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By Dr. Kuvent, August 16, 2010 11:46 am

If you have a bunion on the outside of your foot, where the 5th toe meets the 5th metatarsal bone of the foot, you don’t just have a bunion, you have a Tailor’s Bunion. And if you have a Tailor’s Bunion, you can blame those who lived during the Renaissance period for your pain. You read that correctly, people who lived in the 14th century were responsible, at least in part, for the profession that eventually led to the naming of the Tailor’s Bunion. First, a brief history lesson, then more about your condition.

During the Middle Ages, clothing was merely a means of concealing the body. Then came the Renaissance period, where people sought to accentuate the human form not only in the arts but in the fabric they wore on their backs. Gone were the days of wearing a loose robe that had been so easily created from a single piece of cloth. People began shortening, tightening, cutting, piecing, and sewing swatches of fabric together in an eventually successful attempt to bring into prominence the contours of the human body. This, ladies and gentlemen, marked the emergence of tailoring and, as a matter of fact, the birth of fashion itself. It is not too difficult to imagine that with a growing demand for shaped clothing, came also a growing need for someone who could shape the clothes. First came the “cutter”, whose job was to make the patterns. Then came the “tailor”, who did the sewing.

Now, fast-forward a few hundred years, and you could find tailors in every town or city, sitting crossed legged in their shops, sewing away at their newest conceived design. Consequently the outside of their feet, especially the heads of the 5th metatarsals, would be rubbed on the floor with such vigor that it began to hurt. They would go on to develop prominences, or “bunions” on the outsides of their feet, which was simply the body’s way of protecting itself. This is exactly how the Tailor’s Bunion got its name.

Your next question, logically enough, may be how is it that you can have a Tailor’s Bunion if you are in fact not a tailor, and perhaps you don’t even sit crossed legged. The answer is again related to fashion: inappropriate shoe wear. Just like it’s cousin, the bunion on the big toe, a Tailor’s Bunion can form as a result of wearing shoes with a tight toe box. Increased pressure of the foot against the inside of your shoes can, over time, result in the metatarsal bone moving and ultimately the formation of a bunion. In patients with wide feet, a Tailor’s Bunion tends to be one of the more common complaints because even though these patients have wide feet, they still tend to wear standard sized shoes, which leads to increased pressure on the sides of the feet, particularly the toe joints.

Whether you have wide feet, you’re a tailor who still sits on the floor crossed-legged, or you have a Tailor’s Bunion for some other reason, the good news is that this problem is most often completely curable. If you have pain associated with your bunion, you can use over the counter anti-inflammatory drugs and pain killers to help alleviate your pain. If your pain has persisted for a long time or if the drugs don’t help your pain, then your doctor may decide it’s time to recommend surgery. Wearing appropriate shoes is

another important aspect of treating a Tailor’s Bunion. These special shoes, or any shoe geared towards people with wide feet, can be very effective in avoiding the development of a bunion or reducing the pain associated with bunions. These shoes are best used in conjunction with bunion pads, and in many cases can make your everyday activities much easier on your feet.

If you have a Tailor’s Bunion, you should consult your local Podiatrist today to see what course of action is best for you to return to your regular activities, whether that be a physically demanding job, daily exercise or becoming the next big Design Star!

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By Dr. Kuvent, August 3, 2010 8:25 am

Do your footprints look different than everyone else’s at the beach? If so, chances are you could be a flatfooted individual.

Having flat feet is a common condition involving a collapsed arch, which allows the entire bottom of your foot to come in contact with the ground. There are many various causes of flat feet.

First off, flat feet are normal in infants and toddlers because the arch has not fully developed, so don’t be alarmed if you’re a new parent or grandparent and you happen to notice those precious little feet are flat as a board. The arches will likely develop sometime in childhood and by early adulthood, your little Jack or Jill should have normal arches in their feet.

This being said, a person can be born with flat feet that won’t develop normal arches. The best explanation for this is the simple fact that everyone is different. Some people are tall, some are short; some people have long skinny fingers, others have short stubby ones, and the rest of us tend to fall somewhere in between. If you were born with flat feet, they may or may not cause problems later in your life.

