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Toes + Nails

 Big Toe Joint Pain

We’ve all seen toenails like these at the pool or in the shower at the gym. Yellow toenails, thick toenails and discolored toenails all point to the same thing – fungus. It’s an embarrassing condition, but it’s also very common.

 Ingrown Toenails

An ingrown toenail is one of the most painful conditions we see in our office. Luckily, it’s also one of the easiest to fix. Remember, if the ingrown nail is infected, we want to see you the same day, if possible, to prevent further damage.

 Fungal Toenails

Have you noticed that your nails are changing? Maybe becoming thick, discolored, lifting, crumbling?

Many believe that any change of the nails is due to a fungus of the nails, but this is not always the case.

 Broken Toes

So you’ve dropped something heavy on your toe and it still hurts after a few days. Or maybe you just stubbed it really badly.

If the pain doesn’t subside, if it swells and starts bruising, or if it hurts to walk or put on shoes, you probably have a broken toe that needs to be treated to heel properly.

 Bunions

Bunions are progressive foot deformities that are fairly recognizable once they get going. The tell-tale sign is a big toe that starts leaning out toward the littler toes.

It’s a painful condition that will only get more debilitating with time. But if we can diagnose it early, in most cases we can slow or even stop the bunion from forming.

 Hammertoes

Hammertoes are an unnatural bending upward of the joints in the smaller toes, usually the second and third toe, causing the toe to resemble an upside down V.

This puts pressure on the toe and the center of the foot, especially when wearing shoes, which can lead to pain in the ball of the foot, calluses and cramps.

Arthritis in the big toe can be quite painful, since the big toe is such a vital part of walking. A main cause is Hallux Limitus, which will develop into a painful, degenerative condition if left untreated.

 

When we humans walk, our big toe joint bends up to an impressive 75 degrees just before the foot leaves the ground. But sometimes, due to unusual wearing and tearing of the cartilage in the toe joint, the toe becomes stiff and starts to hurt. It’s a condition known as Hallux Limitus, in which the toe’s movement is limited.

 

When that happens, instead of bending at that awesome angle, the toe is pushed toward the ground each time you take a step.

 

This just causes even more wear and tear on the joint, leading to more pain, more damage and eventually arthritis.

 

If left untreated, Hallux Limitus can turn into Hallux Rigidus, which is a stiff big toe joint that won’t move. We need to make sure it never gets that far.

Gout is actually one of the oldest known types of arthritis, and is caused by eating a rich protien diet and drinking alcohol. If you’ve ever had it before, you know it’s one of the most intensely painful foot conditions out there.

What Causes Gout?

This painful affliction is caused by the build up of uric acid in the blood, which forms when the body breaks down purines. The acid typically dissolves and is eliminated in the urine, but for some it will build up and form tiny crystals that lead to inflammation in the toes, feet and knees. These joints may become red, hot and so painful that even the touch of a sheet or sock is unbearable. Gout attacks can become more severe and longer-lasting with each incident.

There Is Good News

You can almost always control gout with a proper diet. Gout is particularly associated with rich foods like cream sauces, red meat, beer and red wine. If you suffer from gout, you need to eat properly and cut back on alcohol. Focus more on vegetables, healthy starches and lean meat like chicken and fish, reduce your intake of red meat, and avoid drinking alcohol.

Sesamoiditis is a type of tendonitis that occurs in those who spend a lot of time on their toes, namely runners, catchers in baseball and dancers.

Causes Of Sesamoiditis

To understand sesamoiditis, we need a brief biology lesson. The body has several “sesamoids,” which are small bones that are not connected to other bones, but are instead connected to tendons or muscles. Two tiny sesamoids, which are about the sizes of a pencil eraser, are located on the bottom of the foot near the big toe. They’re actually located within the tendons and act as a pulley to increase the tendon’s leverage over the big toe. They help the foot bear weight and the big toe to function. When the tendons that surround these sesamoids become inflamed, that’s sesamoiditis.

What Does Sesamoiditis Feel Like?

Symptoms usually come on gradually and include pain under the big toe where it meets the forefoot, discomfort in moving the big toe, tenderness, swelling and bruising or redness.  The pain starts out as a dull ache and will increase to an intense pain or even throbbing during activity.

