Your Feet - The Good, the Bad, and the Ugly: Top NYC Podiatrist Offers Advice on Bumps and Bends in Your Feet

According to Robert Piccora, DPM, an Associate Professor at the New York College of Podiatric Medicine and chairman of Podiatry at Gramercy Surgery Center in New York City, "In a recent survey by the American Podiatric Medical Association, more than half of all adults say they regularly experience foot pain. And people ages 36 to 45 report more acute pain than any other age group. Some of the most common types of pain come from problems with the toe joints, and the most common types of these problems are bunions and hammertoes. Unlike more superficial problems, such as blisters and calluses, these conditions are the result of changes in the bony framework in the foot. They look bad, they often feel worse, and they won't go away on their own.

New York, NY (PRWEB) November 15, 2007 -- Unless they're killing us, most Americas don't give much thought to our feet. Even though they support us and carry us everywhere -- an average of more than 50,000 miles by the time we're 50 years old -- we don't spend as much time or money on our feet as we do on our faces or our hair.

Perhaps we should. Whether we notice or not, our feet take a beating, and all those miles can definitely take a toll, leaving feet looking -- and feeling -- battered. According to a recent survey by the American Podiatric Medical Association, more than a quarter of US women say they hate their feet, most often because of the way they look. What's more, more than half of all adults say they regularly experience foot pain. And people ages 36 to 45 report more acute pain than any other age group.

The truth is, having painful or unattractive feet is not an inevitable part of life. No one should consider foot problems "normal," says Robert Piccora, DPM, an Associate Professor at the New York College of Podiatric Medicine and chairman of Podiatry at Gramercy Surgery Center in New York City. "Sure, your feet might feel a little sore after you've been on them more than usual -- maybe you went for a long hike or spent the day shopping," he says. "And you might get a blister if you wear shoes that don't fit perfectly. But if you're in pain -- or if you notice any bumps, bulges or bends in your feet -- you should pay attention."

Some of the most common types of pain come from problems with the toe joints, says Dr. Piccora, and the most common types of these problems are bunions -- caused by misalignment in the junction of the big toe and the foot -- and hammertoes, which are deformities in the second or third toe joints. Unlike more superficial problems, such as blisters and calluses, these conditions are the result of changes in the bony framework in the foot. They look bad, they often feel worse, and they won't go away on their own. "Both bunions and hammertoes tend to run in families," Dr. Piccora says. They're often caused by an inherited defect in the mechanical structure of the foot, which creates abnormal stresses and, eventually, deformities in the bone and joint. "You don't inherit the problem," he explains, "just the predisposition." Other causes are foot injuries, neuromuscular disorders, arthritis and congenital deformities such as flat feet or low arches. People whose jobs place a lot of stress on their feet, such as ballet dancers, are also prone to developing bunions and hammertoes.

What can you do about them? Dr. Piccora offers some advice.

Bunions: Beyond "the bump"

Most people think of a bunion as a bump on the outside edge of the big toe. But a bunion is much more than that, Dr. Piccora explains. Instead of pointing straight ahead, the first joint of the big toe slants outward, angling the big toe toward the other toes. The "bump" forms as the joint becomes enlarged and the bones grow more and more out of alignment. Bunions are essentially misaligned big toe joints that can become swollen and tender. In some cases, the joint stiffens, as well.

"Bunions form when the normal forces that are exerted on the foot are disrupted," explains Dr. Piccora. "This makes the big toe joint -- known as the Metatarsophalangeal, or MTP, joint -- unstable," Dr. Piccora says. "Years of unnatural motion create pressure in the joint, causing it to move out to the side and forcing the toe to bend inward." Bunions cause pain, swelling, a burning sensation and sometimes numbness. Some people also develop calluses and ingrown toenails. If you've got bunions, you'll probably notice them most when you're wearing shoes that crowd your toes -- shoes with a tight or pointy toe box or high heels. In addition, spending long periods of time on your feet can aggravate bunion symptoms.

