Advanced Foot Care » feet

From Sewing to Surgery: A Brief History on Tailor’s Bunions

Dr. Kuvent — Mon, 16 Aug 2010 18:46:28 +0000

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!

Got Callus? Call Us!

Dr. Kuvent — Wed, 21 Jul 2010 16:03:17 +0000

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.

Red Flags

Dr. Kuvent — Wed, 17 Mar 2010 16:49:03 +0000

One of the most interesting aspects of the lower extremity is how many systemic diseases tend to show up in the feet, ankles, and lower legs. Diabetes is, of course, an obvious example, but there are also many diseases affecting the blood vessels which tend to show up in the lower limbs either before or during the time that they begin to affect other vital organs of the body. Many of these disorders will demonstrate predictable skin manifestations which help to offer clues about the underlying disease process.

‘Vasculitis’ is a general term referring to a state of inflammation or damage to the arteries or veins which transport blood throughout our body. There are many different diseases within this category which can affect different-sized blood vessels as well as different organs. However, many of the disorders result when the immune system causes damage to the walls of a blood vessel which in turn allows blood cells to leak out of these vessels. This can lead to skin lesions of the feet and lower legs which typically involve both extremities and may be severely painful.

One important thing to keep in mind about vasculitis is that different conditions can present with a variety of different symptoms. Some diseases will involve painful blistering or ulceration of the skin while others will result in skin color changes, pain with walking, or nail pathology. Besides immune system malfunctions, other causes of vasculitis include infections, various types of cancer, and drug reactions. Similarly, the long-term and systemic prognoses of these diseases can vary widely. If left unchecked, some of these disorders may go on to cause blindness or other severe outcomes.

Unfortunately, it isn’t possible to discuss each of the different vasculitis conditions here. However, if you would like a professional opinion, an appointment with your local Chandler podiatrist is certainly worth your while. He can perform several simple exams and help to sort out the possibilities in order to differentiate your symptoms from other possible skin or blood vessel disorders. Ultimately, he may recommend a biopsy to confirm the diagnosis before deciding on the appropriate therapy.

While vasculitis may seem like merely an irritating rash of the feet or lower legs, in reality it is a systemic disease which can affect your joints, nerves, heart, lungs, kidneys, or GI tract. Therefore, early screening and detection is very important. The symptoms of the lower extremity may be just the tip of the iceberg.

Tarsal Tunnel Trouble

Dr. Kuvent — Wed, 17 Mar 2010 16:44:55 +0000

There’s a good chance that you’ve heard in passing of “carpal tunnel syndrome” and you may know that it is a painful condition which can affect the hands, wrists, and arms. There’s probably a smaller chance that you have heard of “tarsal tunnel syndrome” which is similar but in fact a completely different problem. Both of these conditions result when important nerves become entrapped or compressed in some way, but while carpal tunnel syndrome affects the upper extremities, tarsal tunnel syndrome affects the ankles, feet, and lower legs.

Similar to the wiring in a house which must travel a certain distance to supply electricity, the nerves in our body must travel from our central nervous system (the brain or spinal cord) out to the distant parts of our body to supply electrical impulses. To accomplish this, one of the most important nerves must travel down the inside of the lower leg and course behind and below the bump or “malleolus” on the inside of the ankle before it enters the foot. While it’s not usually a problem, this inside area of the ankle also contains many other structures including tendons, ligaments, blood vessels, and bony structures. Occasionally, this congested area may become further compressed by a tumor, fracture, or other entity which creates an irritating pressure on the major nerve in that location.

From tumors, lesions, and fractures to systemic diseases and biomechanical deformities, there are many possible causes of tarsal tunnel syndrome. Often times, there is no clear and specific cause which can complicate the diagnosis. However, the symptoms are fairly consistent which include burning, tingling, or shooting pains which may radiate either up or down the foot or ankle into the toes. This pain is often made worse with activities such as standing or walking and relieved with rest, although night pain is also not uncommon.

A visit to your Chandler podiatrist is certainly a good idea if you’re experiencing these symptoms because he can help to determine whether tarsal tunnel syndrome truly is the cause of your pain. Many other etiologies are also possible such as a nerve root problem, peripheral vascular disease, tendon irritation, a heel spur, or a stress fracture. Once these other potential diagnoses are ruled out, you and the doctor can discuss the treatment options which will have the best chance of helping you. These can include certain medications, steroid injections, or specific shoe gear modifications before moving on to consider a surgical intervention to decompress the area.

If a tumor or fracture is indicated during your evaluation, it may ultimately require surgery for a complete resolution of the problem and is yet another reason to schedule an appointment sooner rather than later.

Fat Pad Atrophy

Dr. Kuvent — Wed, 17 Mar 2010 16:39:28 +0000

For most of us, losing fat is considered a goal, and something that many Americans strive for each year. However, when it comes to our feet, the reverse is true, and as we age the fat in our heels sometimes becomes thin and something to hold on to for as long as possible. Imagine driving a car in which the tire treads have worn thin, the air pressure is low, and the rims are nearly riding against the ground. The same principle occurs when the layer of fat beneath our ‘calcaneus’ or heel bone becomes worn down. Often times, this phenomenon is the cause for a great amount of heel pain.

While it’s commonly thought that age is the cause of fat pad breakdown, there are also many other important causes and factors. Surgery, diabetic nerve problems, arthritic conditions, the use of steroids or steroid injections, and even a unique disorder known as Complex Regional Pain Syndrome can all lead to fat pad thinning. Of course, the way that we use our bodies can also play a big role. In the same way that cartilage tends to break down with overuse leading to knee and other problems, the cushioning fat pad of our heels can also wear out due to certain lifestyles, being overweight, or simply from genetics.

