Archive for the ‘Bunions’ Category

Those Pesky Bunions and What to Do About Them

July 9th, 2015 by Blue Ridge Foot and Ankle

The telltale sign of a bunion is a bump on the side of the big toe. But the bump that you see is actually only an outward reflection of the real problem: changes in the bony framework of the front part of the foot. Bunions may or may not be painful but they are a progressive condition that requires medical attention. At Blue Ridge Foot & Ankle Clinic our board certified podiatrists, Dr. Stewart M. Chang and Dr. Kevin P. Murray will take the time to conduct a thorough examination of your foot to diagnose a bunion.

Signs and Symptoms

In addition to the bump on the side of the big toe, there are other symptoms which may occur at the site of the bunion:

  • Inflammation and redness
  • Soreness or pain
  • Numbness
  • Burning sensation

You may notice the symptoms more when wearing shoes that have a tight toe box or high heels that force your toes to be compressed in the front of the shoe. Even with all of these symptoms and the bump, our podiatrists may also order a digital x-ray to determine the extent of the deformity.

Treatment

There are treatments that are aimed at reducing the pain and discomfort of bunions. These include: wearing shoes with a wide toe box that won’t cramp the toes, padding the bunion, reducing standing time, orthotics, and oral nonsteroidal anti-inflammatory drugs, such as ibuprofen. Icing the bunion may also provide relief. All of these treatments, however, will not correct the underlying problem. If your bunion is severe and impacting your ability to function on a daily basis, our podiatric doctors may recommend surgery.

If you are suffering with a bunion, don’t wait. Contact us at our Fishersville or Charlottesville office to schedule a consultation today. You’ll be glad you did.

Custom Functional Orthotics

Custom orthotics are the best decision people can make to improve their foot health and function. Custom orthotics are unique and specially made to your feet.  Orthotics treat and correct individual foot ailments. Proper shoes fitted with custom foot orthotics are the best insurance that we can give ourselves to protect our feet.

Your orthotics are manufactured by a state-of-the-art fabrication facility utilizing the latest advancements in machinery and technology available today.  The fabrication starts with an analysis of your feet and a laser casting.  The image produced from this scan is sent to our lab where your device is “born”.  The technicians analyze these scans and make subtle adjustments to ensure a precise fit and form. Exact models of your feet are created on an automated CAD/CAM milling machine.  These models are used to form your orthotics with a high temperature pressure fit system.  Then they are assembled by hand and laminated.  The result is a set of orthotics made to your feet with Dr. Murray’s or Dr. Chang’s specific instructions and modifications to optimize your foot function.  This process typically takes 2 weeks and you will be called when they are ready.

Please bring the shoes you plan on using the orthotics with so one of our assistants can check for a proper fit. You will be given instructions to use with the orthotics during the “breaking-in” period. A follow up appointment will be made to discuss with the doctor how the orthotics are working for you. Some patients may need more time to get used to their orthotics and some orthotics may require adjustments.  Although most patients are happy with their devices immediately, we want you to appreciate the uniqueness of the human body and understand this process can sometimes take time to make the proper adjustments. Our goal is to help treat and correct your ailment so you can live a healthy and active lifestyle. Therefore, we include free adjustments for 90 days.  

One set of orthotics may suffice for many of our patients, but different activities require different accommodations. Therefore, some of our more active patients order multiple pairs of orthotics. Here are a few of the reasons why:

Custom Orthotics by Blue Ridge Foot and Ankle Clinic

Blue Ridge Foot and Ankle Clinic Custom Orhotics

I need a second set of orthotics for when my other pair gets wet.” – Local runner

I need orthotics for standing on a concrete floor all day and another pair for hiking with my family.” – Factory worker

My orthotics really help in my athletic shoes. I wish they worked in my dress shoes.” – Local business woman (we offer the Cobra, which is an orthotic designed to work with many casual and dress shoes)

Most of our orthotics are designed to last 5 to 10 years. Depending on your particular ailment, activity, and amount of use, your orthotics may need to be refurbished (re-covered) during this time period.

Cost:

First set – $395.00

Additional set – $300.00

Refurbishment – $75.00

These are the prices for non-covered orthotics; when covered by insurance, the prices are predetermined by the terms of the insurance plan.

Insurance coverage: Please verify with your insurance company that custom orthotics are a covered benefit and how your deductible and coinsurance apply.

Welcome to the Blue Ridge Foot and Clinic team. We look forward to helping you stay healthy and active.

 
Blue Ridge Foot and Ankle Clinic
 
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887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 417 South Magnolia AveWaynesboro, VA 22980
540-949-5150
New office in Fishersville will open early 2015 @
66 Parkway Lane Suite #102
Fishersville, VA 22939
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
rsz_running_card

 

We Offer Custom Functional Orthotics

September 22nd, 2014 by Dr.Chang

Orthotics are commonly suggested aides to recovery and injury prevention. Orthotic shoe inserts control the motion between the forefoot and the rear foot, evenly distributing the weight and pressure exerted on the foot. They reduce excessive motion that may occur in certain feet, they can act as a binding force that absorbs strain as pressure is exerted on them, and they can accommodate and cushion painful or injured areas. “While not everyone needs orthotics,” Dr. Murray notes, “they are a highly successful conservative treatment strategy for certain types of feet and foot conditions.” For problems ranging from structural deformities, such as bunions, to conditions such as posterior tibial tendonitis, orthotics are an economic way to both treat pain and prevent further injuries.orthotic pic reduced

Through their forty years of combined experience in working with Charlottesvillian feet, Dr. Murray and Dr. Chang have found resounding success in prescribing and fitting orthotics to fit a variety of foot types and injuries. The process for getting orthotics takes some time, primarily because Dr. Murray and Dr. Chang want to make sure that orthotics are right for the health of your feet.

