A bunion is a prominence or bony growth, on the side of the foot by the big toe. Both pressure from your shoes and motion in the big toe joint can cause pain. Bunions can often progress gradually until running and sometimes even walking are extremely painful. Causes: A bunion is a condition that can be due to heredity, a genetic defect or a biomechanical problem (over-pronation). People with flat feet or very flexible feet are more prone to develop bunion problems. Other causes can include such things as trauma, arthritis or neuromuscular diseases. Tight-fitting shoes do not cause bunions, but they can exaggerate either of these pre-existing conditions.

Symptoms: The severity of the bunion does not necessarily correlate with the degree of pain. A bunion that looks severe may not be painful at all, whereas a small or mild bunion can sometimes be extremely painful or debilitating.

Pain can usually develop for one of two reasons: Either over the prominence due to friction irritation from the inside of the shoe, or due to the mal-alignment of the big toe joint. Both of these sources of discomfort may, over time, limit walking, exercise or even standing comfortably.

If the joint has been in a mal-aligned position for many years, osteoarthritis can develop, which can lead to increased stiffness and pain within the joint.

Bunions can also affect the other adjacent toes. If the big toes starts to lean outwards, the increased pressure on the second toe may cause it to be pushed upwards, leading to a hammertoe deformity and often an associated callous on the bottom of the foot.

Treatment: If the symptoms are mild to moderate, the easiest and solution to try is to wear a pad over the bunion to reduce friction on the inside of your shoes. A wider, more accommodating shoe, often with a deep toe box, can also be very helpful. If your podiatrist thinks over-pronation is the cause, and the bunion is in the early stages, try a custom orthotic. This will reduce the excessive pronation and attempt to minimize the future growth of the bunion. Anti-inflammatory mediations can often provide temporary relief.

When the bunion pain is persistent, despite trying various conservative treatment options, surgical correction should be discussed with your podiatrist. In a symptomatic foot, the longer that surgery is delayed, the more arthritis can wear on the joint, and often the more complicated the surgery can become. Those patients that have their symptomatic bunions corrected earlier tend to have greater satisfaction after the procedure.

What Does The Surgery Involve? The goal of bunion surgery is to remove any bony prominence and to re-align the big toe joint into a normal, more functional, pain-free position. Often during the procedure, the bony prominence is removed and the bone is cut and moved back into a 'corrected' position. Pins and / or screws may be used in order to hold the bone in proper position. If the joint has advanced arthritis and is beyond repair, it might need to be removed, fused or replaced with an artificial joint.

The exact procedure, and post-operative recovery course, that is right for you should be discussed with your podiatrist, as everyone's needs and expectations will vary.

Prevention: Assuming the bunion isn't inherited, the most important measure that you can take is to make sure that your shoes fit properly and provide adequate support for your feet. If over-pronation is a problem, look to purchase 'motion-control' shoes.

Activity Restrictions: None, unless the bunions have become too painful.

A condition where a toe is bent or contracted. It usually occurs in the second, third or fourth toe. Hammertoes themselves usually are not painful, however the friction of them rubbing against the inside of shoes can create a build-up of thick, hard skin (a corn), which can be very uncomfortable. Causes: Hammertoes are usually the result of foot misalignment. Although the condition may be inherited, usually over-pronation causes the tendons on the bottom of the foot to pull on a funny angle, causing a buckling or bending of the toe. Over time, a toe can become fixed in a bent position. Corns, which form as a result of rubbing inside of shoes, are actually a type of protective layer of thick skin over one of the toe joints. Tight or ill-fitting (running) shoes, which rub against the toe, will tend to make this condition worse.

Treatment: It is always best to try to catch this, or any condition, in the earlier stages, before the toe becomes fixed. Orthotics can often serve to correct the biomechanical faults, which cause the hammertoe. There are also over-the-counter devices called hammertoe crest pads, which serve to try to move your toe back into a normal position, assuming it is not rigid or fixed. Corns can be removed with pumice stones or by a podiatrist quickly and painlessly in the office. Toe joints that are susceptible to recurrent corns can be protected with moleskin or other pads. If the toe is in a fixed or rigid bent position, the choices are either to put up with the discomfort, get deeper or more accommodating shoes or undergo a relatively minor surgical procedure to correct the contracted joint.

Prevention: Make sure your shoes are wide enough and deep enough in order to prevent rubbing or friction irritation and the formation of a corn. Motion-control shoes and / or orthotics can serve to reduce any over-pronation.

Activity Restrictions: None really. It depends on the severity of pain.

Ingrown toenails almost always occur on the big toe. They can cause significant pain, and as well have the potential for infection. Causes: An ingrown nail can result form a number of factors, ranging from; tight shoes, poor or improper nail care, and genetic predisposition.

