Bunions Painful?

Prolonged changes to normal foot patterns can lead to the formation of bony protrusions commonly known as bunions.

Typically caused by tight fitting footwear, a bunion can be an eyesore, although the real sore is experienced on the great toe and sometimes the fifth toe (Tailor's Bunion). For early stages, preventing the bunion from enlargement is important.

Prevention can be achieved with orthotics that relieves pressure on the bunion.
Orthotics may be semi-rigid to rigid to meet the accommodations each person needs who are suffering from bunions. Orthotics are devices worn in your shoes that provide correction to your feet, helping them to function more efficiently.

Prescription orthotics may help relieve your pain by realigning and stabilizing the bones in your feet, restoring your natural walking pattern. They will also help alleviate pain from rubbing, which often leads to enlargement of the protrusion.

Patients should be advised to wear comfortable shoes that help support their feet. Taking preventative measures in the initial stages of the bunion’s existence is a great way to slow its growth.

Be sure to come by and see Dr. Weaver about getting your custom orthotics today and stop the unsightly growth of your bunion. The key to better health could be right under your toes.

High price of wearing heels

For a quarter-century, Catherine Ange has worked as a seller of high-end furniture at the Atlanta Decorative Arts Center. Before computers became a mainstay of the job, a typical day could find Ange bending down, standing on tiptoe or moving furniture across 22,000 square feet of showroom space — all while wearing shoes with a 3- to 4-inch heel.

“I thought, ‘I feel so good in these heels. I can sell anything. I am invincible,’ ” said Ange, 47, of Buckhead. Her feet, unfortunately, were not so resilient.

By the time she reached her 30s, Ange was feeling the pain — a sharp, stabbing pain in the ball of her foot. She tried alternating heels and flats, but soon even flats were uncomfortable. She went to a doctor for injections of anti-inflammatories. Eventually, the only thing left to treat her Morton’s neuroma — a condition that causes thickening and pain in the nerves between the toes — was surgery.

After four surgeries in three years, heels are a thing of the past. “It is no laughing matter when you can no longer wear your Chanel pumps,” said Ange, who mostly wears custom orthotic inserts in her boots or sturdy tennis shoes.

The kind of debilitating foot pain that Ange experiences is a common problem for high heel wearers, particularly women who have been wearing heels for many years.

About 25 percent of women older than 40 have severe foot problems related to shoe choice, said Katy Bowman, a biomechanics expert and author of “Every Woman’s Guide to Foot Pain Relief: The New Science of Healthy Feet” (BenBella Books, $17). The problems can range from short-term issues such as blisters and calluses to long-term structural damage to the feet or body, such as shortening of the calf muscles.

“There are a lot of people trying to work themselves out of foot pain,” said Bowman, whose book helps women understand the mechanics of the foot and explains how to transition from heels to more sensible shoes.

“We know barefoot is natural, but you can’t just take off your shoes and start running,” she said.

Bowman’s advice includes exercises to help ward off foot troubles — at least for a while, because some women seem unable to resist the lure of high heels.

“No matter what I say, they are going to [wear heels],” said Dr. Jay Spector, of Northside Podiatry, who advises wearing no more than a 2-inch heel ... ever. Serious foot pain related to high heels can develop in as little as one night or a few weeks, he said. If you must wear high heels, Spector said, wearing them for shorter periods of time, then switching to a shoe with a lower heel can help.

Margaret Lisi of Midtown, a marketing manager who’s in her mid-40s, learned just how quickly heels can hurt when a pair of new gray pumps did a number on her feet.

“I felt like my feet had been cut open,” said Lisi, describing the pain. “I walked out of my building to go home and didn’t even make it across the street. I took the shoes off and tiptoed all the way to my car.”

The next day, Lisi shoved her scarred feet into a pair of boots. “[My feet] were like little loaves of bread rising in the warm environment of my cowboy boots,” Lisi said.