If you suspect that you need orthotics or if you have foot pain, a first visit will include a foot examination, as well as an examination of your shoes. That’s right, bring your shoes to your appointment. The reason being is that the number one cause of foot pain and related injuries is worn out shoes. “Shoes are just not made to be worn forever,” comments Charlottesville shoe guru, Mark Lorenzoni of Ragged Mountain Running. Lorenzoni, a veteran runner and long-time shoe salesman, argues that you should be just as wary of your daily shoes as you are of your athletic shoes. Shoes should be sized properly in regard to the width of the different parts of your foot as well as your gait, your arch, and any propensities your foot may have to pronate. Shoes support your foot by guiding its motion.

If you did not consider which shoes are best for your individual feet, or if you wore out your shoes and kept using them, you may be experiencing a host of problems. Shoes that are too loose can cause blisters or problems with your Achilles tendon; shoes that are too tight could cause plantar fasciitis or aggravate bunions and bursitis; shoes too wide could cause problems in the ankle of people who pronate, and shoes too tight could cause ankle pain in a supinator. So if you come in telling Dr. Chang and Dr. Murray that you have kept working out in over-worn or ill-fitted shoes, they may just send you back to Lorenzoni’s shop. There, a number of trained shoe experts will conduct a gait analysis and draw on their years of expertise in the industry to match your feet to the proper shoe. And a time-saving strategy may be just trying new shoes and replacing your shoes every 200-400 miles, according to the chart below. The good news is that purchasing new shoes is often a complete solution to burgeoning foot pain! The shoe mileage chart below, created by the family at Ragged Mountain Running Shop, can help you sort out when to replace your shoes.

Shoe Mileage Chart

Over half the injuries runners and walkers experience can be directly attributed to “worn out shoes”. Worn out refers to the midsole (engine) of the shoe, which is the most important component of an athletic shoe. Don’t use the outsole/tread wear as a way of determining how much life is left in your shoes! This midsole component generally lasts about 375-450 miles of athletic use. Cut that mileage rating in half if you choose in addition to use your shoes for anything other than your running or walking exercise (i.e. “wearing around”). Here is a sample mileage chart to determine how often you might need to replace your exercise shoes.

Exercise miles/week5 miles/week10 miles/week15 miles/week

20 miles/week

25 miles/week

30 miles/week

35 miles/week

40 miles/week

50 miles/week

When to replace shoesEvery 18 months-two yearsEvery 10 months-1 yearEvery 6-9 months

Every 5-7 months

Every 4-6 months

Every 3-4 months

Every 3 months

Every 2.5-3 months

Every 2-2.5 months

*Created by the family at Ragged Mountain Running Shop*

New shoes, however, may not solve all your foot pain. If you still feel pain after you try out your spiffy new, well-fit shoes, it is time to visit your Charlottesville podiatrist. To get closer to the root of your foot pain problem, Dr. Murray and Dr. Chang are likely to suggest that you wear an over-the-counter shoe insert for a couple of weeks. These inserts cost between $35 and $60, and test whether your foot needs a little extra support or more specific support from an orthotic. If pain still occurs, upon the next visit Dr. Murray, Dr. Chang and their staff will assist you with taping your foot. The tape, in addition to the over-the-counter shoe inserts, will help to redistribute weight throughout the whole foot, binding it in a way similar to an orthotic to test whether a pair of custom-made orthotics will help you. Orthotics last about 5 years (depending on use), they lessen the likelihood of injuries, reduce doctors visits, and relieve pain.

The prescription for your orthotics will depend on your foot type, your condition or injury, and the intended purpose of the orthotic. To this effect, there are different kinds of orthotics. Orthotics are mainly grouped into two categories: functional and accommodative. Functional orthotics correct for excessive motion of the foot, preventing pain during ambulation. Accommodative orthotics are used to distribute weight away from a painful or injured area. Dr. Murray and Dr. Chang will scan your foot and write a customized prescription for your orthotics to fit your orthotics’ purpose and your intended activities. They will consider materials used, the rigidity of the device, and the shape of the heel or head to ensure you go home with the right product.

The process to begin wearing orthotics is gradual. It takes 2-3 weeks to work up to wearing an orthotic full time since the adjustments they make with your foot function could cause initial soreness or pain in the feet, ankles, knees or hips. It takes several months before athletes can run in orthotics comfortably. Be attentive to any pain that may surface in the initial weeks, as adjustments to your orthotics are free under a six-month warranty with the lab that makes them.