Unfortunately, bunions are progressive. They begin with a leaning of the big toe, slowly producing the bump, which gets more and more prominent and problematic. But some bunions progress more rapidly than others. Sometimes, your doctor will evaluate your condition and then simply observe the bunion, scheduling periodic office exams and x-rays to determine if the deformity is advancing. This strategy will reduce the chances of irreversible damage to the joint.

In most cases, however, bunions require some type of treatment, which can include modifying your activities (avoiding anything that causes pain, such as standing for long periods), placing pads over the area, applying ice, and wearing custom orthotics in your shoes.

If bunion pain is interfering with your daily activities and you're not getting relief from other measures, you might need surgery. "The good news is that we've had several recent advances in the surgical techniques we use to treat bunions, so we've got a very high success rate," says Dr. Piccora. Today's procedures remove the "bump" of bone and also correct problems in the bony structure and the surrounding soft tissues.

Hammertoe: Looks even worse than it sounds

"'Hammertoe' is actually a very good way to describe this condition," Dr. Piccora says. "Technically speaking, it's a contracture -- or bending -- of one or both joints of little toes. In plain English, it's a permanent sideways bend in your middle toe joint. And when it develops, the toes really do look like hammers." Like bunions, hammertoes usually start out as mild deformities that get progressively worse over time. In their early stages, hammertoes are flexible and not especially sore. But if left untreated, they become increasingly rigid -- and painful.

The most common cause of hammertoe is an imbalance in the muscles and tendons that can lead to structural changes -- i.e., bending and even joint dislocation -- in the affected toes. Common symptoms include pain or irritation, as well the development of corns and calluses (areas of thickened skin) on the bottom of the toe or on the ball of the foot, which are often painful in their own right.

Because of their progressive nature, hammertoes shouldn't be ignored, Dr. Piccora stresses. "Without some kind of treatment, hammertoes never get better."

Luckily, there are a variety of treatment options, including trimming of corns and calluses (leave this to the professionals; attempt it yourself and you run the risk of a serious infection). Your doctor may also prescribe orthotics or non-medicated pads. In some cases, patients are fitted with splints or small straps to realign the bent toe; corticosteroid injections are also used.

In advanced cases, surgery is required. The most common surgical procedure is called arthroplasty, in which the surgeon removes a small section of the bone from the affected joint. Another option, arthrodesis, is usually reserved for more severe cases in which multiple joints or toes are involved. In this procedure, the surgeon fuses a small joint in the toe, implanting a pin or other device to hold the toe in position while it heals.

Best advice: Change your shoes

If you've got bunions or hammertoes -- or if you know that they run in your family -- you can take one big step towards minimizing them, says Dr. Piccora: "Wear shoes that fit -- period," he says. In your bare feet, stand on a sheet of paper and trace around your foot. Now place your shoe over the outline. See any lines extending beyond the shoe? That means the shoe's too small -- and your feet are paying the price.

And to make sure you're buying well-fitting shoes, have your feet measured every time you go shopping for shoes. "Most people don't realize that their feet can grow in both length and width as they get older," he says. (The APMA survey found that more than 34 percent of men and 65 percent of women could not remember the last time their feet were measured.)

"Whether you've got foot problems or not, you should wear shoes that support -- and don't contort -- your feet," urges Dr. Piccora. "That means wearing shoes that mimic the shape of your foot, not some fashion designer's idea of what a foot should look like."

Bio:

Dr. Piccora is an Associate Professor on the faculty of the New York College of Podiatric Medicine. He also served as Chairman and Residency Director for the St. Barnabas Medical Center Podiatry Program from 1988 until 1998. At the time of his tenure as director it was the largest podiatric residency program in the nation. Currently, Dr. Piccora serves as chairman of Podiatry for Gramercy Surgery Center. Dr. Robert Piccora is a graduate of the New York College of Podiatric Medicine and performed his residency at six New York Hospitals. He is board certified by the American Board of Podiatric Surgery (ABPS) and the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) and has been practicing in New York City and Westchester for the past twenty two years.

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