Women may take such isolated experiences lightly, but anyone who consistently wears heels can experience more severe problems over time, said Dr. Jason Morris, of Primera Podiatry, a new practice opening in February that offers advanced podiatry services such as a laser center and medical foot spa.

“The most common problem for patients who wear high heels daily or more than two to three times per week is thinning of the fat pad at the ball of the foot,” Morris said.

The abnormal positioning of the foot in high heels creates pressure on the ball of the foot, which thins the protective layer of fat and leads to a painful condition called metatarsalgia, he said.

Morris uses a new treatment — an injection of the filler Sculptra — to replace the fat pad and plump the area. The treatment can last 12 to 18 months, he said.

Morris also has treated heel wearers for stress fractures and another problem, bunions, which are caused by weakening of ligaments that hold the foot bones together. Bunions are genetic, but wearing heels can speed their development, Morris said.

Bunion surgery landed Michele Caplinger, senior executive director of the Atlanta Chapter of the Recording Academy, in the operating room just over a year ago. After more than 20 years wearing 3-inch heels on a regular basis, Caplinger had developed painful bunions on both feet.

“The pain was gradual, but I would literally end up in tears an hour into wearing a pair of heels,” Caplinger said. “In my line of work, I have many events, and I have to dress up, so I was constantly in pain.”

She went to foot doctors at least once a year and all recommended surgery, but Caplinger was terrified. When Caplinger met Dr. Perry Julien, the pain had become unbearable. She consented to surgery and has since been pain free.

The experience made Caplinger more thoughtful about her footwear choices but not quite ready to leave heels behind. “I am back in heels,” she said. “I do find myself in better-made, more reasonable shoes. That is an easy choice to make when vanity is not a priority.”

Have high-heel hangover? Here's help

High heels push the pelvis forward, shifting body weight and loading the small bones and tissues of the forefoot. Hello bunions, fasciitis and hammer toes.

Photograph by: Wayne Cuddington, PNG Merlin Files, Vancouver Sun

We often talk about the post-holiday hangover: the sluggish feeling we get from all the food and drink consumed. But there is another hangover many women experience. It starts in the feet and works it's way up. We're talking about the high-heel hangover.

We all know that high heels are bad for our feet, but there are so many fabulous heels out there and they sure can dress up an outfit and make our legs look great. So we often ignore the obvious and pretend that a well made, well fitting pair of heels is the answer.

Maybe we don't wear them every day, but during the holiday season, with parties every other day, we donned them more often than usual.

And now we are suffering the high-heel hangover.

"Foot health is a really big issue for people over the age of 40, to the point where one in four can't really walk without foot pain," says U.S.-based bio-mechanics expert Katy Bowman, author of Every Woman's Guide to Foot Pain Relief.

According to Bowman, who is also the director of the Restorative Exercise Institute in California, foot pain is the canary in the coal mine of human health. Jimmy Choos and Manolo Blahniks are the poison.

"Your foot pain is like an early indicator of the state of everything," she says. "Every other ailment of the body, from your body composition to even something like depression, all of those ailments are affected by physical mobility. But more than that, foot pain tells us that our knees, hips and back are at risk.

Most of us totally ignore our feet. We may exercise all the other parts of our bodies, but do nothing south of the ankle. Many of us can't spread our toes, fewer still can lift each toe individually.

That is where the problem begins, says Bowman. "The feet are just breaking down under the weight of the body because there is no muscle to resist it."

Then we mess with our posture by wearing high heels.

If we are standing with perfect posture, our pelvis is in the middle of a vertical line from our head to our heels, which as the densest structure of the foot are the best equipped to take our weight, says Bowman.

But when we wear heels, we push the pelvis forward positioning our weight over the front of the feet and loading the small bones and tissues of the forefoot. Hello bunions, fasciitis and hammer toes.