Heel pain in general is a very broad topic which includes disorders of nerves, blood-flow, inflammation, metabolism, and even tumors. Therefore, it’s never a bad idea to visit your local Chandler foot doctor if you are having symptoms, because these other conditions can be properly ruled out. Fat pad atrophy may go on to cause stress fractures or various arthritic conditions, so a thorough evaluation including X-rays can indicate whether a more serious process is foreseeable.

Much research is currently in the works regarding the injection of silicone and other synthetic materials to act as a near-natural replacement for fat pad loss. This may hold great promise in the future. For now, however, the gold standard of treatment continues to be specific shoe gear modifications, padding, and the use of customized inserts to provide optimal support to the heel bone. Feel free to discuss your best options with your podiatrist.

Despite some of the natural changes that occur with aging, there are still some very viable options to keep you healthy and active. The best thing you can do for your overall well-being is to stay on your feet.

A Foot Nerve’ous Breakdown

Dr. Kuvent — Wed, 28 Oct 2009 06:05:44 +0000

If you’ve ever walked barefoot across a gravel parking lot, you’re probably well-aware that human feet are very sensitive structures. That’s a good thing because it allows our feet to move and adjust to potentially damaging objects on the ground-such as a sharp stone or a piece of glass. Normally, we are able to avoid such objects with ease and protect ourselves from cuts, infections, and other risks. However, the greatest threat to our feet is more internal rather than external. It occurs when our nerves become damaged and that vital protective sensation in our feet is lost.

There are unfortunately MANY things which can lead to weakened or damaged nerves in our feet. One of the most common and well-known causes is diabetes. As individuals lose control of their blood sugars, the nerves particularly in the feet tend to become damaged and insensitive. Other metabolic issues such as B-vitamin deficiencies, alcoholism, and various toxins such as heavy metals can also lead to this problem. It’s pretty interesting to consider how certain health issues like Ulcerative colitis or Crohn’s disease can affect vitamin absorption to affect nerve function and indirectly the health of our feet!

Certain inherited and autoimmune disorders can also cause the feet to become insensitive. Things like Charcot-Marie-Tooth disease, Lupus, Guillain-Barre syndrome, allergic conditions, and blood disorders can all have this effect. Mechanical issues like an entrapped nerve or a spinal root problem may also be causing the problem. On top of these and other causes, the medications you are taking can also alter the nerve function in your feet. Various seizure medications, immunosuppressive agents, oral contraceptives, and tuberculosis drugs can all have this side effect.

Perhaps one of the biggest problems with nerve dysfunction to affect our feet simply occurs as we age. Often times, visual changes in combination with insensitive feet make it extraordinarily difficult for individuals to monitor the ground as well as the health of their feet. Believe it or not, it’s not uncommon for some people to have needles and other sharp objects lodged in their feet without them even knowing it! Not only can the individual not feel the object, but they’re also not able to see what may be a large and potentially-infected wound. This can be a huge hazard for those who live alone or do not have their feet checked regularly, as the infection can spread quickly and cause major damage.

Podiatrists have lots of experience dealing with insensitive feet. They’re able not only to closely monitor the various components of nerve degeneration, but they’re also able to check for infections, care for wounds, and determine whether a foreign body is actually lodged within the foot. Sometimes various objects show up within the foot on an X-ray which is not otherwise very obvious. If you suspect you’re having such a problem, contact your podiatrist immediately.

Somewhere In Between

Dr. Kuvent — Tue, 22 Sep 2009 19:32:44 +0000

Some of the potentially most irritating places on the feet are the areas between the toes-also known as the “web spaces” or “inter-digital spaces” of the feet. You’re probably quite aware of how hot and moist our feet can become under normal circumstances while wearing socks and shoes and forced to perform standard activities. Now consider that the areas between the toes are subject to those same conditions in addition to further heat and pressure and it suddenly becomes obvious that they are a natural place for superficial infections and irritation to occur.

There are many different causes which can lead to irritations between the toes. A common suspicion is “Athlete’s foot” which is a fungal infection of the skin. However, fungal infections which affect the web spaces can actually be caused by several different types of fungus which are each treated differently. Furthermore, fungal infections need to be distinguished from bacterial and parasitic infections which also have a predilection for the inter-digital spaces and are, of course, treated differently. Even metabolic diseases and autoimmune disorders need to be considered when assessing symptoms. Finally, friction and mechanical stress caused by a mal-aligned toe or inappropriate shoes may be causing the problem and should be ruled out.

Common symptoms that people may experience include burning, stinging, or itching sensations between the toes. They may also encounter certain changes as the skin becomes scalded, beefy red, cracked, or scaly. Of course, there are many other possible symptoms-each of which depends on the particular underlying cause. For this reason, podiatrists do a thorough assessment-which may include taking skin scrapings and using other simple measures-to determine what that cause is. From that point, the appropriate regimen is implemented which may range from oral or topical treatments to shoe-gear adjustments to changing the medications that you are currently using.

When one considers how often we wash our hands compared to our feet throughout the day, it’s not surprising that our feet are frequently susceptible to attack from microscopic organisms and other potential risks. Keeping your feet clean and dry as often as possible is a big step you can take to prevent infections. Thankfully, when serious irritations do occur, appropriate treatments are available.