Bunions: Hallux Valgus

Diagram of the formation of a bunionA bunion (hallux valgus) is not just a bump on the foot. A bunion is a structural change in the foot, resulting in a bone deformity, which looks like a bump on the foot. As seen in the image on the right, the long bone at the inside of the foot moves toward the inside of the body medially, while the big toe (great toe) moves toward the little toes. This shifting of bones is what causes the development of a bunion.

Bunions are caused by a combination of factors. The most common contributing factors are genetics, foot type and shoes. Although tight, narrow shoes don’t cause bunions, they definitely contribute to the development in some foot types. Individuals with more flexible and flat feet are more likely to develop bunions due to an imbalance in the foot.

Treatments for bunions include custom made orthotics, padding, splints, wider supportive shoes and anti-inflammatory medications. If these steps do not work and the pain limits daily activities, recreation or job activities, then surgery may be indicated. A bunion is not just a bump on the side of the foot, which means that it’s rare that surgery involves removing only the bump. Generally, surgery involves moving the bones back into place. The long bone, called the metatarsal, is essentially broken, shifted to the side and the big toe is moved back into place. Screws are used to stabilize the bone after it is broken. Recovery time involves about 4-6 weeks in a surgical shoe and the toe can be stiff and swollen for 4-6 months following surgery.

More information on bunions, bunion treatments and bunion surgery.


Foot Pain: Where it Hurts and Why

Foot anatomy image labeled

Anatomy of the lateral foot labeled

Anatomy of the anterior view Anatomy foot posterior view labeled
Medial Lateral Anterior Posterior

The images above illustrate areas of the foot that develop foot problems. The first image is of the inside of the foot. You can see the origin of the plantar fascia, where many develop heel pain, known as plantar fasciitis. The second images is of the outside of the foot. The peroneal brevis tendon insertion is labeled, which is a common area of pain in peroneal tendonitis.   In the third image, the extensor tendons, tendons that lift up the ankle and the toes are shown, along with the great toe and the area of nerve impingement. Two common problems at the great toe are bunions and osteoarthritis. The last image is of the back of the foot and ankle. The Achilles tendon and it’s insertion are labeled. These are the two common areas of pain in Achilles tendonitis.

For more information on common foot problems and anatomy, visit NorthCoastFootCare.


Foot Anatomy and Orientation

The images below show four views of the foot. The first image is a view of the dorsal foot, which is the top of the foot. The second anatomy image is the plantar aspect of the foot, the bottom. The front of the foot is the anterior aspect and the back of the foot is the posterior aspect.

Dorsal view of foot anatomy Plantar view of the anatomy of the foot Anterior view of the anatomy of the foot Posterior view of the anatomy of the foot and ankle.
Dorsal Plantar Anterior Posterior



When referring to body parts, the medial aspect is the inside of the foot and the lateral aspect is the outside of the foot. Distal means away from the body and proximal means closer to the midline of the body. In the foot anatomy image below, distal is labeled near the toes.

Foot anatomy orientation, distal, proximal, medial and lateral


For more information, images and illustrations on foot and ankle anatomy, visit Northcoast Footcare’s Foot and Ankle Anatomy Page.


Skin Temps Predictive of Foot Ulcer in Diabetics

A new study published in the Journal of Foot and Ankle Research reviewed the literature back to 1960 to evaluate whether measuring skin temperatures in the diabetic foot were predictive of foot ulceration. Results support the theory that increases skin temperature in the diabetic is predictive of foot ulceration when compared with the same site on the other foot.

Diabetics are at risk of foot ulceration, infection and amputation due to a loss of sensation in their feet and a loss of circulation. A loss of sensation (neuropathy) results in the development of open sores and a loss of circulation impairs the body’s ability to heal those open sores.

More on diabetic foot care.
More on diabetic ulcerations.
More on foot anatomy.


Vitamin D Not Helpful for Knee Arthritis

Chemical structure of Vitamin DA recent study published in the January issue of the Journal of the American Medical Association found that Vitamin D supplements did not help individuals with osteoarthritis. In a two year study on patients with painful knee osteoarthritis, researchers at Tuft’s University divided 146 participants into two groups, one receiving serum 25-hydroxy vitamin D supplements daily and a placebo group. At the end of two years, the Vitamin D supplementation group had no improvement in pain or improvement in function as compared to the placebo group.