 

To diagnose sesamoiditis, we conduct a thorough physical examination of the foot. We’ll move the foot around and put light pressure on areas around the sesamoids to determine exactly where the pain originates. If sesamoiditis is suspected, we’ll likely conduct X-rays and possibly a bone scan.

Treatment Options For Sesamoiditis

There are a few treatment options for sesamoiditis, starting with rest. The tendons need a break from the activity that is causing the inflammation, so we’ll prescribe rest and possibly ice therapy. We might also recommend changes in your shoes, taping, shoe pads to cushion the sesamoids, and possibly steroid injections.

 

If the X-rays show that the sesamoids have been fractured, we may also recommend orthotics to cushion the bones further and allow the tendons to heal.

Tennis requires a lot of stopping, starting and changing direction, which has made it the headlining sponsor for a common sports injury called tennis toe. Frequent sudden changes in direction can lead to bleeding under the big toenail, which can be both painful and less than attractive.

Causes Of Tennis Toe

Not limited to just tennis, the condition is caused by the big toe and toenail being constantly jammed against the tip of the shoes. The blood is trapped under the toenail and places pressure on the nerves, which is what causes the pain.

When Should You Seek Treatment For Tennis Toe

If tennis toe is merely unattractive, there’s really no need to treat it beyond taking steps to ensure it doesn’t get worse. It’s important to keep your toenails trimmed and wear shoes that will give your toes ample space. Shop at sporting good stores where the staff is trained to properly fit shoes for athletes. We can offer local recommendations if you need them.

Treatment For Tennis Toe

If the tennis toe is causing you pain, it’s important to relieve the pressure from the pooled blood. We can drain the blood by pushing a small hypodermic needle through the toenail. It sounds a lot worse than it really is, but we promise, it won’t hurt. We’ll also recommend that you change your shoes and give your foot a rest so it can recover.

When a big toe is jammed over and over again on a hard surface, it can cause an injury called turf toe. We see this mostly with athletes who play on artificial turf and repeatedly stop and start suddenly, such as with soccer and football.

Symptoms Of Turf Toe

This sprain of the joint where the big toe meets the foot can cause pain at the base of the big toe, which may be accompanied by swelling or stiffness. If left untreated, it will get worse. It can also lead to  instability, dislocation, arthritis and loss of cartilage.

 

If you suspect that you might have turf toe, we will do a thorough examination and will probably take X-rays to make sure there aren’t any other problems that might be causing the pain.

Many Athlete’s Try To Ignore Turf Toe At First

While it’s understandable that most athletes don’t want to be sidelined, the primary means of treating turf toe is rest. It takes at least three weeks for turf toe to heal, so we direct patients to take time off from their sport and avoid activity on that foot. This rest might also be coupled with applying ice, taking anti-inflammatory medications and elevating the foot. We will also recommend special inserts that can decrease motion of the big toe joint to help you avoid future injury.

 

Patients that don’t heed this advice risk further injury and an even longer recovery time, so it’s better to take a few weeks now than have to miss an entire season.

Brachymetatarsia is a condition in which one or more of the metatarsal bones is abnormally short. This can be a congenital condition or acquired if any injury or trauma occurs while the growth plates are open.

 

Not only can this condition cause cosmetic concern but it can also cause pain and affect the way one walks.

 

The toe that is part of this metatarsal shortening is shorter in appearance and can contract dorsally, causing rubbing and irritation in shoes.

 

This condition most commonly affects the 4th metatarsal and is more common in women. It can cause abnormal pressure distribution in the ball of the foot causing pain and difficulty with walking. It can also be difficult finding regular shoes to wear.

 

Conservative Treatment Options

  • Custom orthotics with areas to help support or offload the affected area
  • Good shoes with wide toe box area
  • Padding
  • NSAIDs
  • Alter physical activity level

 

What If Treatments Don’t Work?

If conservative treatments fail, referral for surgery may be recommended. With surgical intervention, the affected shortened metatarsal is exposed and cut towards the base of the metatarsal where there is good blood supply.

 

Then an external fixator device is placed with a pin on each side of the bone cut and this is used to grow the bone out to length over time until desired length is achieved. This typically requires a non-weightbearing period of up to 6-8 weeks. Typically this procedure brings the entire ray, the metatarsal and toe, out to length and physical appearance and function is improved.

IF YOU ARE EXPERIENCING FOOT PAIN, CALL OUR OFFICE OR MAKE AN ONLINE APPOINTMENT

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