Archive for August, 2011

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.


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.


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.


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.


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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With summer now in full swing, many of our patients are excited to get in shape and restart their outdoor exercise routine. Exercise can create a great amount of strain on the body’s bones, joints, ligaments and tendons. During a 10-mile run, the feet make 15,000 strikes. Each strike is at a force of three to four times the body’s weight.

Are you feeling pain when you run?  It is important that you are aware of the difference between typical running injuries and possible symptoms of more serious ailments, such as Peripheral Artery Disease (P.A.D.). Many common symptoms of running injuries are the same as those of P.A.D., so we caution you to treat any discomfort seriously. Common symptoms of P.A.D. include:

  • Painful cramping of leg muscles
  • Numbness, weakness or heaviness in the muscles
  • Toe and foot sores that do not heal

Fortunately, there are easy-to-use, non-invasive diagnostic systems that can be utilized in our office to help identify P.A.D. and determine whether medical or surgical treatment is necessary. These tests can be completed in just 15-20 minutes during a regular office visit.

Please contact us if you would like to schedule an evaluation!


Our feet are susceptible to a variety of injuries and conditions: fractures, flat feet, bunions, ingrown toenails, and the list goes on…and on… Anticipating surgical treatment for your feet can certainly be frustrating, but thinking about the positives of recovering from your injury and being pain free is an important element for a successful surgery and expedient recovery.  First off, if you are reading this blog, chances are you are in the experienced and attentive hands of Dr. Kevin Murray and Dr. Stewart Chang. With years of podiatric care and foot surgery under their belts, you can be confident that they will take great care of you and your feet. On a more personal note, think of the surgical recovery process as providing you with time to regroup and care for your feet, your body and your self. Preparation for surgery can allow for long-term planning of your podiatric health and the recovery process can enable you to enlist the support and care from your friends and family.

That being said, knowing more about your surgery and what to expect after surgery will help you prepare for the process, ensuring a successful and efficient recovery from general foot surgery.  The pointers below will provide guidelines and suggestions for the different steps along the way.


Each individual’s feet, injuries and conditions are unique, and it’s important that you know the basics of your injury and why surgery is the best option for you. Whether you are suffering from an injury or underlying condition, what surgical procedure you will have and the expectations from the procedure are all important questions for you and your podiatrist to answer together. You should also know whether you will have general or local anesthesia during the surgery and about the post-operative recovery room conditions, especially if you have other preexisting conditions (if you are diabetic, for example, note that glucose monitoring is available during surgery).

There is an enormous variety of surgical procedures and healing times for them. Cryosurgery, for example, has a recovery period of two days to a week. Other invasive surgeries can take up to six months or more to heal. This time frame could put a considerable wrench in your schedule and regular daily activities. Be sure to discuss a realistic recovery time frame with your Charlottesville or Waynesboro podiatrist so that you can plan ahead and give your body the proper time to rest.


Preparing for the post-operative phase begins well before your surgery even starts. Consider what care and support you’ll need, such as a drive home from the hospital and help cooking meals or taking showers. Enlist the support of your family, friends or a nurse. You will want to stock up on basic groceries for when you return home and medications you might need for after surgery. Chances are that your movement will be restricted, so you may want to have a bed on the ground floor or in a main room of your house. Having pillows to elevate your foot, a backrest for sitting up, water bottles, writing materials, and a way to keep track of your medications are all helpful post-surgery. You may need to supply yourself with a range of entertainment – a computer and plug within reach, DVDs, magazines, books, and music.

Showering can be challenging after getting surgery, and falls in the shower after surgery commonly lead to damage of the surgical area or additional injuries. Preparing the bathroom and shower area with grab bars and a shower stool may be helpful. You may also want to stock up on plastic garbage bags or purchase a cast protector in order to keep your leg and foot dry while showering. Obtaining a Temporary Handicap Placard from the DMV is possible for post-surgery patients. In most states this requires your physician to complete Temporary Disabled Parking Permit form. You can also download a form from the Virginia DMV.

POST SURGERY: Managing the Pain

After surgery, be prepared for your foot to swell at the incision site. This swelling is due to the increased blood flow in the foot because of the surgery and compounded by the lack of movement in your leg, decreasing your capacity to return blood to the heart. Swelling often causes pain. Since the greatest swelling occurs in the first few days after surgery, it is no surprise that this is also when you will need to pay the most attention to pain and swelling management.