Treatment: There are two steps to treating an ingrown nail: 1) clear up any infection that might be present, 2) remove the part of the nail that is growing into the toe. Cutting the nail on your own can be very painful, and could promote infection if not done properly. Having a podiatrist do it, under local anesthesia if necessary, is the best way. Soaking the toe 2 - 3 times per day in warm salt water can help to reduce any infection. Antibiotics are rarely needed. If the condition is chronic, a podiatrist can permanently remove all, or part, of the nail root so that the ingrown toenail never recurs.

Prevention: Cut your toe nails regularly, but cut them straight across. Never round the corners or edges. Make sure you wear shoes that have adequate width and depth, and are not too tight.

Activity Restrictions: None. But don't let an ingrown nail sit unattended too long. Prevention and early treatment are the best solutions. These can be painful.

Pain, numbness or tingling in the forefoot, usually between and extending into the third and fourth toes, almost always indicates a neuroma. A neuroma often hurts more when you're wearing shoes and feels better when you take them off and massage the feet. Neuromas slowly become more painful with time if left untreated. Causes: A neuroma is caused by pinching or irritation of one or more nerves in the forefoot. This is usually the result of poor biomechanics and/or over-pronation. If you over-pronate, the metatarsal bones can have excessive movement which in turn can cause irritation, by a tight ligament, to the nerve which runs between the metatarsal heads. The result of this direct irritation is inflammation and pain. If a neuroma is left untreated the nerve can become chronically scarred, creating even more pain.

Treatment: You can try using a metatarsal pad under the affected area. This should reduce some of the excessive motion of the metatarsals and hopefully reduce the pain. Exact placement of the pad is important. Custom orthotics are often used to control the over-pronation. They often incorporate a specialized metatarsal pad within them and can occasionally provide more relief. If this doesn't work a podiatrist should be consulted to assess the degree of nerve damage. An injection may be warranted. An excellent new option is a minimally invasive nerve decompression (MIND) procedure. This is a simple in-office procedure, which provides very effective, long-term relief of the chronic pain from neuromas. As a last resort, open surgery might be indicated to remove the damaged nerve. This will solve the problem, but will lead to permanent numbness between two toes.

Prevention: Since over-pronation is very often the culprit, switching to running shoes with more motion control should be helpful.

Activity Restrictions: None really, but it is best to wait until the pain subsides or is treated before engaging in long runs or lengthy activities.

New Neuroma Treatment: Open surgical treatment has been used for decades and can have it's drawbacks including permanent numbness in the affected two toes, regrowth of the nerve and time off one's feet for recovery.

The anatomy exhibits that a ligament called the intermetatarsal ligament holds the adjacent metatarsal heads together. These ligaments tend to bring the metatarsals closer together, not allowing them to spread apart. Much like carpal tunnel syndrome in the hand, the nerves become entrapped under the ligament and become irritated. It is believed that if the adjacent metatarsal heads could move apart slightly, it would allow for less squeezing of the nerve. Releasing or cutting the affected intermetatarsal ligament allows for more space and less restriction of the nerve, especially in the third/fourth intermetatarsal space where nerve entrapment is most common.

Koby Surgical (www.kobysurgical.com) has developed precision instrumentation to allow doctors to effectively release the intermetatarsal ligament. Modelling their instrumentation and theories after carpal tunnel procedures, this new technique is a breakthrough in treating Morton's Neuroma. Koby has recognized the doctors at Allied Foot Specialists as one of the first doctors in Canada to use this particular procedure.

Allied Foot Specialists continue to be leaders in Canadian podiatric treatments and is committed to utilizing the most innovative, modern procedures and instrumentation.

The Minimally Invasive Neuroma Decompression (MIND) procedure is performed in the office under local anaesthetic. It involves placing the precision instrumentation in the affected area and releasing the intermetatarsal ligament. The procedure takes under ten minutes and patients walk immediately after. There is minimal "down time" required and patients can resume normal activities very quickly. There is minimal, if any, post operative pain and patients can walk immediately.
“The Isogard system by Koby is the technique of the decade because it is so innovative and minimally invasive". The Isogard system is remarkably simple and allows for patients to resume activities in days rather than weeks. The MIND procedure has a small (3 - 5%) failure rate, if this occurs the patient may opt for traditional neuroma excision.

A wart is a growth in the skin caused by a viral infection. Warts tend to be hard and flat with elevated, rough surfaces, with or without well-defined boundaries. Some may often have one or more black pinpoints. They are frequently called plantar warts because they appear on the bottom, or plantar surface, or sole of the foot. Children, especially teenagers, tend to be more susceptible to warts than adults. It is often possible that other benign lesions such as corns or calluses, or more serious lesions, such as carcinomas and melanomas, can be mistakenly identified as warts. Because of these identification problems, it is always best to consult a podiatrist regarding any suspicious growths or eruptions on the feet. If warts are left untreated, they can grow and spread into clusters.

What Can You Do? Avoid walking barefoot. Change shoes and socks daily Keep feet clean and dry. Avoid home remedies.

What Will A Podiatrist Do For You? Perform a through physical examination and evaluation. Initiate treatment, either topically or discuss possible surgical excision. Prescribe medication, if indicated.