Wearing heels also causes the calf muscle to shorten, which in turn causes a cascade of problems, including knee and hip osteo arthritis. Research has shown people who have worn high heels regularly for more than 20 years have calves 13-per-cent shorter than everyone else.

"That is what causes the knee osteo arthritis, because the calf muscle attaches above the knee joint so the tighter the muscle the less joint space your knee has."

Even low heels can do the damage, says Bowman, adding there is no such thing as a sensible heel, except "in same way as there is a sensible cigarette." If we must wear heels, we should treat them like we treat dessert, she says.

"There is a consequence that comes with eating a lot of desserts and there are steps you can take to mitigate the effects. The same thing goes with high heels.

"If you are going to wear them, instead of trying to come up with a healthier way to do so, you want to come up with another daily habit or habit you cultivate every time you wear them that undoes some of the permanent tissue changes so that you don't have to deal with the full effects of wearing them."

These habits should include stretching, strengthening and wearing flat, flexible footwear or bare feet the rest of the time. Fifteen minutes of exercise a day is enough to protect your feet, says Bowman, and no fancy equipment is needed.

So avoid the hangover. Limit your time in heels and mitigate the damage they do. Here are four basic exercises that anyone can do, even as they watch TV or work at their desk.

Calf Stretch: Put your hands on a wall, place one foot in front of the other and keeping both heels on the ground, bend the front knee until you can feel the stretch in your back calf. Hold 30 seconds. A second calf stretch can be done on stairs; hang one heel off the stair until you can feel the stretch. Hold 30 seconds. Switch.

"A calf stretch is what anyone who wears any shoes should do, because even your general athletic shoe is technically 1½-2 inches (3.8-5 cm) in the heel, so that is a high heel, too," says Bowman. "So calf stretch, calf stretch, calf stretch."

Toe spread: Sit in a chair and rest your feet on an ottoman or low table. Spread your toes so that there is a space between each one. Repeat. (if you can't do this, start with wearing pedicure spacers).

Toe lift: Standing straight, lift your big toes off the ground while keeping all the other toes on the ground. Then lift the other toes one by one.

Tennis ball massage: While seated, roll a tennis ball under your feet to stretch your plantar fascia. If your feet are inflamed or tired, roll your foot over a bottle of water that has been frozen.

Foot Anatomy: Your Amazing Feet

Despite delicate foot anatomy, your feet are able to take a pounding every day. Help them go the distance by identifying and correcting common foot problems, from corns and calluses to Athlete's foot and hammertoes.

The human foot has 42 muscles, 26 bones, 33 joints, and at least 50 ligaments and tendons made of strong fibrous tissues to keep all the moving parts together … plus 250,000 sweat glands. The foot is an evolutionary marvel, capable of handling hundreds of tons of force — your weight in motion — every day. The foot’s myriad parts, including the toes, heel, and ball, work in harmony to get you from one place to another. But the stress of carrying you around puts your feet at high risk of injury, more so than other parts of your body.

Many foot problems, including hammertoes, blisters, bunions, corns and calluses, heel spurs, claw and mallet toes, ingrown toenails, toenail fungus, and athlete’s foot, can develop due to neglect, ill-fitting shoes, and simple wear and tear. Your feet also can indicate if your body is under threat from a serious disease. Gout, for instance, will attack the foot joints first.

Foot Problems: Athlete's Foot
Caused by a fungus that likes warm, dark, and moist environments like the areas between the toes or on the bottoms of the feet, athlete’s foot can inflame the skin and cause a white, scaly rash with a red base. The athlete’s foot fungus also causes itching, burning, peeling, and sometimes a slight odor; the infection can also migrate to other body parts. You can avoid athlete’s foot (also called tinea pedis) by keeping your feet and toes clean and dry and by changing your shoes and socks regularly. Over-the-counter antifungal creams or sprays can be used to treat athlete’s foot. If these remedies do not work, however, you may need to see a podiatrist and ask about prescription-strength medication.