Throughout your recovery process, and especially right after surgery, try hard to stay on top of your pain using a number of strategies. Your foot surgeon may use nerve blocks around the operative site that numb your foot and reduce pain for the hours immediately after the procedure. Your podiatric surgeon will also provide you with a prescription for narcotic pain medications. Be sure to discuss pain medication options with your podiatrist, and know whether your medication is long acting (requiring only 2-3 doses per day) or fast acting (requiring a higher dosage). Because pain medication side effects can include confusion, felling strange, and nausea and vomiting, keep track of your medication intake. Additionally, be aware that these drugs may also cause problems including constipation (which you can counteract with products like Metamucil) and the potential for addiction. Your podiatrist may also recommend that you take non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, Advil, Motrin, or Aleve, after the initial recovery period. Consult your podiatrist before self-prescribing these, as they may have negative effects on bone, tendon and ligament healing. These drugs can also cause stomach irritation, ulcers and kidney problems when taken in high dosages. Drink lots of water with NSAIDs and consult your podiatrist or physician if you are having any such side effects.

Other methods of pain-reduction include foot elevation (prop your foot up 6-18 inches above your heart as you lie down), avoiding activities that require you to keep your foot dangling downwards for long periods of time and using crutches and/or a walker to keep your weight off your foot. If your foot is not in a cast, then place ice in a plastic bag or use a cold pack, applying it to the swelling for 15 minutes at a time. Ice will restrict the blood vessels in your foot, reducing blood flow to the area just enough to help minimize the swelling. Note that you should never ice your foot when it is numb from post-operative drugs like nerve blocks, since your foot will be prone to frostbite.

On top of managing swelling, try to keep your bandages clean and dry in order to keep the incision site infection-free. Consult your local Charlottesville or Waynesboro podiatrist if your foot, ankle or leg turns blue, cold or numb or if you are running a fever or have thigh or calf pain.


Resting up is a full time job and will help your recovery enormously. In the first week to month after your surgery, you will need to be a dedicated couch potato, lying down with your foot elevated. Don’t plan on being productive during post-operative rest! Chances are that you will be woozy from your medications, in pain, and need more rest than anticipated. Just focus on your recovery, allowing yourself and your body the time it needs to be on the mend. In addition to plenty of rest, healing requires your attention to eating well and drinking plenty of water. Additionally, be sure to avoid caffeine, alcohol and cigarettes as these will have negative effects on your healing process.

During the initial bed-ridden period, you can expect generalized soreness and aches, often because of being more sedentary than usual. Movement stimulates blood flow, cycling of oxygen and the removal of toxins from our bodies. Inactivity can therefore cause us to be sore. To counteract this achiness and to stimulate the release of toxins generally prompted by everyday exercise and movement, you can gently stretch, move and massage the non-effected areas of your body with neck, shoulder and arm rolls or by gently twisting your torso to loosen up your abdominal muscles. Do not stretch or massage your legs or feet until your podiatrist tells you it is okay to do so. And again, drink plenty of water and eat oxygen rich foods like vegetables (especially leafy greens) and fruits, in order to help flush your system and to provide metabolic support for your joints.


Once you’ve made it through the post-operative period of being a (healthy and medically sanctioned) couch potato and managed to finagle as many massages out of your family and friends as possible, it’s time for you to start activity again. In this phase, expect to visit the Physical Therapist often as well as your podiatrist for follow up appointments. Since your body has been sedentary while recovering, expect that you will feel slower and a bit weaker than you did before surgery. Work with your Physical Therapist and your podiatrist, pacing yourself with activity and being honest about your level of pain. Be sure that you don’t over-do the rehab process; slow and steady is the name of the game. If you feel like you’re doing too much too soon, speak with your physical therapist and podiatrist to modify your rehabilitation plan. And finally, recognize that your body should set the pace for recovery. Be patient with your feet and continue to be responsible and caring for them.

All the best with your surgery and recovery: stay positive, communicate you’re your health providers, accept help from your family and friends, and remember that you can control the conditions of your recovery, whether by healthy eating and fluid intake, managing swelling and pain or dedicated rehab. Your local Charlottesville and Waynesboro podiatrists, Dr. Chang and Dr. Murray, are around when you need them or have questions.

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.


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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