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Forefoot conditions

A child's feet standing on a stumpYour forefoot is a very complex area of the foot. It is made up of 26 bones and many small muscles, ligaments, tendons and other soft tissue structures, such as nerves and blood vessels. As a result, numerous conditions can affect the forefoot and lead to debilitating pain. Due to its complexity, it is very important that you see a practitioner with in-depth knowledge of the foot to make an accurate diagnosis. A poor diagnosis often results in poor treatment outcomes.

At Podiatry Illawarra diagnosis is carefully made by first taking a thorough history of your complaint. A comprehensive knowledge of the forefoot anatomy and the numerous conditions affecting the forefoot, is vital to be able to perform detailed examinations of the area of complaint.

Morton's neuroma

A Morton’s neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Morton’s neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock.

Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb.

This condition can be diagnosed by our podiatrists, an ultrasound may also be required (we can refer you for the ultrasound) to confirm the presence of a neuroma. The treatment normally consists of footwear advice and off the shelf insoles insoles.

Bunions

Bunions A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe. The movement of the big toe angles in toward the other toes. The growing enlargement or protuberance then causes irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists. Wearing shoes that are too tight may accelerate the development of bunions however they are linked to genetics, normally because of a malfunctioning foot structure. Foot injuries, flat feet, and pronated feet can contribute to their formation.

Bunions can also lead to secondary problems, such as hammertoe, bursitis or arthritis. Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The bigger the bunion gets, the more it hurts to walk. Because they are bone deformities, bunions do not resolve by themselves. Our objective is minimum invasive treatment initially as this is less hazardous and the patient is less likely to suffer side effects and complications of more invasive methods. Our podiatrist’s will remove the corns and calluses gently with a scalpel and can advise on the best form of treatments available which may also include protective padding or orthotics,. In severe cases where these conservative methods have failed referral to a specialist surgeon may become necessary.

Tailors bunion

A Tailor’s bunion is similar to a bunion, the main difference being that it occurs on the outside of the foot presenting as an enlargement of the joint at the base of the little toe.

Common symptoms will include pain, swelling and redness over and around the enlargement of the joint. This inflammatory response is due to irritation of the soft tissues overlying the joint. Wearing shoes that are too narrow or pointed in the toe box is the primary cause of this.

The underlying causes of a tailor’s bunion may include the structure and function of the bones that make up the joint. Changes to the alignment of the long metatarsal bone and smaller toe bones will often result in a protrusion of the joint. This protrusion is easily aggravated when a shoe rubs against it. Continued wearing of narrow or tight fitting shoes may actually speed up the development of the bunion.

Treatment will initially involve measures to decrease the pain and inflammation. Primarily with pressure deflection and the correct footwear.

Orthotics or customised insoles may also be prescribed to help protect the joint and correct any structural alignment issues.

If pain and dysfunction continues after persisting with the conservative treatments mentioned above, consultation with an orthopaedic surgeon would be considered.

Plantar Plate Tears

The plantar plate is a thick, fibrous structure at the base of each joint in the ball of the foot. The fibrous band stabilizes the toe, preventing elevation and rotation. When a tear of the plantar plate occurs it causes instability, deviation of the toe and results in pain and inflammation around the joint. This condition is most common in the 2nd metatarsal phalangeal joint and is a result of faulty foot mechanics, hypermobility of the 1st ray and chronic 2nd metatarsal overload. The chronic overload causes repetitive micro trauma to the joint and surrounding tissues, especially the plantar plate. Traumatic injuries can cause plantar plate tears, but they are not as common as chronic, repetitive stress as a result of abnormal foot mechanics.

Conservative treatment with splints and footwear advice will normally resolve the problem.

Hammer toes

Hammer Toe /Mallet Toe/Claw Toe These terms are used to describe deformities that sometimes develop in the lesser or smaller toes. They are common in people with bunions or people who have very flat feet or feet with very high arches. A hammer toe is when the inter mediate joint of the little toes are bent right over and eventually the joint becomes completely rigid. A mallet toe affects the distal (end) joint at the end of the toes, if both joints are curled over they are called ‘claw toes’. All these deformities can cause corns and calluses where the prominent joints rub against the shoes or the ground. In severe cases extreme pressure can cause the affected areas to ulcerate. Initially we treat this condition conservatively as this is less invasive and the patient is less likely to suffer side effects and complications than more invasive methods. We will remove the corns and calluses gently with a scalpel and discuss with you treatments that you may benefit from in the future.

Hallux rigidus/limitus (stiff and painful big toe joint)

Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. ‘Hallux” refers to the big toe, while “rigidus” indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis.

This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.

Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus,” in which the big toe becomes stiff, or what is sometimes called a “frozen joint.”

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