IMG_1762But it all comes back to shoes. Truth be told, orthotics are only as good as the shoes in which they are inserted. Make sure that your footwear is foot-friendly and accommodates orthotics. It is important to recognize that worn out shoes will negate the work of the orthotic. Note that not all shoes are made to accommodate orthotics, no matter the brand, style, or cost. Consult your podiatrist or local shoe store for more information on which shoes are compatible with orthotic devices. Although one pair of orthotics can be used in multiple pairs of shoes, most patients purchase multiple pairs of orthitcs to fit a variety of shoes.

As sand and dirt can abrade them, reducing their functional period, wash your orthotics every two weeks with mild soap and lukewarm water, letting them dry overnight before reinserting them. If you find that your orthotics squeak, remove them from your shoes and sprinkle talcum or baby powder on them, which should prevent the squeaking.

Your orthotics will work to restore your gait, posture, and to prevent a host of injuries that could be caused by your foot condition. Orthotics are affordable and last for years, and prevent a host of conditions, from runner’s knee to lower back pain. They are a highly effective, cost efficient, non-invasive, and all-around successful treatment technique. Orthotics are only helpful when used, so Dr. Murray and Dr. Chang suggest that you wear orthotics continually to reduce pain and to improve your posture and alignment.

Click here for a free book offer.

 
Blue Ridge Foot and Ankle Clinic
 
887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 
417 South Magnolia AveWaynesboro, VA 22980
540-949-5150
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
rsz_running_card

What is Morton’s Neuroma?

September 19th, 2014 by Dr.Chang

 A neuroma is a growth or thickening in the nerve tissue due to compression or irritation of the nerve. While neuromas can develop in different parts of the body, they are most commonly found in the feet between the third and fourth metatarsals and called Morton’s Neuroma, or intermetatarsal neuromas. Populations who wear restrictive shoes, or have foot abnormalities such as bunions, hammertoes, flat feet, or more flexible feet, are at a higher risk of developing this type of nerve damage. If you suffer from Morton’s neuroma, you probably already know this by the instant relief from the burning and aching toe pain once you take off your shoes. That’s because the width of your shoes often aggravate an already irritated nerve.

Neuromas have a variety of symptoms that vary from pain to tingling, burning or numbness, and even feeling as if something is inside the ball of the foot. Symptoms often have a gradual onset, first only flaming up when wearing shoes with a tight toe box or while engaging in activities that stress the ball of the foot. Initially, symptoms can be relieved by removing a constricting shoe, massaging the tender area, and by avoiding aggravating activities. However, as time passes, symptoms will get progressively worse. If untreated, neuromas can lead to permanent nerve damage, so consult your podiatrist early about your neuroma.

Treatment and prevention vary. First, make sure you have the proper shoes for your feet! Your podiatrist may suggest special padding techniques to relieve the pressure from the affected area. Additionally, icing, using over the counter or custom made orthotics, modifying activities that aggravate the injury, taking NSAIDs, or even cortisone injections can help. In more severe cases, surgery will be a viable option to remove the neuroma altogether.

Click here for a free book offer.

 
Blue Ridge Foot and Ankle Clinic
 
887 A Rio East Court Charlottesville, VA 22901
434-979-8116
 
417 South Magnolia AveWaynesboro, VA 22980
540-949-5150
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
rsz_running_card

 

Blisters, Ingrown Toenails and Athletes Foot

July 28th, 2014 by Dr.Chang

INGROWN1Blisters are a result of the abrasion between your skin and sock or shoe. Because they can arise suddenly, it is important to take preventative measures to ensure your foot’s comfort. Preventing blisters begins with well fitting shoes, not too snug yet not too lose. Your socks should be snug fitting and made out of synthetic wicking material and with seams that cause minimal abrasion. Even after taking such precautions, many runners and athletes get blisters. If you find that you are prone to blisters, try regularly applying moisturizer to your feet, as dry skin is prone to friction, leading to blisters. Additionally, you may want to try rubbing your feet with Vaseline before a run if dryness is a problem for you, using foot powders to decrease moisture if your feet sweat too much, or wearing two pairs of socks so that they rub together instead of rubbing against your skin. You podiatrist may also prescribe prescription antiperspirants for more effective drying.

The rule of thumb is to leave small blisters intact so that the outer layer will protect the skin underneath. If you do get a blister on or off the trail, and it is large enough to see fluid inside, the best thing to do is to drain it and avoid it popping during activity. First, wash the affected area with soap and water. Sterilize a needle by rinsing it and soaking it in rubbing alcohol. Do not put the needle in a flame for sterilization as this method can lead to getting infectious carbon bits in your skin. Next, make a hole in the blister and squeeze out the fluid. Avoid removing the skin over a blister, because it provides padding and protection for the new skin growing underneath.  Finally, use hydrogen peroxide to prevent infection and wrap the area with antibiotic ointment and a bandage. You may want to use products like Second Skin or Band-Aid Blister Blocks, or soak your foot in Epsom salts to draw out fluid when you take off the bandages. If you find your blister is emitting yellow or green discharge, swell or reddens, you will want to see your doctor, as it is most likely infected. Additionally, if your blister is under or at the base of the toenail, see your podiatrist for treatment. Home removal of the toenail can cause infections and other complications, but your podiatrist will know how to drill a hole in the nail with an electric file.

ingrownIngrown toenails are one of the most commonly treated ailments. These are nails that are incorrectly shaped, so that they curve and grow into the skin, usually at the sides of the nail. This irritates the skin, causing pain, redness, swelling and warmth in the toe. Your toe may incur an infection if the nail breaks the skin, allowing bacteria to enter and cause an infection (indicated by a foul odor and a discharge of discolored fluids).  Ingrown toenails can be caused by a number of factors. While they are often hereditary, they can be the result of traumatic injuries, improper trimming, poorly fitting footwear, and nail conditions (such as fungal problems).