Foot Problems: Hammertoes
If your second, third, or fourth toe is crossed, bent in the middle of the toe joint, or just pointing at an odd angle, you may have what’s called a hammertoe. Hammertoes are often caused by ill-fitting shoes. Early on, wearing inserts or foot pads can help reposition your toe, but later it becomes fixed in the bent position. Pain then sets in and you may need surgery. Because hammertoes are bent, corns and calluses often form on them.

Foot Problems: Blisters
It’s this simple: If your shoes fit well, you won't have blisters. Soft pockets of raised skin filled with clear fluid, blisters are often painful and can make walking difficult. It’s important not to pick at them. Clean the area thoroughly, then sterilize a sewing needle and use it to open the part of the blister located nearest to the foot’s underside. Drain the blister, slather with antibiotic ointment, and cover with a bandage. Follow these same care steps if a blister breaks on its own.

Foot Problems: Bunions
A bunion is a crooked big-toe joint that sticks out at the base of the toe, forcing the big toe to turn in. Bunions have various causes, including congenital deformities, arthritis, trauma, and heredity. A bunion can be painful when confined in a shoe, and for many people, shoes that are too narrow in the toe may be to blame for the formation of bunions. Surgery is often recommended to treat bunions, after conservative treatment methods like over-the-counter pain relievers and footwear changes fail.

Foot Problems: Corns and Calluses
Corns and calluses form after repeated rubbing against a bony area of the foot or against a shoe. Corns appear on the tops and sides of your toes as well as between your toes. Calluses form on the bottom of the foot, especially under the heels or balls, and on the sides of toes. These compressed patches of dead skin cells can be hard and painful. To relieve the pain, you may want to try placing moleskin or padding around corns and calluses. Don’t try to cut or remove corns and calluses yourself — see a podiatrist for care.

Foot Problems: Plantar Fasciitis and Heel Spurs
It’s common for doctors to confuse heel spurs and plantar fasciitis when a patient comes to them with heel pain. Heel spurs are found in 70 percent of patients with plantar fasciitis, but these are two different conditions. Plantar fasciitis is a painful disorder in which the tissue that connects the ball of the foot to the heel – the fascia – becomes inflamed. Heel spurs are pieces of bone that grow at the heel bone base and often develop after you’ve had plantar fasciitis. The heel spurs themselves are not painful; it’s the inflammation and irritation caused by plantar fasciitis that can hurt. Heel spurs are often seen on X-rays of patients who do not have heel pain or plantar fasciitis.

Foot Problems: Claw Toes and Mallet Toes
Claw toe causes all toes except the big toe to curl downward at the middle of the joints and curl up at the joints where the toes and the foot meet. Calluses and corns may often form when someone has claw toes. While tight shoes can be blamed for claw toes, so can nerve damage to the feet (from diabetes or other conditions), which weakens foot muscles.

With mallet toes, the last joint of the toe bulges, and a painful corn will grow near the toenail. Generally the second toe is affected because it’s the longest. Injuries and arthritis are among the causes of mallet toe.

Foot Problems: Gout
Gout is a type of arthritis caused by a build-up of uric acid in joint tissues and joint fluid, which happens when the body is unable to keep uric acid levels in check. One of the first places for this build-up to occur is in the big toe joint — temperature-wise, the toes are the body’s coolest parts, and uric acid crystallizes with temperature changes. You’ll know a gout attack when it happens: The toe will get warm, red, and swollen and will be painful to even the slightest touch. The best way to prevent a gout attack is to learn to identify triggers, including high-purine foods, red meat, seafood, and alcohol. Applying ice, keeping hydrated, and staying bed may help, too.

Foot Problems: Ingrown Toenails
The right way to clip toenails — straight across — is key to foot health. If you don’t cut them properly, the corners or sides of the nail can dig into skin and become ingrown. Other causes of ingrown toenails include shoe pressure, a fungus infection, and even poor foot structure. When you cut your toenails, use larger toenail clippers and avoid cutting nails to short, as this can also cause ingrown toenails or infection.

