Solutions to Four Common Foot Problems

One surprise of aging: Your tootsies can feel the worse for wear. Here's how to deal with bunions, heel inflammation, hardening skin and nail fungus

by Emily Listfield
feet image
Photograph: Illustrated by Thomas Fuchs

What you can do at home: If you have bunions, opt for soft, supple leather shoes with a thick sole to decrease pressure on the bone. “Stick to a shoe with a heel no higher than two inches and a wide toe box,” recommends Naomi Shields, MD, an orthopedic surgeon in Wichita, Kansas, and a member of the board of directors of the American Academy of Orthopedic Surgeons. An orthotic that supports the arch can also reduce stress on your big toe and slow the progression of the bunion. (See “How to Choose an Orthotic”) You might also try using a bunion pad (available in drugstores) to make your shoes more comfortable.

What a surgeon can do: If you experience so much pain that it interferes with your daily activities, surgery may be your best option. There have been significant improvements in bunion surgery, and while no one would call it a walk in the park, it is not as brutal as it once was: Newer techniques considerably reduce both the recovery time and the risk of recurrence.

“In the old days, doctors would shave the protruding bone, and the bunion would often grow back because the bone wasn’t realigned with the toe joint,” Baravarian explains. “Now doctors cut the bone and line it up with the joint, holding it in place with special screws. There is less postoperative swelling because there is no motion between the bone and the joint and therefore very little pain.” You wear a boot for four to six weeks and sneakers for a couple of weeks after that. You won’t need crutches, but you’re not going to be training for a marathon either. Many activities can be resumed about two months after the operation, and in most cases the bunion does not regrow.

You may hear about a less invasive but more controversial surgical technique called a mini tightrope, which has been developed in the past five years. In this operation, a doctor subcutaneously ties together the first and second metatarsals (the bones leading up to the first and second toes) to realign them without cutting any bone. “In the right circumstances, mini tightrope can be a very good procedure,” says Baravarian.“The problem is that in very active patients, the FiberWire can break, or it can pull through bone. We use it in older patients who are less active.” But with the advent of new kinds of screws, the trend in the general population is toward more aggressive surgery to prevent the bunion from returning, says Mark Berkowitz, MD, an orthopedic surgeon at the Cleveland Clinic.

Condition 2: Plantar Fasciitis
What it is: An inflammation of the tissue on the bottom of the foot (plantar fascia) that connects the heel to the toes.

Symptoms: Pain in the heel, especially when you first get up in the morning.

Causes: Plantar fasciitis (PF) is among the most common foot problems, one in which genetics doesn’t seem to play a role. “In patients who have tight calf muscles, flat feet or a tendency to put a lot of strain on their arches, the tissue begins to tear at the bottom of the heel, causing pain,” Baravarian explains. “The pain is usually worst first thing in the morning, because the plantar fascia gets tight while you sleep. It stretches out during the day and feels a little bit better, but over time scar tissue forms and causes increasing amounts of pain.” You can exacerbate plantar fasciitis if you wear shoes that don’t offer ade-quate support or overdo a new work-outroutine without a proper buildup.

What you can do at home: “Most cases of plantar fasciitis will improve if you wear proper shoes and do certain stretches, but recovery is a slow process and can take from three months to a year,” says orthopedic surgeon Jonathan Deland, MD, chief of foot and ankle service at the Hospital for Special Surgery in New York City. The best footwear: shoes with one-and-a-half-inch heels. “Flats put too much pressure on the ball of the foot, which pulls at the heel,” Shields explains.

First published in the September 2012 issue

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