Effect of Vitamin D Supplementation on Progression of Knee Pain and Cartilage Volume Loss in Patients With Symptomatic Osteoarthritis JAMA, January 9, 2013, Vol 309, No. 2

More information on osteoarthritis.


Neuropathy Treatment: NeuRX-TF

NeuRX-TF treatment for neuropathyNeuropathy is a medical term used to describe damage to the nerves that disrupts the communication between the skin, muscles and joints with the brain. Peripheral refers to the body parts on the outer edge of the body, such as the feet, legs, arms and hands. The peripheral nerves carry information from the extremities to the spinal cord and the brain. Sensory nerves carry sensations, such as hot, cold, pain, vibration and position sense to the brain. The most common type of neuropathy is a sensory peripheral neuropathy.


Sensory peripheral neuropathy means that the sensory nerves carrying sensory information to the brain are not functioning properly and the result can be burning, tingling, numbness and electrical pain. Although there are many causes of neuropathy, diabetes is the most common cause of sensory peripheral neuropathy.


NeuRX-TF™ is a new treatment for peripheral neuropathy and contains alpha lipoid acid, acetyl L carnitine and methyl B12. NeuRX-TF™ claims to decrease the burning, tingling, numbness and shooting pains associated with neuropathy, but there is little research on the actual product. But, the products contents have been studied fairly extensively. In the International Journal of Endocrinology a meta-analyis showed that 300 mg of alpha lipoic acid twice a day improved neuropathic pain after three weeks. In Diabetes Care, a study showed that acetyl L-Carnitine improved vibration perception and decreased pain in individuals with pain associated with peripheral neuropathy. High doses of methyl B-12 have been found to promote nerve regeneration. The combination of these these three active ingredients are what makes NeuRX-TF™ unique, but it’s important to remember that it’s not clear if the combination of these products has an advantage. NeuRX-TF™ includes:

  • alpha lipoic acid 350 mg
  • acetyl L-carnitine 250 mg
  • methyl B12 1000 mcg

There are many emerging treatments for peripheral neuropathy which is encouraging for those suffering from painful peripheral neuropathy. NeuRX-TF™ does not require a prescription, but cannot be found at your drug store. It is one treatment that is only available through a physician’s office (podiatrist or neurologist), although it appears that it can also be purchased on the internet. NeuRX-TF™ should be taken twice a day and side effects include impact on blood sugar levels, skin rash and stomach upset.


More information on diabetic neuropathy.

More information on painful diabetic neuropathy.



Supportive Shoes and Orthotics for Heel Pain

Area of pain in plantar fasciitis

I’ve been advocating to my patients for years the importance of supportive shoes and inserts for the treatment of heel pain. I became a firm believer when I experienced heel pain myself. It was a beautiful Fall day and I stepped out of the car onto my foot and immediately felt an intense pain in my heel. I knew immediately what it was, plantar fasciitis!  Plantar fasciitis, pronounced plan – TAR   fash – EE – I – tis, is the tearing and inflammation of a long ligament on the bottom of the foot that supports the arch. Plantar fasciitis is the most common cause of heel pain and is a result of repetitive stress on the foot and arch. When I stepped down on my heel I felt as if a nail was driving through my heel, as I continued to walk it eased up, but still felt like a “stone bruise”. I thought to myself, “this is exactly how patients describe the pain to me.”

I had recently injured my right knee and had been compensating by transferring the weight to my left foot and leg. This is a very common reason to develop plantar fasciitis. The extra weight and strain on the plantar fascia causes small microtears which results in inflammation and pain in the initial phases of the condition.

Lowa S-Cope Trail Running ShoeMy immediate response was to find a supportive pair of shoes with my custom made orthotics. I have a fantastic pair of Lowa trail shoes which have a fairly stiff sole and fit my orthotics nicely.  Once I put on my shoes with my orthotics and take a few steps, my pain disappears. The simple process of protecting the plantar fascia with a supportive shoe and providing support for the plantar fascia with a custom orthotic has eliminated the strain on the plantar fascia. If the abnormal strain is eliminated, the fascia is not under as much stress which means that it is not tearing, not becoming further inflamed and not causing pain.