INGROWN3Home treatment of ingrown toenails should be limited to consistently cutting and filing the nail straight across and soaking the nail in Epsom’s salt. Never cut notches in the nail, do not repeatedly trim the nail borders, and do not place materials (such as cotton) beneath the nail, as all of these methods increase the likelihood of bacterial infection. Over-the-counter topical medications only relieve pain but do not cure the symptoms. “Home surgery” on your ingrown nails is not recommended, since repeated cutting of the nail can cause the condition to worsen over time. If your nail does not improve, visit your podiatrist for a simple procedure. Dr. Chang and Dr. Murray can easily perform a minor surgical procedure. They will take off the small offending border that is causing pain and permanently remove it so that it does not grow back into your skin. Note that they do not remove the entire nail, so this simple procedure can alleviate your pain with minimal recovery time.

Athlete’s foot, officially known as tinea pedis, is a fungal infection between the toes and on the soles of the feet. With this infection the skin on your foot may feel itchy or painful, will have scales redness and blisters. Podiatrists will recommend the applications of a fungicide such as Desenex, Tinactin, Lotrimin or Lamisil. Using these products a few times a day for two weeks to a month will help remedy the irritation and other symptoms. If symptoms reoccur, be sure to rotate the fungicide you use so that the fungus does not build up a tolerance to one brand. You may want to try additional remedies for the itching, such as soaking your feet in a baking soda and water solution, removing the dead skin with a pumice stone, or rubbing fine sandpaper along the bottoms of the feet (and disposing of the sandpaper after use!).

 

Blue Ridge Foot and Ankle Clinic
887 A Rio East Court Charlottesville, VA 22901
417 South Magnolia Ave Waynesboro, VA 22980
**FISHERSVILLE OFFICE COMING SOON**

cycle

Common cycling injuries are often due to trying to do, “too much, too soon”, but may also be due to improper equipment, biomechanics, technique, or bike fit.  As with all athletic injuries, pain that is persistent indicates a need to seek treatment from a sports medicine specialist familiar with cycling injuries.

Foot Pain

1. “Hot foot” (numbness and burning in the ball of the foot)

Impingement of small nerve branches between the second and third or third and fourth toes can cause swelling which results in numbness, tingling, or burning, or sharp shooting pains into the toes.  Loosening shoe toe straps, wearing wider shoes with a stiffer sole and using anatomical footbed with a metarsal pad will help alleviate the problem.

Besides tight shoes, another risk factor is small pedals, especially if you have large feet.  Small pedal surfaces concentrate pressure on the ball of the foot.  Switching to larger pedals may be the cure.  Re-focus the pressure on the ball of the foot by moving the cleats towards the rear of the shoe.  If your cycling shoes have flexible soles like most mountain bike shoes, they’ll be less able to diffuse pressure.

Physician-designed custom orthotics provide biomechanical benefits and can be made with built-in “neuroma pads”.  Cycling orthotics are different than those for runners, as cycling is a forefoot activity, not a heel-strike activity.mt climb

Cortisone injections occasionally may be helpful for symptomatic relief, but they do not address the cause of the pain.

2. Sesamoiditis:

The sesamoids are two small “seed-like” bones found beneath the big toe joint.  Injury to these tiny bones can result in inflammation or even fracture, leading to debilitating pain and inactivity. Sesamoiditis can be relieved with proper shoe selection, accommodative padding, and foot orthoses.

Leg Pain

1. Achilles tendonitis

Irritation and inflammation of the tendon that attaches to the back of the heel done can be caused by improper pedaling, seat height, lack of a proper warm-up, or overtraining.  This condition is usually seen in more experienced riders and can be treated with ice, rest, aspirin, or other anti-inflammatory medications.  Chronic pain or any swelling should be professionally evaluated.  Floating pedals which allow excessive foot pronation may also worsen this condition.

2. Shin splints

Pain to either side of the leg bone, caused by muscle or tendon inflammation, which may be related to a muscle imbalance between opposing muscle groups in the leg.  It is commonly related to excessive foot pronation (collapsing arch).  Proper stretching, changing pedals, and corrective orthoses that limit pronation can help.

Knee Pain

Some intrinsic knee problems like swelling, clicking, or popping should be immediately evaluated by a sports medicine specialist.  Cartilage irritation or deterioration, usually under the knee-cap, can be caused by biomechanical imbalance, improper saddle height, or faulty foot positioning on the pedals.  Riding in too high a gear “mashing”, excessive uphill climbing, or standing on the pedals all may aggravate the problem.  Cleated shoes or touring shoes with ribbed soles that limit side-to-side motion can cause knee pain if the knees, feet, and pedals are misaligned.

1. Chondromalacia

Pain under the kneecap.  Most chondromalacia sufferers can ride at some level no matter how sever the degeneration.