Foot Problems: Toenail Fungus
Toenail fungus can give nails an unattractive, deformed appearance. It can alter the nail’s color and spread to other nails, even fingernails. Avoiding toenail fungus is difficult, especially if you walk through wet areas where people tend to go barefoot, such as locker rooms and swimming pools. People with chronic conditions, such as diabetes or immune deficiency diseases like HIV, are especially vulnerable and may want to keep their shoes on.

Regular trips to a podiatrist will help keep you on your toes

It's all too easy to take healthy feet for granted — they take you where you want to go without complaint and don't ask for much in return. But, over time, those puppies can really start barking due to corns, calluses, bunions and other assorted ailments.

Many people are surprised to learn that the normal aging process affects feet as much as any other body part. Feet become wider and flatter, the protective fat pads on the soles thin out and circulation throughout the feet can decrease, all of which can lead to foot pain and damage. But you don't have to suffer alone. You — and your feet — need an ally. That's where a podiatrist comes in.

Doctors of podiatric medicine focus their practices entirely on the foot, ankle and lower leg. Their medical education and training includes four years of undergraduate education, four years of graduate education at an accredited podiatric medical college and two or three years of hospital residency training. Each state requires podiatrists to be licensed to practice there.

"We're primary physicians and specialists for the foot and ankle," says Dr. Marlene Reid, president of the Illinois Podiatric Medical Association. "That's all we do, which means it's best to go to a podiatrist for any foot or ankle condition, large or small."

Unlike many familiar screening guidelines, like getting your first mammogram at age 40 or your first colonoscopy at age 50, there is no definite rule about when to start seeing a podiatrist. "I always suggest coming in for an initial look once you're past your 30s," says Dr. Kirk Contento of Contento Foot & Ankle Center in Palos Heights and Chicago. "We're all about preventing little problems from developing into something major later."

Here are three common foot conditions that become all the more common as we age, and here's what to do about them.

1. Toenail fungus - Podiatrists suggest seeing a podiatrist whenever a nail thickens or becomes discolored. "The doctor can thin the nail, then medicate topically or orally and get the patient started on a good home treatment regimen," Contento says. "Fungal infections often thicken the nail, which can lead to a secondary problem of an ingrown nail." Lasers are also an emerging new treatment for this common problem.

2.Arch strain and heel pain - One word here: Orthotics. Either custom or over-the-counter are fine, as long as you receive adequate arch support. "The tendon that supports the foot's arches weakens over time due to decreased blood flow, which means your arch drops," says Reid. "It usually starts as a vague feeling of weakness or muscle strain and is often misdiagnosed as plantar fasciitis. People tend to ignore it but it can cause the tendon to rupture, which may require surgical repair."

3. Arthritis - People tend to think about big-toe bunions when they think about arthritis in the foot, as arthritis often follows when bunions develop. But Reid, who practices in Naperville, says arthritis can develop in any joint. "Older people often develop arthritis across the top of the foot or in the instep, and it's quite painful," she says. "This is another instance where proper orthotics early on can make a big difference."

One last caveat: If you have diabetes, put your podiatrist on speed-dial because you'll be seeing a lot of each other. "Diabetes is a multi-organ disease that requires constant vigilance because decreased blood flow and neuropathy magnifies everything that happens in the feet," says Contento. "I want to see all my diabetic patients twice a year if they are not having problems and every 2 to 3 months if they are. Diabetics literally should not even be cutting their own toenails due to the risk of infection."

Fortunately, Medicare should cover nail trims every 60 days for people with diabetes. "That's a good interval," Contento says. "It lets me check the feet's skin, neurological status and circulation on a regular basis."