Conservative treatments for plantar fasciitis include eliminating the aggravating activity, icing in the initial stages, stretching the plantar fascia, taking anti-inflammatory medications and most importantly, wearing supportive shoes and orthotics.
More information and treatments for plantar fasciitis and heel pain.


McFadden Healed From Lisfranc Injury

Darren McFadden was injured while playing against the Kansas City Chiefs during week seven of the 2011 season. He was initially diagnosed with a “midfoot sprain” and thought to only need a short period of ice and immobilization. McFadden was expected to return to play the Broncos in early November. Unfortunately, this was not the case. It was only last month that McFadden announced that he finally healed from this injury.

Last December it was announced that McFadden had a Lisfranc’s injury. It is not uncommon for these injuries to go undiagnosed because they do not show up on standard X-rays. A simple midfoot sprain can look exactly like a low grade Lisfranc injury.

A Lisfranc injury is a partial or complete tear of the Lisfranc ligament and/or dislocation of the joint with breaks in the bones connecting this joint. In more severe injuries, generally associated with motor vehicle accidents, there are multiple broken bones and significant dislocation of the joint. The diagnosis is very apparent when Lisfranc injuries are severe. Mild to moderate injuries can be more difficult to diagnose because the changes on X-ray are very subtle.

Labeled diagram of lis franc joint

The Lisfranc joint is in the middle of the foot and is defined as the joints that connect the long bones in the foot (the metatarsals) to the bones in the midfoot (the tarsal bones). Multiple ligaments on the top and bottom of these bones hold the joint together. The lisfranc ligament connects the base of the 2nd long bone (2nd metatarsal) to the 1st small midfoot bone (medial cuneiform). The Lisfranc ligament is the strongest ligament in this ligament group. When this ligament is torn, the stability of the entire middle of the foot is compromised.

When a Lisfranc injury is suspected, it’s necessary to X-ray both feet while standing. Since the bases of the metatarsal bones overlap, it is difficult to visualize breaks in the bone in this area. It is also difficult to see subtle displacement of the joint which can occur when the ligament is torn. When standing, the weight of the body will displace the bones normally supported by the Lisfranc ligament. A space between the base of the 2nd metatarsal and 1st cuneiform can indicate a Lisfranc injury. Because there are variations in anatomy, it’s best to X-ray both feet for comparison. Some individuals naturally have a space between these two bones. Physicians with flouroscopy in their office may do stress views. In some cases a CT scan is ordered, but it is generally used when considering a surgical correction.

The mechanism of injury in football is usually a direct force to the foot such as when a player has been tackled from behind while the foot is planted. The force from behind places a tremendous amount of stress through the midfoot, causing complete or partial rupture of the ligament. With a significant amount of force the forefoot may dislocate on the midfoot and there can be breaks in the metatarsal bones.

Early diagnosis is important because untreated injuries can result in chronic midfoot instability and increase the chance of future arthritis. Post-traumatic midfoot arthritis is likely regardless of treatment. The treatment is based on  the severity of the injury and may involve a cast and crutches or a walking boot for 6 weeks for minor Lisfranc injuries or surgery with screw placement for more severe Lisfranc injuries.


Augmented Reality Apps Help Surgeons Plan Surgery

Augmented reality apps can help surgeons plan procedures. The application, Hallux Angles, is designed to assist foot surgeons plan bunion procedures by measuring angles on the foot for corrective bunion surgery. By viewing an X-ray through a phone with the Hallux Angles application, measurements can be obtained. The program is designed to supplement the current techniques used to measure angles and plan forefoot surgery.

For more information, visit the Hallux Angles application homepage.

Measure angles with your phone


NBA Players and Plantar Fasciitis

Interesting article on plantar fasciitis in NBA Players.

More information and images on heel pain and plantar fasciitis.


Foot Bones Labeled

There are 26 bones in the foot, which are labeled below. In addition, there are two small sesamoid bones at the base of the big toe joint, bringing the total to 28 bones in the foot. For more information and images on foot bones and foot structure, see our Foot Anatomy Page.