If your child complains of painful feet and they appear to be flat footed, it may be caused by a condition in which two or more of the bones in the foot have fused together. This will limit the motion allowed within the joints of the feet, and often results in a flat foot or two.

Now, if you, like most little ones, had the “normal” flat foot when you were a baby, and then developed proper arches as you grew, there is still a chance you could develop flat feet. This condition, when developed later in life tends to cause pain and possibly other symptoms, such as developing arthritis in the feet. Unfortunately, there are many different factors that can contribute to the development of flat feet, and therefore it is nearly impossible to prevent. Some causes include the position in which a child sits or sleeps or having other various abnormalities in the leg or thigh. More severe causes include trauma to or rupture of ligaments or tendons in the foot. Two more common causes of acquired flat feet in adults are “Posterior Tibial Tendon Dysfunction” (in which that particular tendon – the Posterior Tibial Tendon – malfunctions) and having a tight Achilles tendon (which causes the foot to flatten).

Your local Chandler podiatrist at Advanced Foot Care is experienced in treating flat feet both conservatively and surgically. If you have painful flat feet, don’t simply continue to walk down the beach with those funny looking footprints, call today for an appointment!

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By Dr. Kuvent, July 21, 2010 9:03 am

Have you ever wondered why calluses form or what can be done to prevent them? Most of us, at one point or another, have had a callus on either our feet or hands, or maybe even both. But just because you’ve had them doesn’t necessarily mean you know what calluses are, why they form, or perhaps more importantly, how you can be rid of them!

Calluses are areas of thickened skin that develop in response to repeated friction and pressure. They can develop on any part of the body, but are commonly seen on the hands and feet. Believe it or not, they are one way the body attempts to protect the skin and the structures beneath it from getting damaged. If you’re not familiar with thick calluses, find someone who works with their hands, perhaps a construction worker or maybe a musician, and ask them to show their hands to you. They’ll likely have thick calluses on their palms and/or fingertips. These calluses help protect their fingers and palms while playing their stringed instruments or working on the job.

Calluses can of course develop on the feet, usually on the soles under the heel or up under the ball of the feet. This is because these two spots on the feet bear most of the pressures of walking or standing. While this may not be a problem, calluses can become so thick, they start causing pain because of increased pressure.

Unless you happen to live somewhere that allows you to go barefoot all the time, there is a chance your calluses are due to some structural abnormality in your feet. This is why you should use all home care products for removing calluses with caution; while you may be able to remove the callus on your own, temporarily relieving your pain, you may be ignoring more serious conditions that may require medical attention. Some examples of problems in the feet that may cause calluses are flat feet, hammertoes, or bunions. Like many problems of the feet, wearing ill-fitting, narrow shoes are also a risk factor for developing calluses. Wearing shoes that are extra wide and deep, have soft soles and/or lower heels may help to prevent calluses. These shoes avoid placing increased pressure on areas of your feet that weren’t designed to handle the abnormal pressures.

Whether painless or unbearable, calluses have the potential to cause complications. Calluses can harbor infection that leads to pus-like drainage, increased pain, swelling of the feet, and even a fever if the infection becomes widespread throughout the body. In the event this happens, it usually requires antibiotics to clear up. This can be particularly serious in the diabetic population because diabetics tend to have more difficulty in healing properly than non-diabetics.

If you have a bothersome callus, a quick and easy appointment with a podiatrist may be all you need to diagnose the underlying cause of your calluses. Your doctor can shave down the callus in the meantime, relieving your pain, making each step easier and more comfortable.

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By Dr. Kuvent, July 19, 2010 9:34 am

Have you ever paid much thought to your toenails? Perhaps you enjoy painting them or getting a pedicure, delicately prepping them for the next big event in which you can display them to the world in your newest pair of designer sandals. Or maybe your inner John Wayne prevents you from dolling them up, and you’d rather take your pair of hedge cutters, lop them off and be done with it. Either way, chances are you don’t think of them with every step you take, unless they are painful and cause you trouble. One very common culprit of a painful toe/toenail is an ingrown toenail.

