimal use of high heel shoes, accommodative padding, or an orthotic worn inside the shoe to balance and improve the function of your feet.  If the problem source is identified early this may be reversible.

This may involve many different types of soreness, discomfort, aches and pains that occur to our feet. One common scenario is doc, “My feet are always tired.” Another issue may be related to discomfort in the bottom of the foot that is worsened with walking or while wearing shoes. There are many causes for these general symptoms, as well as many types of treatments. Many of the complaints occur due to imbalances or malalignments that apply abnormal pressure to bones and joints of the foot and ankle. Good sample of complaints are secondary to arthritic or the weakened joints.  Old trauma or old sports injuries to the foot or ankle will play a role when it comes to chronic pain.  Back to Top


Diabetes affects the entire body whether directly or indirectly.  Diabetes directly affects the eyes, kidneys, circulation, wound healing and especially the feet in various ways.  If the diabetes is tightly controlled symptoms and problems may be avoided or lessened. Diabetics should have their feet checked by a Podiatrist once or twice a year to make sure they are not at risk for any serious problems. This would be a good time to ask questions or to be simply reminded that you are on the right track may go a long way.  Ask about the latest treatments or updates.  A simple dietary education for those with fluctuating blood sugar levels may help to get a better handle on their diabetes.  Patients with long thick toenails and calluses should come in every couple of months to have these trimmed to avoid bigger problems.  Diabetic neuropathy involves general numbness and loss of feeling to the extremities. Those with neuropathy usually lose feeling in their toes and it progresses up the feet.  Some patients describe worsening neuropathy with a moccasin distribution.  This makes the feet more at risk for infective ulcers which may lead to amputations of the toe or foot.   As a preventative measure, Diabetics with Medicare may qualify for a pair of quality extra-depth shoes and custom cushiony insoles. These insoles help prevent skin breakdown which may lead to bloody calluses, and ulcers.   Back to Top


What are Ganglions?...
A ganglion is a gelatinous fluid-filled ballooning of the lining of a joint or tendon. Although ganglions can form on any part of the foot, they most often appear on the ankle or top of the foot. Ganglions may grow but does so slowly.  There may or may not be pain associated with the ganglion.  This all depends on the location.   Back to Top


What Are Warts? …
A wart is an infection caused by a human papilloma virus (HPV), which can invade the skin through small cuts or puncture wounds. Over time, the wart develops into a hard, rough cauliflower-like growth with small black dots on the surface of the lesion. A wart is most commonly seen on the bottom of the foot (plantar wart), but it can also appear at the top. There may be a single wart or multiple warts with varying mosaic distributions.  Pediatric or patients with allergies or weakened immune systems are more vulnerable to the wart virus.  Back to Top



What Are Neuromas?
This is commonly known as a Morton’s neuroma.  The problem begins when the outer nerve sheath starts to thicken.  This is caused by irritations to the nerve bundle sandwiched by two bones repeatedly rubbing together. The area between the third and fourth toes is the most commonly affected.  Nerve problems due to diabetes or alcoholism may also cause neuroma like symptoms.  Back to Top


Ankle Sprains

An ankle sprain is a sudden twisting of the ankle bones during activity.  The foot lands off balance to the legs.  Muscles and ligaments give out, allowing the ankle bones to dislocate or sublux (temporary dislocation).  If ligaments connecting the foot bones to the ankle bones overstretch or tear, a sprain is the result. These sudden injuries cause pain both at the time they occur and throughout the healing process. Depending on the sprain, swelling and bruising may extend from your ankle into your foot heels or toes. With proper care, sprains usually heal correctly.  In many instances with proprioceptive training, you may reduce the risk of reinjury.

Left untreated, sprains may not heal properly, making reinjury more likely.   Back to Top



Gout attack is caused by crystallization of uric acid in a single or several joints.  If you have many chronic gouty attacks, crystals may form large deposits called tophi. Tophi can damage joints and cause deformaity.

To minimize a gout attack, avoid these foods.

  • Alcohol (beer, red wine).
  • Certain meats (red meat, processed meat, turkey).
  • Organ meats (kidney, liver, sweetbread)
  • Shellfish (lobster, crab, shrimp, herning, mackerel).

Foods which may help:


Degenerative arthritis is a condition which slowly wears down joint cartilage.    Back to Top


Common Foot Problems:

Pressure ulcers are sores that occur when pressure cuts off the blood supply to the skin. Stress caused by the body’s weight and the impact of striking the ground place the ball of the foot, the big toe, and the heel at greatest risk. Left untreated, an ulcer may allow infection to enter your body. If infection reaches the blood stream or bone, your life or limb may be at risk. But with your doctor’s help, your health can be protected. Pressure ulcers can be controlled and even prevented.

The arch of your foot is the main supportive structure. If this arch loses strength, the bony framework begins to collapse, causing your foot to flatten. Like a sagging bridge, the weakness in the middle strains the joints at both ends of your foot.

The plantar fascia is a fan shaped ligament-like band which runs from the heel bone to the ball of the foot. This band helps stabilize the foot and holds up the arch during our weight bearing activities.  If the band becomes irritated or lacks blood-flow to the area due to excessive weight or constant pressure it will weaken and cause inflammation to the area producing chronic pain.

© 2012 Dr. James C. Lee, D.P.M.

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