Foot Anatomy; the bones in the foot labeled.


Flavonoids May Improve Bone Strength

A recent study in the Journal of Bone and Mineral Research has found a connection between flavonoids and bone health. Flavonoids are a group of bioactive chemicals found synthesized by plants. Over 3000 Scottish women were surveyed on their food intakes and flavonoid intake was estimated based on specific fruit and vegetable intake as evaluated on a food frequency questionnaire.

The investigators found a greater the intake of flavonoids correlated with a greater bone mineral density at both the femoral neck and lumbar spine. Markers of bone resorption were also measured and found to be inversely related to flavonoid intake.

The authors concluded that flavonoid intake from fruits and vegetables increases bone mineral density and decrease bone resorption.

These results are consistent with previous in vitro and animal studies which have found that isoflavones, a class of flavonoids, stimulate bone formation by stimulating osteoblasts and inhibit bone resorption, by inhibiting osteoclasts.

Although the study results are encouraging, the investigators did not evaluate fracture risk. Clinical trials evaluating flavonoid intake and fracture risk will help determine if flavonoids can prevent fractures.

Hardcastle AC, Aucott L, Reid DM, Macdonald HM. Associations between dietary flavonoid intakes and bone health in a Scottish population. J Bone Miner Res. 2011 May;26(5):941-7. doi: 10.1002/jbmr.285.

More information on stress fractures.


What Type Of Inserts Are Recommended?

Insert: An insert is any device which will fit into a shoe. This can be a soft, cushioned insole you find at the drug store for $10, or it can be a custom made orthotic costing a couple hundred dollars at your doctor’s office. Soft insoles are flexible and add comfort and cushion to a shoe. When you purchase a soft, flexible insole, you should know that they will not be providing support, only extra cushion.

An insole is actually the innersole or lining of the shoe. All shoes come with some type of insole. The insole may be thin and stitched into the shoe or thicker, cushioned and removeable. Insole has become a general term to describe inserts or arch supports.

Arch support is a general term to describe any device which slips into the shoe and supports the arch. Placing something under the arch may add comfort or support and sometimes simple arch supports or pads from the drug store will do the trick. I

Read more at www.northcoastfootcare.com



Superfeet Insoles

A variety of Superfeet insoles for athletic shoes, snowboard and ski boots, everyday shoes, flats and high heels.  Superfeet’s firm, contoured shape provides support, balance and comfort that soft insoles cannot achieve. Superfeet combines the best materials with the best design and support to help keep the foot in it’s ideal functioning position. Superfeet Blue insoles are the most versatile. Superfeet Green insoles provide maximum support. Superfeet Wintergreen are specifically designed for outdoor activities. Superfeet Dress are available for men’s and women’s dress shoes and Superfeet High Heels fit comfortably in high heeled shoes.

Read more at www.northcoastfootcare.com



What is Gout?

Amplify’d from www.nlm.nih.gov

Gout is a common, painful form of arthritis. It causes swollen, red, hot and stiff joints. Gout occurs when uric acid builds up in your blood. This happens if your body produces extra acid or does not eliminate enough, or if you eat too many foods with purines, such as liver and dried beans. Pseudogout has similar symptoms and is sometimes confused with gout. However, it is caused by calcium phosphate, not uric acid.

Often, gout first attacks your big toe. It can also attack ankles, heels, knees, wrists, fingers and elbows.

You are more likely to get gout if you

  • Are a man

  • Have family member with gout

  • Drink alcohol

At first, gout attacks usually get better in days. Eventually, attacks last longer and occur more often. Uric acid buildup can lead to kidney stones. Untreated gout can cause permanent joint and kidney damage. You can treat gout with medicines.

Read more at www.nlm.nih.gov



Tai Chi Can Provide Arthritis Relief

Amplify’d from www.nlm.nih.gov
Arthritis patients may gain physical and emotional relief from the ancient Chinese art of Tai Chi, finds a new study, the largest of its kind.
Patients with osteoarthritis, rheumatoid arthritis and fibromyalgia felt better and moved more easily after taking twice-weekly classes in Tai Chi, a system of meditative exercise, researchers found.
“It reduced pain, stiffness and fatigue, and improved their balance,” said study lead author Leigh F. Callahan, an associate professor of medicine at the University of North Carolina at Chapel Hill School of Medicine.