2. Patellar Tendonitis

Strain of the tendon which attaches the kneecap to the leg, this injury often occurs in the novice cyclist or early in the cycling season.  The first sign of a problem may be an ominous twinge after cycling in too hard a gear.mark_1

Cycling tips

Bike fit is key; have a professional check your fit and make bike modifications as needed.

Carefully choose the shoes you will wear in cycling.

Train properly using adequate warm-up and cool-down. If you are doing “too much, too soon” and start having pain, reduce training frequency, intensity, and time.

Pain is not normal and may indicate a medical condition. Seek medical attention from a sports medicine specialist.

Before beginning any exercise program, be sure to check with your physician.

-The American Academy of Podiatric Sports Medicine (AAPSM)

 

Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro, VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years.  Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming
you to our practice.

POWERSTEP CONTROLBlue Ridge Foot and Ankle Clinic is throwing in five pairs of Protech Powersteps as prizes at the Devils Playground steeple chase run on Sunday May 19th.  Come out and enjoy the fun.  Devils Backbone Brewing Company is a great place to eat, have a beer and enjoy the mountains.  Register here: https://www.runreg.com/Net/3555.  We’ll see you there.
 
 
 
 
 
 
 
Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
 
 
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980       (540) 949-5150
                            
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

BUNION SURGERY

April 10th, 2013 by Dr.Chang

WHAT ARE BUNIONS?
          Bunions are enlargements of the joints at the big toe (hallux valgus) or little toe (Tailor’s Bunionette). However, bunionsbunion before are more than just bony protrusions: they are structural abnormalities in the foot, misalignments caused by hereditary factors or lifestyle habits such as wearing narrow shoes, high heels, and tight sporting or dance shoes. The structural change causes the “V” shape, or “valgus” of the big toe, that is marked by an enlarged joint.
          Especially because your feet support the weight and movement of your entire body each day, it makes sense that any sort of disturbance to the structure of your bunionfeet can cause considerable pain. However, the “V”ing of your first toe joint places considerably more stress on the joint than when the bones in the joint connect in a straight line. Bunions can therefore be excruciatingly painful. Luckily, treatment 
and surgery for bunions are highly effective means to limiting your pain and allowing you to return to your daily activities!
 
TREATMENT FOR BUNIONS
          Initial, non-invasive treatments for bunions include side lining your tight-fitting shoes in favor of comfortable, well-fitted footwear (shoes that do not bunch your toes together or cause pressure on your toe joints). Splints and orthotics can also do wonders for repositioning your toes. Bunions caused by arthritis in the joint are treated well by medications that can reduce pain and swelling. If these methods do not improve your foot pain, your podiatrist may suggest surgery, which is a highly effective form of addressing the structural misalignment in your foot.
 
WHAT IS BUNION SURGERY?
          The main goal of bunion surgery is to improve your ability to walk and do other activities on your feet. Bunion surgery straightens the structural misalignment of the bones in your foot, decreasing the pressure on the joints. As a result of your surgery, your pain will be drastically improved, if not eliminated.
          Bunion surgery involves work on the soft tissue and/or bone of the big toe joint in order to relieve the pain in the joint, and to restore normal alignment to the joint. Not all bunions are created equally, and, as follows, not all patients with bunions will receive the same sugery. In fact, there are over one hundred kinds of bunion surgery!
 
Common types of bunion surgery include:
 
*Removal of the metatarsal head (the part of the foot that is bulging out toward the center of your body). This is called an “exostectomy” or “bunionectomy.”
*Realignment of the soft tissues (ligaments) around the big toe joint.
*Removal of a small wedge of bone from the foot (metatarsal osteotomy), or from the toe (phalangeal osteotomy).
*Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe (metatarsophalangeal joint). At this joint, both the big toe and the metatarsal bones are reshaped (resection arthroplasty).
*Fusion (arthrodesis) of the big toe joint
*Fusion of the joint where the metatarsal bone joins the mid-foot (Lapidus procedure)
*Implant insertion of all or part of an artificial joint
Bunion after 
          The more involved the bunion is, the more complex the surgery. In the case that the joint is severely deformed, a surgeon may stabilize the re-alignment with wires, stitches, screws, or plates. Depending on your foot misalignment, your surgeon will suggest the optimal procedure for you.
          Bunion surgeries are most frequently conducted as an outpatient operation, and take about one hour. Most often, patients receive local anesthetics with IV sedation (twilight anesthisa). You will be required to have a follow up visit to take your stitches out in two weeks.  In most cases the healing process takes about 6 weeks.
 
 
DEBUNKING THE MYTHS:
          Unfortunately, there are many distressing myths about bunion surgery that you may find while browsing the internet. Let us help to quell your fears by assuring you that an overwhelming number of bunion surgeries (over 90%!) are successful in relieving pain and properly realigning the joint.
          While surgery can be painful, bunion surgery is no more painful than any other invasive procedure. The greatest cause of pain, in fact, is the swelling after surgery.  Remember that, because your foot is below your heart, it is more difficult for your veins to fight gravity in order to return blood from your foot to your heart. Therefore, the swelling can often throb, and you will have to consistently elevate your foot. Furthermore, your feet have an incredible amount of nerves without much soft-tissue padding around them. The swelling can aggravate the nerves and cause pain. However, in the long run, bunion surgery vastly reduces pain that bunions cause with walking and standing for long periods of time.
          Another myth is that bunions can reemerge after surgery. While reoccurrence is possible, it is not likely. Furthermore, a bunion would come back over time and due to a lack of change in lifestyle and habits that caused your bunion in the first place. Go into the surgery aware of the fact that you will have to stay committed to the health of your feet! Side-lining your high heels and prioritizing comfortable shoes and time for foot exercises will be necessary for the longevity of the surgery.
          Finally, depending on your specific surgery, you won’t necessarily have to take a lot of time off of work. Most patients can return to a desk job after two weeks, and to an active job after two months. Additionally, over 90% of our patients report an amazing decrease in pain and increase in function after their surgeries!
 