An ingrown toenail occurs when the sharp edge of the nail grows down into the skin of the toe. This usually causes pain, and may involve redness and swelling around the nail. When this happens, it’s usually a good idea to take care of the problem promptly. This will avoid prolonged irritation by the nail, which in turn can increase the chances of harboring infection, not to mention the longer you wait, the longer you’ll likely be in pain.

There are a number of potential causes of ingrown toenails. Two of the more common ones are wearing ill-fitting shoes and neglecting the importance of trimming your toenails properly. Having poor eyesight or being physically unable to reach your toes easily can also make it difficult to properly trim your nails. Also, if you’re one of those people who have a tendency to pick or tear at the corners of your toenails with your fingers, just know that you can increase the likelihood of developing an ingrown toenail by continuing this seemingly harmless habit. Unfortunately for some people, being prone to ingrown toenails is just in their DNA. You may have toenails that are simply too large for your toes It is also possible that you were born with curved nails that grow downward, into the skin. Although the big toe is the usual suspect, harboring the greatest potential for developing an ingrown toenail, any toenail can become ingrown.

There are a few practices you may want to either begin, or continue if you already employ them, to help prevent the development of an ingrown toenail. First, you may soak your feet in warm water to soften the nails, being sure to use a clean bowl or tub. When trimming your nails, always use a clean, sharp nail trimmer or cutter, and try to trim your toenails straight across as opposed to tapering or rounding off the corners, as this may only put you at an increased risk of developing an ingrown toenail. Also be sure not to trim your nails too short.

 If you have diabetes, poor blood circulation, any kind of nerve damage, or an infection around your toenail, absolutely do NOT try to treat an ingrown toenail on your own. Go to your podiatrist right away. For the rest of you, while there are some home remedies for ingrown toenails that may work, it is usually best to see your local podiatrist, who as a foot specialist, is the most qualified doctor to deal with such a problem.

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By Dr. Kuvent, June 25, 2010 2:12 pm

“Arch Pain” is a common term used by many to describe symptoms that may occur in the arch of the foot. One of the most common findings in a patient with arch pain is inflammation of the tissues within the midfoot (you know, that portion of the foot further down from the ankle and heel, but closer than the toes). You may know where the arch of the foot is on your own feet, but what is involved in forming this arch? A tight band of tissue called the “plantar fascia” connects the heel bone to the toes, forming the arch. Now, this band of tissue is very important in ensuring that the foot performs as it should mechanically, and it is important in walking because of its role in transferring weight from the heel to the toes with each step. When this arch-forming tissue becomes irritated and inflamed, it causes that infamous “arch pain” and patients may experience severe pain even with the simplest of movements.

Knowing that the plantar fascia is an important structure in forming the arch of the foot should lead you to believe that plantar fasciitis (a commonly used medical term meaning inflammation of the plantar fascia) is the most common cause of arch pain. Symptoms of plantar fasciitis include pain right away in the morning when you first get out of bed or pain with long walks or prolonged periods of standing. If you experience arch pain early in the morning, chances are it is due to the plantar fascia becoming tight while you sleep. Upon waking up and walking to the kitchen for your morning cup of coffee, the plantar fascia is still tight from your slumber and it gets irritated when it stretches out during walking. This in turn makes the already difficult walk (depending on the amount of sleep you get) to the kitchen even more difficult due to intense pain.

The best treatment for plantar fasciitis is often a combination of some simple stretching exercises, anti-inflammatory medications such as Advil, and inserts for your shoes to help support your arches, which reduces the amount of stretching of your plantar fascia. If these conservative treatments aren’t enough to take care of your pain, you should see a podiatrist to discuss other options.

Another cause of arch pain involves collapse of the midfoot, placing excess stress on the arch. This stress affects the plantar fascia, as well as some tendons running along your ach and the joints of the midfoot. Over time, excessive stress on the midfoot joints can result in arthritis.

There is a particular tendon that helps support the arch and prevents it from collapsing. When excess stress is placed on the midfoot, this tendon becomes overstressed, which can result in tearing, inflammation, pain and eventual breakdown of the tendon. This may require therapy, being placed in a cast, or even surgery.