According to Reid, at a certain point, even people 55+ without diabetes should plan on leaving the regular foot care to a pro: "Once reaching or seeing your toes becomes a problem, plan on coming in every few months. An office visit charge of $40-$60 is well worth the peace of mind."

Copyright © 2011, Chicago Tribune

Bunion research focuses on patient quality of life

Lower extremity practitioners know the effect of hallux valgus on a patient’s quality of life starts with a frustrating inability to find fashionable shoes that fit—but evidence suggests it doesn’t end there. Pain, function, and self-image all play significant roles.

By Larry Hand

Recent studies have concluded that increasing severity of hallux valgus (HV) leads to a series of conditions or behaviors—increasing pain, decreasing functional ability, withdrawal from normal daily activities—that contribute directly to a progressive decline in health-related quality of life.

The chain reaction applies to men and women, but studies have shown that women are much more likely than men to develop HV and more likely to experience a drop in quality of life. And practitioners interviewed for this article said more and more younger people are being seen with juvenile-onset HV, a disorder that is most often inherited.

It’s logical to think that eliminating the deformity would necessarily reverse any downward quality of life trends. And recently published research does conclude that some surgical procedures are effective for correcting HV. What happens after surgery, however, can vary greatly, depending on the procedure done, the patient’s own tendency to stiffen after surgery, whether patients get physical therapy, and whether they comply with surgeons’ recovery instructions.

“The most common quality of life issue is they just can’t put on the kind of shoes they want to wear,” said Lowell Weil, Jr., DPM, of the Weil Foot and Ankle Institute in Des Plaines, IL. “A typical patient is a woman in her mid- to late-40s who has seen her bunion progressively get worse and she’s tried wider shoes, deeper shoes, and less-high-heeled shoes. While that works for a time, the shoes are becoming less and less comfortable because of the progressive pain. She could probably find an ugly orthopedic shoe that she could get into, but that just doesn’t work for her professionally or socially.”

As the bunion progresses, Weil continued, women start to become embarrassed by their feet.

“They don’t want to go barefooted. They don’t want to wear sandals or flip flops. It’s an ugly deformity to them, and some people even have concerns that the opposite sex find it unappealing,” he added.

Mounting evidence

In a study e-published ahead of print in November by Arthritis Care & Research, researchers at the Musculoskeletal Research Centre at LaTrobe University in Australia and Keele University in the U.K. concluded that a progressive reduction in both general and foot-specific health-related quality of life occurred in people with increasing severity of hallux valgus deformity, or greater HV angle. They analyzed the records of people aged 56 and older in a six-year follow-up of the North Staffordshire Osteoarthritis Project in the United Kingdom.

More than 36% of the study’s participants were affected by HV, which was more prevalent in females and older patients. However, after adjusting for age, sex, education, and body mass index, Medical Outcomes Study Short Form 36 (SF-36) quality of life scores decreased as HV severity increased. After the same adjustments, increasing HV severity also was linked to greater impairment on the pain and function subscales of the Manchester Foot Pain and Disability Index (MFPDI). The same type of association existed for bodily pain, general health, social function, reduced physical function, and mental health subscale scores after adjusting for pain in the back, hip, knee, and foot.

The researchers used survey questionnaires to obtain their self-reported data, and they used five validated line drawings that showed various degrees of HV, with angles ranging from 0° to 60°. They started with a population of more than 11,300 people registered with three general practices from the North Staffordshire Primary Care Research Consortium. The researchers reasoned that, since more than 95% of people are registered with a general practice in the UK, the registers provided a valid sampling population.

Almost 3600 people completed the first of two surveys three years after recruitment into the trial, and the second survey three years later returned about 2800 responses, for an adjusted 83.9% response rate. Those reporting HV were most likely to be female and older than others, and they generally had a lower body mass index and shorter stature. Just over 40% had unilateral HV and just under 60% had bilateral HV. Of the 2681 respondents who could be considered for foot deformity severity, just over 33% characterized their worst foot severity as a 30° angle or higher, while most (almost 45%) characterized their foot angle as at least 15°. Only 57 people said their angle was more than 60°.