AFTER SURGERY:
          Depending on the surgery, you may be placed in a surgical boot and able to walk within two weeks of the surgery. With more complex surgical procedures, you may be required to wear a cast or splint, and walk on crutches.
          In order to best maintain the results of your surgery, it will be important for you to continue to be dedicated to the health and wellbeing of your feet. Committing to lifestyle changes, such as not wearing tight shoes and doing prescribed exercises and stretches for your toes and feet, will drastically increase the benefits of surgery, and reduce the likelihood of any future pain.
 
 
            Dr. Chang and Dr. Murray to have decades of experience successfully treating and operating on bunions. Remember that treatment and surgeries are most successful when you address and treat your bunion early. So contact us at Blue Ridge Foot and Ankle – we can help you solve your foot pain!
 
Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
 
 
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980       (540) 949-5150
 
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

Navigating the beastly bunions…

August 31st, 2011 by Dr.Chang

Bunions, also known as hallux valgus or hallux abducto valgus, are commonly known as unattractive big red lumps on the first toe joint, making it painful to wear shoes or engage in the activities you love, like running. But the most important thing to know about bunions is that they are symptomatic of a change in the structure in the front of the foot.  Bunions crop up when another underlying cause makes the big toe lean toward the second toe, throwing bones out of alignment, causing the laxity of muscles and ligaments, and various other misalignments in the foot. In turn, as the big toe moves inward, the bursa sac, the fluid-filled sac that covers the joint, becomes more exposed and increasingly inflamed – and that’s the big red painful lump. Because a bunion is caused by a deformity in the foot, it is essential to consult Blue Ridge Foot and Ankle Clinic for a diagnosis and proper treatment plan.  Dr. Murray and Dr. Chang can help you work with your bunions and their underlying causes, finding the proper balance of treatment, rest, and methods to get back to the activities that you love.

WHAT CAUSES BUNIONS?

Bunions are most often caused by inherited faulty mechanical structures of the foot. The lump itself isn’t inherited, but the faulty foot structure that makes feet prone to developing bunions. Hereditary factors could include congenital foot shape, congenital foot bone structural relationships, ligament laxity, overpronation and equinus. Environmental factors, like shoes that crowd toes, won’t cause bunions, but they may make the deformity get worse at a faster rate, making signs and symptoms appear earlier.

BUNION SYMPTOMS

Symptoms usually only crop up after the deformity has progressed enough for the bunion’s bump to appear. These symptoms include foot pain, soreness, inflammation, redness, a burning sensation and numbness. They occur most often when wearing shoes with a tight toe box, crowding at the toes, or high heels, spending long periods of time on your feet can also aggravate the symptoms.

Such symptoms aren’t always on the joint just below the big toe. A related problem, Tailor’s Bunion, or a bunionette, is a similar deformity – a prominence of the fifth metatarsal bone at the base of the little toe. This deformity is similar to bunions, but is not as common. Similar to bunions, bunionettes are caused by a change in the foot’s bony framework, resulting in the development of the bump or enlargement. Bunionettes require much of the same diagnostic and treatment methods as bunions.

TREATMENT PLANS

Some bunions progress faster than others, so treatment plans may vary. Sometimes, all you need is to observe that your foot is forming a bunion so that you can treat it in a way that it prevents further injury, which primarily focuses on fitting your foot with proper custom made orthotics. A treatment plan might also include (1) making sure you’re wearing the correct shoe wear – shoes with a wide toe box and not wearing (or limiting the use of) pointed shoes or high heels which will make the bunions worse; (2) padding the area to minimize pain, to be obtained from your podiatrist or purchased at the pharmacy; (3) activity adjustment, which means staying away from activity that triggers the pain, including standing for a long time; (4) NSAIDs to reduce inflammation; (5) Icing; (6) injection therapy (for treating the inflamed bursa sometimes seen w/ bunions). It is important to realize that these treatments will not reverse the bunion deformity; they will only slow the rate at which the deformity progresses.

Surgery is needed when other treatment options do not relieve bunion pain and when the pain disrupts daily activities and will focus on the reduction of pain. The procedures will remove the bump of the bone, correct changes in the framework of the foot, and correct soft tissue changes that may have occurred. The surgical procedure will depend on the degree of problems based on X-rays, your age, your activity level among other factors. The length of recovery, time off your feet, and time before you can go back to work, and time before you can drive will differ depending on the procedure(s) performed among other factors. Most patients will experience discomfort for three to five days after the surgery, depending on the procedure conducted.  Follow instructions from your podiatrist to minimize post-operative pain.

