DescriptionAn in-depth report on the causes, diagnosis, treatment, and prevention of foot pain.
Alternative NamesBunions; Corns; Hammertoe; Plantar Fasciitis
A corn is a form of callus, a protective layer of dead skin cells formed due to repeated friction. It is cone-shaped and has a knobby core that points inward. This core can put pressure on a nerve and cause sharp pain. They can develop on the top or between toes. If a corn develops between the toes, it is may be called a soft corn if it is kept pliable by the moisture from perspiration.
Corns develop as a result of friction from the toes rubbing together or against the shoe; they often occur from the following:
Preventing Corns and Calluses and Relieving Discomfort. To prevent corns and calluses and relieve discomfort if they develop:
Removing Corns and Calluses. To remove a corn or callus, soak it in very warm water for five minutes or more to soften the hardened tissue, then gently sand it with a pumice stone. Several such treatments may be necessary. Do not trim corns or calluses with a razor blade or other sharp tool. If the cutting instrument is not sterile, infection can result, and it is easy to slip and cut too deep, causing excessive bleeding or injury to the toe or foot.
Medicated Solutions and Pads. There are a number of over-the-counter pads, plasters, and medications for removing corns and calluses. These treatments commonly contain salicylic acid, which may cause irritations, burns, or infections that are more serious than the corn or callus. Use caution with these medications. The following patients should not use them:
Bursitis of the Toe
Bursitis is an inflammation of the fluid filled sacs that protect the toe joints.
Ingrown toenails can occur on any toe but are most common on the big toes. They usually develop when tight fitting or narrow shoes put too much pressure on the toenail and force the nail to grow into the flesh of the toe. Incorrect toenail trimming can also contribute to the risk of developing an ingrown toenail. Fungal infections, injuries, abnormalities in the structure of the foot, and repeated impact on the toenail from high-impact aerobic exercise can also produce ingrown toenails.
Caring for Toenails. Toenails should be trimmed straight across and long enough so that the nail corner is not visible. If the nail is cut too short, it may grow inward. If the nail does grow inward, do not cut the nail corner at an angle. This only trains the nail to continue growing inward. When filing the nails, file straight across the nail in a single movement, lifting the file before the next stroke. Do not saw back and forth. A cuticle stick can be used to clean under the nail.
Treatments. To relieve pain from ingrown toenails, try wearing sandals or open-toed shoes. Soaking the toe for five minutes twice a day in a warm water solution of Domeboro or Betadine can help. People who are at increased risk for infections, such as diabetics, should have professional treatment.
Antibiotic ointments can be used to treat ingrown toenails that are infected. Apply the ointment by working a wisp of cotton under the nail, especially the corners, to lift the nail up and drain the infection. The cotton will also help force the toenail to grow out correctly. Change the cotton daily and use the antibiotic consistently.
In severe cases, more intensive treatments are needed. Surgery involves simply cutting away the sharp portion of ingrown nail, removal of the nail bed, or removal of a wedge of the affected tissue. Three nonsurgical methods involve using chemicals (usually phenol), cauterization (heating), or lasers to remove the skin. A major review of studies reported that the use of phenol along with simple separation of the nail was more effect than surgery alone in preventing recurrence, although infections were more common after the chemical procedure.
A bunion is a deformity that usually occurs at the head of the one of the five long bones (the metatarsal bones) that extend from the arch and connect to the toes. A bunion typically develops in the following way:
Bunions can be caused by a number of conditions:
Other causes are flat feet, gout, arthritis, and occupations (such as ballet) that place undue stress on the feet increase the risk for bunions.
Shoes and Protective Pads. Pressure and pain from bunions and bunionettes can be relieved by wearing appropriate shoes, such as the following:
A thick doughnut-shaped, moleskin pad can protect the protrusion. In some cases, an orthotic can help redistribute weight and take pressure off the bunion. Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may offer some pain relief.
Surgery. If discomfort persists, surgery may be necessary particularly for more serious conditions, such as hallux valgus. There are over 100 surgical variations ranging from removing the bump to realigning the toes.
The most common surgery is an office procedure known as bunionectomy involves shaving down the bone of the big toe joint. In one procedure the surgeon uses a very small incision, through which the bone-shaving drill is inserted. The physician shaves off the bone, guided by feel or X-ray. It is not a cure, but patient satisfaction is high and results are long-lasting.
More extensive surgeries may be required to realign the toe joint. Although there are variations of each, they generally involve one or more of the following:
In severe cases, surgeons are testing bone grafts to restore bone length in patients who have had previous bunion surgeries or when damage from osteoarthritis has occurred.
Complications with even complex procedures are uncommon, but can include continued pain, infection, some numbness, or irritation from implants used to support the bone. In some cases the metatarsal bone is excessively shortened. Recovery from more invasive procedures, such as arthrodesis or osteotomy, may take six to eight week before a patient can put full weight on the foot. In such cases, patient will need to wear a cast or use crutches. Elderly patients may need wheelchairs.
A hammertoe is a permanent deformity of the toe joint in which the toe bends up slightly and then curls downward, resting on its tip. When forced into this position long enough, the tendons of the toe contract and it stiffens into a hammer- or claw-like shape.
Hammertoe is most common in the second toe but may develop in any or all of the three middle toes if they are pushed forward and do not have enough room to lie flat in the shoe. The risk is increased when the toes are already crowded by the pressure of a bunion. Lying down for long periods, diabetes, and various diseases that affect the nerves and muscles put people at risk.
Treatment for Hammertoe. At first, a hammertoe is flexible, and any pain it causes can usually be relieved by putting a toe pad, which are sold in drug stores, into the shoe. To help prevent and ease existing discomfort from hammertoes, shoes should have a deep, wide toe area. As the tendon becomes tighter and the toe stiffens, other treatments, including exercises, splints, and custom-made shoe inserts (orthotics) may help redistribute weight and ease the position of the toe.
Surgery. Surgery may be needed in some severe cases. If the toe is still flexible, only a simple procedure that releases the tendon may be involved. Such procedures sometimes only require a single stitch and a Band-Aid. If the toe has become rigid, surgery on the bone is necessary, but it can still be performed in the doctors office. A procedure called PIP arthroplasty involves releasing the ligaments at the joint and removing a small piece of toe bone, which restores the toe to its normal position. The toe is held in this position with a pin for about three weeks, then the pin is removed. A 2000 study reported that after five years, 92% of patients who had arthroscopy were still pain free.