An earlier study, published earlier in 2010 in Osteoarthritis & Cartilage, was the first study to assess quality of life’s association with HV and big toe pain in a general community population. (An association had previously been reported in small hospital-based studies.) Researchers at the University of Nottingham in the UK analyzed results of almost 3100 responses received from more than 13,600 questionnaires mailed to individuals registered with two general practices in Nottingham. They used the short version of the World Health Organization Quality of Life assessment instrument (WHOQOL-BREF).

They concluded that concurrent HV and big toe pain—but not HV alone—is associated with overall dissatisfaction with health and low scores on the WHOQOL-BREF physical, psychological, and social domains. They also compared the significance of the association to that of patients with severe knee and hip osteoarthritis who are in line to have joint replacement surgery.

Research involving such large numbers of people relates well to individual patients being seen by practitioners in the United States.

“Much of it has to do with the types of shoes people have to wear and their activity levels,” said Vincent Marino, DPM, a podiatrist who practices in San Francisco, Novato, and Sacramento, CA. “Many of our professional women [patients] who have to wear fashionable shoe types during the day usually suffer more and at an earlier stage than someone who can wear more comfortable shoes. It becomes frustrating because they are in pain a great deal and it becomes an issue with work requirements.”

Often, the pain causes a person to forego activities that, under normal circumstances, they would be doing on a daily basis.

“A lot of times patients will say they’re not able to do the things they normally do, or they have to curtail it; if they usually go out for an hour or two, now it’s just a half hour,” said Althea Powell, CPed, LPed, OST, who operates Powell Shoes in Vero Beach, FL. “We’ve had patients who said they were just unable to exercise. They can’t go for a walk even though the doctor says they need to walk for exercise.”

And the effects go well beyond middle-aged and older women. In an article published last year in the Journal of Foot and Ankle Research, researchers from the University of Queensland reported HV prevalence of 36% in elderly women and 16% in elderly men, 26.3% in adult women and 8.5% in adult men, and 15% in juvenile (under age 18) girls and 5.7% in juvenile boys.

“The unsightliness of the deformity has an effect on many teenage girls and young women. They’re hesitant to wear open-toed shoes because they perceive their foot as being ugly,” Marino said. “They come in because they want to wear some open-toed sandals without having people stare, and it has an effect on their psyche. It also affects the ability of men and women to exercise. They lose the ability to run comfortably and do some of the activities that they put in their everyday lifestyle to help control their stress levels. They stop running. They stop using the elliptical. They stop doing aerobic activities. Every time they put a shoe on, they’re in pain.”

Just getting into a properly sized shoe makes a big difference for even minor bunions, said Chad Brown, CPed, of Brown’s Enterprises, a specialty shoe retailer in St. Louis.

“But in more severe cases, hallux valgus deformity can be just as debilitating as someone who suffers from migraines,” he said. “You’re going through excruciating pain, and it affects everything from going to the grocery store to taking vacations with your family.”

Even professional basketball players are susceptible.

“One player who was a patient of mine probably wore a size 20 or 21 shoe and he had two different-sized feet,” said Dennis Janisse, CPed, president and CEO of National Pedorthic Services and a clinical assistant professor of physical medicine and rehabilitation at the Medical College of Wisconsin in Milwaukee. “I actually had to cast his feet for a high-end dress shoe company so that they could make a shoe over the cast. Because he had such a big-sized shoe, it was so hard for him to get footwear anyway. He was cramming that bigger foot into a smaller shoe, and he ended up with a significant deformity on the one foot and the other foot was fine.”

Wide range of treatments

Treatment for HV, most often a hereditary disorder, ranges from just trying to control the symptoms with proper shoes and orthotics to surgery, often considered a last resort.