Bunion surgery generally has an incredibly high success rate, but long-term success depends on your prolonged dedication to having healthy feet. Get rid of those 4-inch heels and taper-toed pointy shoes, and find shoes that fit you, with padding and over the counter or custom-made orthotics that are right for you. A physical therapy plan may also help to strengthen your foot and to increase its flexibility.

HOW WILL BUNIONS AFFECT MY RUNNING AND OTHER ACTIVITIES?

As this article has explained, bunions are a progressive condition caused by another deformity in the foot. The underlying deformity will probably not slow you down until the bunion appears. The bunion itself may be painful as it rubs against your shoe or throbs when you put impact on it. In the worst cases, bunions can be prohibitive of running. However, if you diagnose their underlying cause early enough, and invest in a treatment plan, your podiatrist can help you can keep the condition at bay so you can keep doing the activities that you love…in moderation!

If you do choose to run with bunions or after your recovery from bunion surgery, you can try a few techniques to decrease the pain. Taping your foot in the normal position before running can help reduce the stress and pain on a bunion. Toe separators between the big and second toe and taping the pad to your big toe have been reported to relieve some pressure from that area of the foot. Toe exercises can help increase blood flow to the joint, such as toe adductions (pull your big toe out to the side away from other toes and hold for a second or two and repeat 10 times on each foot) and toe extensions (raise your big toe and curl your toes tightly down toward the bottom of your foot, use your hand to gently push down on toes, flexing each toe individually or your toes as a group, and hold for two seconds doing ten repeats on each foot). These stretches will not cure the bunion condition or deformity, but they may help reduce pain in the short-term. Be sure to discuss these methods with your podiatrist and physical therapist to find the proper treatment plan for your individual needs.

The most important thing you can do to take care of your feet long-term is to buy the proper footwear for activities and everyday wear. Feet with bunions require a few main considerations when buying the proper shoes: foremost, since bunions are indicative of foot deformities, your feet require supportive shoes. Second, there are a variety of shoes made with wide toe boxes and snug fitting heels that are good for runners with bunions and bunionettes. Depending on your foot, you may need supportive shoes, shoes with more cushioning, motion control, mesh material, and so on. Your local shoe dealers, Ragged Mountain Running, the Charlottesville Running Company, Crozet Running, and Richey and Co. Shoes, can all provide foot assessments and expert advice about properly fitting shoes.

Above all, remember that the first step to treating your foot pain is visiting your podiatrist to diagnose the underlying cause of your bunions. With the help of your Charlottesville or Waynesboro podiatrist, you can arrange a proper treatment plan to prevent further wear and tare on your feet and to slow down the progressive deformity that your bunion is indicating. Visit your Charlottesville or Fishersville podiatrist for a diagnosis and integrated treatment plan that is right for you.

Comment on this post to share your story about running with bunions or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic
              Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
              Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150
 
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years.Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

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Women athletes, especially those who run and do triathlons, are often told that they are more susceptible to certain lower extremity pain. But what are the unique qualities of the female physique and subsequent common injuries? This post will discuss lower extremity pain common among women due to musculo-skeletal characteristics, hormonal changes and even cultural factors. Below you will also find a few simple suggestions for reducing the risk of foot and ankle injuries. However, Ladies, injuries are cause by a variety of factors and treated in a variety of ways depending on your individual body type and list of activities. If you are experiencing foot and ankle pain, never hesitate to consult your local Charlottesville podiatrist for more information.

Female Musculo-Skeletal Factors in Injuries

There are a few factors that doctors consider when discussing female-specific injuries. Foremost, the angle that represents the relationship between the pelvis, leg and foot, referred to as the Q angle, is more dramatic in females because of women’s wider hips. Knowing this angle is important for athletes because repetitive and continual stress throughout the lower back, pelvis, hip, knee and ankle will often produce injuries in the lower part of the body, especially among women with wider Q angles. Determining whether your Q angle falls outside of the normal range may help in considering the causes of foot and ankle pain, not to mention pain in the lower back, pelvis and even the neck.  If you are concerned that your Q angle is affecting your running or causing foot and ankle pain, visit Dr. Murray and Dr. Chang for a professional assessment. They will be able to provide various suggestions, including fitting you with over the counter and custom orthotics.

Common running injuries due to a wide Q angle include patellofemoral pain syndrome or runner’s knee, iliotibial (IT) band syndrome, and shin splints. Women commonly feel pain from patellofemoral pain syndrome, otherwise known as runner’s knee, behind or around the kneecap. Runner’s knee has a range of causes – from over use, direct trauma or misalignment to flat feet. Women commonly are afflicted by runners knee due to a weak VMO muscle (vastus medialis oblique <<image>>), a muscle in the interior thigh. The good news is that it is easy to strengthen the VMO through knee extension and hip abduction exercises. Contact your Charlottesville or Waynesboro podiatrist to find the right exercise plan for you.

Iliotibial band syndrome is also a common injury found among female runners and triathletes. The IT band is made up of tissue that runs on the outside of the thigh, from the pelvis to just below the knee. While crucial to stability during activity, its continual abrasion against the top of the femur and the knee can make it inflamed, causing pain in the hip, thigh and/or knee. Often, using a foam roller can help runners prevent and heal sore IT bands. Stretching is a great preventative measure for IT band pain. Try standing straight up, and bending to the side as far down as is comfortable. Two sets of 15 repetitions on each side should work wonders. Hip flexor exercises can do the trick as well. Kneel on one knee and turn the torso until you feel a stretch on the IT band. Hold this for 5-10 seconds, and repeat 3 times on each side. Again, consult Dr. Murray and Dr. Chang or another licensed professional to design the appropriate workout for you.