Smaller studies have also linked Tai Chi to similar benefits for people with arthritis, but colleagues had questioned the applicability of the findings to a larger population.

In this study, in addition to evidence of mild to moderate relief from Tai Chi, participants reported gaining a better sense of physical stability,

Read more at www.nlm.nih.gov


Superfeet Blue Orthotics

Superfeet Premium Blue Insoles are multi-purpose prefabricated inserts designed to offer full arch support. Superfeet has a unique two component design to help provide lasting comfort & support. Factory made insoles just don’t compare. Superfeet Insoles help reduce the cause of foot, knee and back problems by maximizing comfort and improving shock absorption. Superfeet Blue Insoles are primarily designed for footwear with a removable insole, but work well with tighter fitting shoes. Superfeet BLUE can fit many shoe and foot types, but are ideal for low & medium arch feet, which can’t tolerate maximum arch support.

Recommended footwear for Superfeet Blue: Cleated athletic footwear and all types of Casual and Dress shoes.

The heel cup is moderately deep and aids in shock absorption. The anatomical arch shape offers comfortable support and the compressed foam, full length top cover helps to control friction. Read more at www.northcoastfootcare.com


ARCH Molds: Moldable Custom Insoles

ARCH Molds: Moldable Custom Insoles for arch pain relief and general arch support. The Heat Moldable inserts mold to the shape of your foot, helping arch and heel problems without compromising support. They eliminate the gaps between your foot and footwear. You can re-mold them up to 5 times! Preheat the oven to 225 degrees, bake, place in your shoe and stand on the insole for 1 minute. Instant custom insoles. Arch molds heat moldable insoles are firm and supportive, have an aggressive arch support, yet they are still comfortable because they are molded to the exact shape of your foot. Available in hard to find sizes! Women’s shoe size 4 & 5 and Men’s shoe size 13, 14 and 15.

- Deep Support Heel Cup: to keep the foot stable inside your shoe.
– Anti-Bacterial Nano-Silver Top Sheet: kills bacteria & reduces odor.
– Aggressive Arch Support: support your arch and reduce arch pain.
– 1.5 mm Polyurethane Cushion: supports and cushions.
– Heat Moldable Sub Layer: custom molds to your feet.Read more at www.northcoastfootcare.com


“Knocking Socks Off” Saves Limbs and Lives

Amplify’d from www.apma.org

During Diabetes Awareness Month, the American Podiatric Medical Association encourages patients to see a podiatrist for regular foot examinations.

Bethesda, MD—The number of Americans diagnosed with diabetes continues to rise toward record levels, with an estimated one in three adults predicted to have the disease by the year 2050, according to the Centers for Disease Control. Because many serious complications from diabetes present in the lower limbs, proper foot care for those with the disease is a vital step to keeping the disease in check. In fact, a new study on foot care for people with diabetes conducted by Thomson Reuters confirms that care by a podiatrist can drastically reduce the incidence of diabetes-related hospitalizations and amputations.
“During November’s Diabetes Awareness Month, it’s important to realize that simple lifestyle changes can go a long way toward staying healthy with diabetes.Read more at www.apma.org

Diabetic foot care.


Five Tips For Holiday Healthy Feet

Amplify’d from www.foothealthfacts.org
Don’t let sore, achy feet ruin your holiday season. The American College of Foot and Ankle Surgeons offers five tips to healthy holiday feet.
1. If the shoe fits, wear it—When hitting the dance floor or the shopping malls during the holiday season, don’t compromise comfort and safety when picking the right shoes to wear. Narrow shoes, overly-high-heeled ones or shoes that aren’t worn very often, such as dress shoes, can irritate feet and lead to blisters, calluses, swelling and even severe ankle injuries. “To ward off problems, choose a shoe that has a low heel and fits your foot in length, width and depth while you are standing,” says Tennessee foot and ankle surgeon Christopher Hendrix, DPM, FACFAS. “Be proactive, protective and preventive with your selection of appropriate shoes for the occasion.”
2. Don’t overindulge in holiday cheer— Did you know your feet can feel the effects of too much holiday cheer? Read more at www.foothealthfacts.org

Osteoarthritis Pain May Be Helped With Bracing

Amplify’d from www.nlm.nih.gov
Wearing a brace can help people with osteoarthritis better manage their pain, the Arthritis Foundation says.