If you are experiencing any of the discussed symptoms of arch pain, make an appointment with your local podiatrist to determine the best course for relieving your pain and making your morning walk to the kitchen easier!

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By Dr. Kuvent, June 24, 2010 3:35 pm

Pain in the ball of your foot is often slapped with an all inclusive, catch all medical term that leaves patients feeling as if they’ve become just another number in the crowd with an obscure, difficult to pronounce condition. While this is one broad condition, its causes are many, and to properly treat your foot pain, the root of the problem needs to be discovered.

While pain in the ball of your foot is generally not serious or life-threatening, it can be a hindrance keeping you on the sidelines instead of participating in the things you like to do. Fortunately for you, conservative treatments, such as ice and rest or proper footwear along with insoles or arch supports, may be all you need to solve, or at least minimize your pain and get you back on track!  

You can ask five people, all experiencing pain in the ball of their feet, and get a different list of symptoms from each of them; needless to say, symptoms vary. You may be experiencing sharp, intense pain, or a dull, aching pain, or even both depending on the day of the week. You may find that your pain lies in the area around your second, third and/or fourth toes — or, only around your big toe. Most likely, your pain will get worse when you stand, walk or run and will improve after resting. It’s possible to have sharp, shooting pain in your toes or to have completely numb toes. Some patients also report feeling as if they’re walking with a pebble in their shoe. Most of the time, any or all of these symptoms will develop gradually over time; however, they can start suddenly if you’ve recently increased the amount of time you spend exercising or the intensity at which you exercise.

In each of your feet, there are five metatarsal bones that run from your arch to your toes. When you push-off during walking or running, your body weight is transferred to these metatarsals and your toes. Most of the time, pain experienced in the ball of the foot is due to some problem affecting the way your weight is distributed to these bones, putting excess pressure on the metatarsals, which causes inflammation and pain, especially in the ends of the metatarsals where they connect with the toes. Sometimes the pain is caused by one problem, but often it is due to a combination of reasons. These reasons range from increased activity, to wearing ill-fitting shoes, to gaining excess weight.

When left untreated, the pain can spread to other areas of the same foot or the other foot, and after enough time, it may even spread to other areas of the body such as the knees, hips or back. This is why you should not ignore pain in the ball of your foot for too long. While you don’t necessarily need to rush to your podiatrist the first time you take a painful step, you should consider making an appointment if the pain persists or worsens over the course of several days to weeks.

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By Dr. Kuvent, June 10, 2010 10:36 am

Have you noticed lately that you are unable to walk as far as you used to without needing to rest? Do you experience calf pain soon after beginning an activity, forcing you to stop before you want to? Have your feet felt cold or your toenails become thickened? Has the hair on your feet stopped growing? If you can answer yes to any or all of these questions, you may be suffering from a serious problem involving the blood vessels in your legs and feet. In the medical community, this condition is called PVD (“peripheral vascular disease”), but all this medical jargon really means is that the blood vessels in your legs are blocked, leading to decreased blood flow to your calves and feet. This blockage may be due to a number of reasons, like clogging, narrowing or hardening of the arteries. No matter what the underlying cause is, you should see a doctor to determine the proper treatment to get you back on your feet and walking without pain. Your podiatrist will be able to do a series of physical tests to assess your problem, and they may request a consult with a doctor who specializes in blood vessels to aid in the diagnosis of the specific problem at hand.

A hallmark of this clinical condition is that the pain occurs periodically with an activity such as walking, then after a moment of rest (the length of this rest time varies from patient to patient), you are able to continue walking. Other signs that point to PVD include a bluish discoloration of the lower legs and feet, decreased hair growth or shiny skin on the tops of the feet and toes, decreased temperature of the affected limb, and decreased pulses felt in the feet.