“Unfortunately there’s not a lot that really works,” Weil said. “For somebody who is developing a bunion, there’s nothing you can do to arrest the progression. No mechanical device or change of shoe gear is going to prevent the progression of the problem. Basically you treat it with finding wider and deeper shoes that are more amenable to the deformity. You change activities to make it more comfortable. Shoes and orthotics may make it less painful—until it gets bad enough to have surgery.”

More than 130 procedures have been described for HV as far back as the early 1900s, but in the last 20 years, techniques have improved and have been refined based on technological advances in surgery in general, Weil said.

In 2000, a Cochrane Database Systematic Reviews article cited a consistently high (25% to 33%) rate of dissatisfaction among osteotomy patients postoperatively. However, recent publications have pointed to different, highly positive results. A June 2007 paper published in Quality of Life Research concluded that surgery improves the quality of life for HV patients in terms of bodily pain, vitality, and mental health. A study to be published in the March 2011 issue of Clinical Orthopaedics & Related Research cites improvements in AOFAS pain and function scores from 61.5 to 90.3 in patients who underwent a unilateral scarf osteotomy combined with distal soft tissue alignment at the Hospital for Special Surgery in New York City.

Still, opinions vary as to the effectiveness of surgical procedures, depending on who you ask. Some pedorthists and physical therapists still see patients postoperatively who may be predisposed to stiffness in joints or otherwise have not fared well after surgery for various reasons, including not complying with surgeons’ instructions. Marino, however, said noncompliance is not a significant problem in his San Francisco practice.

“I personally drill into their heads that I won’t operate unless they know what they have to do afterward. I tell them, ‘If you don’t listen, then we’ll just end up doing this again,’ ” he said.

Some results depend on the reason for the surgery in the beginning, and the expectations of the patients, particularly with regard to wearing stylish shoes.

“In our neighborhood, people have surgery based on what they can’t wear and the amount of deformity, which is a lousy reason to do it, quite frankly,” said Stephen Paulseth, PT, DPT, SCS, ATC, in private practice in Los Angeles, near Beverly Hills.

He recommends the use of orthotics before and after surgery, as needed.

“We always try to get the patient in before they consider surgery, to see if we can get them a little bit more mobility, get them in some calf/soleus exercises and calf stretching, and to use their flexor hallucis during push-off. They tend to allow their foot to deviate at push-off, which drives their first-toe into abduction,” he said.

Most of the patients seen by RobRoy Martin, PT, PhD, assistant professor of physical therapy at Duquesne University in Pittsburgh, PA, are postoperative patients.

“A lot of them have inappropriate preoperative expectations, thinking they can go back to the shoes they wore before they had surgery,” he said. “The really fashionable shoes are just so bad. I’ll trace their foot and then put the shoe on top of the trace and ask the patients, ‘how can you possibly jam your foot back into that?’ ”

Other people, he added, are simply prone to stiffness after surgery. He tries to counter that with aggressive joint stretching and mobilization exercises, and he recommends a good cross-training shoe that is sturdier and stiffer than a running shoe to maintain forefoot stability.

If a person’s job requires a higher fashion, therein lies the rub. Although most shoes that are wide enough and deep enough to accommodate HV are functional, Powell said, “They’re not pretty. It does not matter the age group, whether someone is in their 30s or 80s, they are looking for function as well as aesthetic.”

That said, the footwear options available for patients with HV today are much better than in the past, Janisse said.

“You’re not going to find a three-inch spike heel or anything like that that’s going to accommodate something like a significant deformity. But a lot of the footwear out there today is much more accommodating and is acceptable, unlike it was years ago,” he said.

Still, shoe manufacturers “definitely need to keep their efforts strong in making shoes that are more fashionable, even though they have made a lot of progress in the past 10 years,” said Brown in St. Louis.

And the shoes need to accommodate all ages, he added.

“The younger people don’t want to look like they’re wearing the same pair of shoes their mom or grandmother wore,” Brown said.