The foundation mentions these possible benefits of bracing, which can improve pain and mobility:

  • Improve stability in weakened joints.

  • Improve distribution of weight and joint alignment.

  • Improve joint function.

  • Improve a person’s risk of falling, providing an increased feeling of security.

Read more at www.nlm.nih.gov


Does Caffeine Trigger Gout Attacks?

Amplify’d from arthritis.webmd.com
An extra jolt or two of caffeine may trigger a gout attack in people with the painful and often disabling arthritic condition, preliminary research suggests.

“We found that overall, as the number of servings of caffeinated beverages increased, so too did the chance of having recurrent gout attacks,” says Tuhina Neogi, MD, PhD, associate professor of medicine at Boston University School of Medicine.

For example, drinking four servings of caffeinated beverages in the previous 24 hours was associated with an 80% increased risk of recurrent gout attacks, compared with having no caffeinated drinks.

Drinking more than six servings of caffeinated beverages in the previous day was associated with a 3.3-fold higher risk of a flare-up, the study of 663 gout patients suggests.

When habitual and occasional caffeine drinkers were looked at separately, the link was only observed in people with gout who typically drink less than two caffeinated beverages a day, Neogi tells WebMD.

Read more at arthritis.webmd.com


Research Shows, Common Foot Disorders Can Be Inherited

Amplify’d from www.nlm.nih.gov
A new study confirms that two common and often painful foot disorders can be inherited.
As part of the Framingham Foot Study, which examined common foot disorders among more than 2,000 participants between 2002 and 2005, researchers studied 675 people with a bunion deformity in which the big toe angles towards the smaller toes (known as hallux valgus), and 154 people with high-arched feet that don’t flatten when bearing weight (known as pes cavus). Their average age was 66, and 57 percent of the participants were female.
Using statistical genetics software, the researchers determined that the bunion deformity was hereditary in about 39 percent of women and 38 percent of men. They also found that the condition was inherited in 89 percent of people under age 60.

The disorder involving high-arched feet was inherited in 68 percent of women and 20 percent of men. Among those younger than 60, the condition was inherited in 99 percent of women and 63 percent of men.

Read more at www.nlm.nih.gov


Plantar Fasciitis And Stretching Therapy

Amplify’d from www.medicalnewstoday.com
According to a new study from the Journal of Bone and Joint Surgery (JBJS), patients with acute plantar fasciitis who perform manual plantar fasciitis stretching exercises, as opposed to shockwave therapy, had superior results and higher patient satisfaction.

Study details and findings
A total of 102 patients who had acute plantar fasciitis pain, were randomly assigned to two groups. Acute is defined as any patient that experiences pain for less than six weeks. 54 people performed an eight-week stretching program, while 48 people received repetitive low-energy radial shock-wave therapy once a week for three weeks. Each group was asked to refrain from any other forms of physical therapy.
Patients in the stretching group, were told to perform stretching exercises three times a day, for eight weeks. All patients were contacted by phone every two weeks to check on training compliance.Read more at www.medicalnewstoday.com

Shopping for New Shoes

Amplify’d from www.nlm.nih.gov
Wearing shoes that don’t fit can contribute to a long list of foot problems.
The American Academy of Orthopaedic Surgeons suggests how to choose the right footwear and keep your feet happy:
  • Always measure both feet each time you go shoe shopping.
  • Try on shoes late in the day, when the feet tend to be a bit larger.
  • Women should opt for heels that are no higher than 2 1/4 inches.
  • Make sure the shoes fit properly in the heels and the toes, with 1/2 inch of space between the shoe and your longest toe.
  • Try on both shoes to be sure that they fit comfortably on both feet. Opt for the size that is most comfortable on your largest foot.
  • Walk around the store with both shoes on to make sure the fit is comfortable. Don’t count on “breaking them in.”

Read more at www.nlm.nih.gov