While this may seem odd or opposite to common sense, exercise is often the best option to improve your symptoms (provided they are mild – severe symptoms will often require more intensive forms of treatment). You should always talk with your doctor before beginning an exercise program, to ensure your health won’t be compromised. Let’s say, for example, you experience pain and require rest after walking two blocks. This should not encourage you to simply avoid walking two blocks! Instead you should set realistic goals, such as making it three blocks before resting, then seek to improve your ability to walking four blocks and then five, and so on. Medications that aid in controlling blood pressure, diabetes and cholesterol will help keep your blood vessels in good working order, and thus help you to walk further without pain.

If your doctor determines the blockages in your arteries are too serious to simply prescribe exercise, they may consider surgery. This option is typically reserved for conditions that are life or limb threatening or significantly interfere with your ability to complete activities of daily living.

You deserve to enjoy the activities in your life! If you suffer from any of the symptoms discussed above, make an appointment with your local Chandler podiatrist today and get started with the rest of your life!

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By Dr. Kuvent,

The term “gangrene” is derived from Greek and Latin words, neither of which have anything to do with the word “green”. It is purely coincidence that the tissues affected by this condition may have a greenish color. Whether you know of someone who has it or you’ve watched any number of different war movies, you’ve probably heard of gangrene. The question is: what exactly is it, and what will happen to those who have it?

Gangrene, by definition, is a condition involving cell death and is characterized by the decay of body tissues. The affected tissues may become black, green, or even yellowish brown, and often have a foul odor. It is most common in the lower extremities, particularly the feet and toes. Gangrene can be caused by an infection of some sort, but more often than not, it is the end result of critically reduced blood supply to the affected tissues. Some major risk factors for developing gangrene are disease states like diabetes or circulatory problems, and long-term smoking.

There are three types of gangrene: dry, wet and gas.

Dry gangrene often starts in areas like the toes and feet. It develops in cases where blood supply is interrupted by some reason other than infection. This particular type of gangrene spreads slowly until the blood supply is so poor that the tissues are no longer able to survive. The affected area is dry and dark black, and some say it resembles mummified flesh. People with impaired blood flow, such as diabetics and the elderly, are at a greater risk of developing dry gangrene. Early signs include a dull ache, the affected area feeling cold, and the skin appearing pale white. If caught early, it can be reversed by surgery; however, if tissue death occurs, the affected tissue must be removed.

Wet gangrene occurs more often in naturally moist tissues and organs but can occur in the foot. Here, the tissue is infected, which causes the tissue to swell and give off a foul smell. While dry gangrene spreads slowly, this tends to develop rapidly. In the affected area, blood pools and remains still, which promotes the rapid growth of bacteria. These bacteria produce toxic products which are absorbed into the blood and can spread to the whole body, potentially resulting in death. Like in dry gangrene, the affected area is swollen, soft, rotten and dark.

Gas gangrene is very serious and deadly. Like wet gangrene, it is caused by an infection, only in this case, the infection produces gas within tissues and spreads rapidly into the nearby healthy tissues. For this reason, gas gangrene is considered a medical emergency. 

Treatment of gangrene revolves around restoring adequate blood flow to the affected area, to allow proper healing. Other treatment options include removal of the dead tissue or amputation of the affected limb.

If you or someone you know has signs or symptoms of gangrene of the foot, you should seek medical treatment right away! Your local podiatrist will know the appropriate course of action to make sure everything that can be done to save your foot will be done.

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By Dr. Kuvent, May 27, 2010 12:00 pm

If you have an ulcer anywhere on your foot or ankle, you should never mutter that ever popular Monty Python phrase “it’s just a flesh wound” and ignore it! An ulcer is a serious wound involving the complete loss of the top layer of skin and possible extension into the deeper layers and tissues. These are especially dangerous in the diabetic population. If you, or someone you know, has diabetes, then you must be aware of the signs to look for involving ulcers, and you should see a podiatrist routinely. Diabetic foot ulcerations are the most common single precursor to lower extremity amputations.