Shin splints, known to doctors as medial tibial stress syndrome (MTSS), result from too much force on the shinbone and the connective tissue attaching muscles to it. If you run, chances are that you’ve had the ‘splints. Studies show that up to 15% of running injuries are shin splints, and the advertisements in the back of running magazines are certainly a good testament to that fact. Shin splints are common among runners who have flat feet or over-pronate. In other cases they are caused by tightness in other various muscles and tendons (another good incentive to warming up and stretch!) and by increasing mileage too quickly. Try your best not to increase mileage more than 10% per week; especially with the female disposition to have diminished bone density, female runners are up to 3.5 times more likely than men to contract stress fractures from shin splints.

By far, the single most important to preventing shin splints, along with all of the Q-angle injuries mentioned above, is wearing properly fitted shoes and being attentive to when your shoes are worn out. Your local shoe dealers, Ragged Mountain Running, the Charlottesville Running Company and Richey and Co. Shoes, can all provide foot assessments and expert advice about properly fitting shoes.

Age and Hormone-Related Causes of Injuries

The female Q angle can take tolls on knees, ankles and feet of all ages. High school athletes have a high incidence of injuries to the ligaments in the knees, primarily the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), because they tend to lack the lateral stability and endurance necessary for optimal performance and injury prevention. Some experts write that 30% of all ACL tears occur among high school females due to the Q-Angle of the female hip. Some helpful tips for ACL/MCL injury prevention among teens include not neglecting a 5-10 minute warm up, followed by stretching, planning for rest, and staying hydrated. High school athletes can also benefit from light to moderate lateral plyometrics such as lunges and squats, and even light weight lifting.

Female-specific hormones may have great effect on female runners throughout their lives. Hormones, such as relaxin, that women release during pregnancy lead to the relaxation of ligaments. Biologically, this allows for smoother births, but these hormones can affect ligaments in the feet, leading to arch pain, collapsed arches, plantar fasciitis and over pronation. While the jury is still out on the benefits of running during pregnancy, most experts agree that easy running in moderation can be helpful for second trimester moms who are runners, as long as it is balanced with enough time resting the feet and attentiveness to overheating and hear rate levels. Consult your obstetrician to determine a proper exercise routine during your pregnancy.

Not surprisingly, pregnancy may necessitate larger shoe sizes due to swelling. Ligament laxity may permanently increase shoe sizes or altered foot shape. Cramming a new foot size into old shoes too often results in foot and ankle pain. Contact your local shoe experts to determine whether your shoe size has changed, and what the best new fit might be – your feet are worth it!

And what about running injuries during menopause? The experts are still out on whether running correlates to an easier ride through menopause. However, the precaution about menopause often is that diminishing bone density resulting from hormonal changes can often lead to osteoporosis. Boosting the amount of calcium in your diet to between 1000-1500 mg before menopause is a good preventative measure to ward off post-menopausal osteoporosis, especially for female runners. Keeping running and strength training up can keep your bones strong, help prevent bone fractures and healthy circulation, not to mention running’s other physical and emotional benefits!

Other Causes of Female Injuries

In addition to biology, nurture, or cultural influences, may be factors in female injuries as well. High heels often lead to bunions, hammertoe, ingrown toenails, sesamoid injuries, Morton’s Neuroma, back pain and other problems. Remember that good-looking shoes are not exclusive of comfort. Consider buying shoes with arch support and room in the toe box from stores like Richey and Co. Shoes.

But high heels are not the only culprits of foot and ankle pain! If your running or athletic shoes do not fit or are worn out, you can likely injure your legs, ankles or feet. Be attentive to the wear in your shoes, and buy new athletic shoes frequently – according to your podiatric experts, Dr. Murray and Dr. Chang, the appropriate shoes will prevent a host of injuries!

Unfortunately, female athletes are particularly susceptible to eating disorders, and what doctors have come to know as the “Female Athlete Triad.” The triad is made up of an eating disorder and weight loss, amenorrhea (missed periods), and osteoporosis. Poor nutrition can lead to bone loss, decreased serum estrogen levels, psychological abnormalities, and, in extreme cases, death. Those who suffer from the Female Athlete Triad may experience fatigue, anemia, depression, decreased concentration, constipation, cold intolerance, and parotid gland enlargement seen in the cheeks. If this isn’t bad enough, the boneless can cause stress fractures that will not heal without proper nutrition and self-care.

Nurture your body! Healthy eating leads to strong bones and can keep you strong, fit and running your best. Balanced and healthy diets improve athletic performance, prevent osteoporosis, and aid in the healing of injuries. Consuming a target of 1000 mg of calcium per day, with sufficient Vitamin D for calcium absorption (which can either be derived from sunlight or regulated supplements), will help prevent stress fractures. Visit our page on bone healing for more information.

So, to all the female runners out there, stay strong and inspired, and remember that consulting your doctor, fully understanding the various causes of injuries and taking care of yourself will aid in injury prevention and healing.

Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

 

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