Now, you may be wondering why diabetics are more susceptible to lower extremity problems. The answer is fairly complex, but here is a general overview: Diabetics may have a series of pathologies in the nerves, blood vessels, muscles, and skin. Problems in the nerves result in impaired protective sensation, making it possible to sustain an injury to the foot without feeling it. The damaged nerves also can result in weakened muscles because without adequate innervation, muscles can’t function properly. This can manifest as hammer toes, bunions and instability while standing or walking. Conditions involving blood vessels can result in many medical problems, including but not limited to insufficient oxygen and nutrient delivery to tissues and possible blockages. This can lead to pain, ulceration and ultimately gangrene of the foot. Lastly, diabetics experience changes in their skin. The skin becomes dry and is more prone to cracking and callus formation, which can lead to increased susceptibility to infections. Toe nails become thickened and brittle, and many times are infected with fungus. Thickened nails coupled with high pressure forces being applied to the nails can lead to nail bed ulcerations.

This picture seems pretty grim, doesn’t it? Well, there is extremely good news: diabetic foot problems are very preventable! Serious consequences, such as amputations usually start out as preventable, easy to treat problems. If you have diabetes, the key is to see a podiatrist on a regular basis for routine inspections of your feet. Studies by the US National Institute of Health show that comprehensive foot care programs can reduce amputation rates by 45-85%. Your local podiatrist can perform proper nail care, reduce callus build-up, and make sure your skin is sufficiently hydrated. Furthermore, he or she can educate you on your specific needs, as every patient experiences different challenges in caring for their feet. Good foot health is just a doctor’s appointment away!

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By Dr. Kuvent, May 18, 2010 9:35 am

While many conditions ending in that ever familiar suffix “-oma” are indeed associated with cancer, you need not worry if your doctor tells you the pain in your foot is caused by a Morton’s Neuroma.

A neuroma, by definition, is an abnormal swelling or thickening of a nerve. Morton’s neuroma (aka interdigital neuroma) is a condition involving an enlarged or inflamed portion of a nerve in the foot, specifically located in the third interdigital space. As the nerves of the foot travel toward the spaces between the toes, they split into two terminating branches, one to each adjacent side of a toe; thus each nerve provides sensation to two different toes. A Morton’s neuroma typically occurs just before these nerves divide into their terminal branches. The nerve lies between the fat padding below it and a strong ligament above it. If there is enough enlargement of this nerve, as you walk or place weight on the foot, the nerve becomes compressed by the ligament and the surrounding structures, causing severe discomfort.

Morton’s neuromas are four times more common in females than males, and more often than not occur in the later years of life. If you have this condition, you will typically experience localized pain, along with any number of the following symptoms: a burning sensation that may spread beyond the site of the neuroma, numbness in the involved toes, swelling, electric shock sensations, or the feeling of a lump in your shoe. A common way to relieve the discomfort is by loosening the laces of your shoes or removing your shoes completely. You may also try gently massaging the affected area to lessen the pain. Your symptoms will usually worsen with a number of activities, all revolving around placing weight on the affected foot.

There are many options to treat Morton’s neuromas. Most doctors will start by obtaining an x-ray of the foot to rule out other causes of pain such as a fracture, and they may even order an MRI to discover the approximate size and exact location of the neuroma. Depending on these imaging studies,  your podiatrist will decide whether conservative treatment will be enough, or if it will require a surgical procedure. Conservative treatments include a change in footwear and taping or padding to offload the pressure around the neuroma. Shoes with a firmer sole will decrease the amount of stretching of the foot and wider shoes will allow for less crowding of your toes, both resulting in less aggravation of the neuroma. Another option is to use an injection of numbing medication mixed with cortisone to temporarily relieve your pain. In severe cases, when conservative treatments do not yield the desired results, surgery may be necessary. Your podiatrist may release some surrounding structures to relieve the pressure around the neuroma, or they may remove the neuroma altogether. Another approach that has proven to be very effective is to use a series of injections of a diluted alcohol to kill the nerve at the site of the neuroma. You should be aware that while these different treatments will relieve the pain, they may also result in loss of sensation between the third and fourth toes (the area supplied by the nerve).

If you are experiencing the symptoms of a Morton’s neuroma, you should talk with your podiatrist soon to find out what can be done to relieve your pain. You shouldn’t have to endure such discomfort with every step you take!