FREQUENTLY ASKED QUESTIONS
How do orthotics help?
Podiatrists can use many different treatment options for lower limb issues, including custom orthotics.
Orthotics are custom medical devices created for your unique feet. They control abnormal biomechanical processes during your gait cycle. For example, if your foot pronates, which is when the arch rolls excessively inward after your foot makes contact with the ground, an orthotic device would control the excessive motion.
When the aim of orthotics is to control movement, we are talking about functional orthotics. There is a second kind (accommodative orthotics), which is used to protect anatomy. Accommodative orthotics are generally softer and not intended to control motion.
These medical devices are used to treat and prevent an array of issues, including bunions, abnormal foot arches (both high and low), hallux limitus (stiff big toe), neuromas, ulceration/calluses, forefoot pain, and plantar fasciitis.
If you would like to find out if orthotics can help relieve your pain and restore your foot function, come in for an evaluation.
When does a broken bone need treatment?
Broken toe bones can be tricky. More than 25% of all the bones in the body are in your feet and over half of these foot bones are in your toes (Phalanges). With many bumps and flares, the bones are like jigsaw pieces that are intended to be arranged in a particular manner. This means the position a broken bone heals can make a difference in toe structure function. If the joint surface is damaged, arthritis and stiffness will develop.
Treating a broken toe bone is important to ensure it will heal in a proper position. If the bone alters its position, it can lead to adjacent pressure between the toes. This would be like having your hand squeezed with a big ring on your finger.
The greatest part of the pain created by an injury is swelling. Early treatment will minimize this and keep you comfortable and allow the quickest recovery.
Toe bones are relatively small, but can cause a lot of pain when broken. Accordingly, part of treatment for these injuries is to relieve painful symptoms. There are various ways we can handle this, but keep in mind that your first step is to come in and see us at our Indianapolis podiatrist office!
When should I see a podiatrist?
A podiatrist is a doctor who is specially trained in evaluating, diagnosing, and treating conditions and injuries that affect the feet and ankles through both conservative and surgical means. Their specialized education and practical experience make them the only choice for dealing with foot and ankle problems, ranging from ankle sprains and heel pain to ingrown toenails, bunions, diabetic wound care, and more.
Foot pain is not normal, and many common foot conditions will not improve without treatment—they will only get worse and harder to deal with the longer you let them go. That’s why we strongly recommend you see a podiatrist as soon as you are able if you have any kind of persistent discomfort or problems with your feet. Timely intervention will save a lot of pain, a lot of trouble, and potentially a lot of money, too.
Jeffrie C. Leibovitz, D.P.M. has been practicing podiatry for more than 30 years, and his state-of-the-art Indianapolis office features the most modern diagnostic equipment.
Why is stretching suggested for pain relief and recovery?
Put simply, we recommend stretching for pain relief, recovery, and prevention because it works! Many lower limb issues are caused by connective tissues that are too tight, especially the plantar fascia and Achilles tendon. These tissues feel excessive pull when the calf muscles are tight. Stretching your lower legs is a great way to relieve stress on them.
Stretching is a smart activity for injury recovery because it is a low-impact way to get your muscles moving, but without placing extra pressure or stress on them. Stretches can also help to make muscles limber again when they have become tight and inflexible due to inactivity.
As effective as a stretching program can be, it is also one of the most boring activities known to man. Like any other task, it is much easier to do when it becomes a habit.
When do bunions and bunionettes need surgery?
There are certainly cases when bunion surgery makes sense, but this should be a discussion we have here in our Indianapolis, IN office. We’ll be happy to assess your situation and help you determine the best course of action. Give us a call at (317) 545-0505, or take advantage of our online form to request your appointment today.
Ingrown Toenail FAQs:
What Treatment Doesn't Work for Bunions?
Most bunion treatment fails fall into “miracle cures” you see on late-night TV or on Facebook ads. Some may even provide acute relief but will not make a difference next week, next month, or next year.
Some of the most common self-remedies involve putting something on the bunion. The goal is to remove pressure from the shoe.
Unfortunately, putting anything over the bunion “bump” will add more pressure; not reduce it. If there is room in the shoe there should be no pressure. If the shoe is tight, then adding something, no matter how soft, still just crowds the bunion more.
Splints and Toe Separators
The hope and promise with these contraptions is to hold the toe in a straight position. They will actually do this… when you wear the device. This is not helpful when you are awake, walking, and wearing shoes.
Splints act like a mouse trap. They pull the toe to the side but the toe springs back when the splint is released. They have been around since Egyptian times.
I guess people keep trying to invent a better mousetrap?
Toe spacers or separators do have their place by decreasing pressure between colliding toes. Do not expect them to change the toe position.
Putting something between the big toe and the second toe only moves the smaller toe over. When there is a pushing match between a big strong person and a small frail person, who always wins? It’s the same with big and small toes.
Physical Therapy and Exercise
I am all for PT for problems that can be physically trained, strengthened, or stretched. But by the time a bunion gets to be symptomatic, it is in the later stages.
A bone deformity is not going to be influenced by soft tissue. The Grand Canyon is not going to be influenced by a small pebble. But A small pebble could have changed the course of the Colorado River when it started as a baby trickle.
There is some initial evidence that suggests the beginning stages of a bunion can be delayed or even halted with correcting of the foot biomechanics. This is very promising but not fully explored.
Gels, Ice and NSAIDS
These can provide short term relief but have their limits.
If I hit my thumb with a hammer, I would put ice on it right away. Unfortunately, if I hit my thumb with each step I take, there would be no help longer than 20 minutes.
Do these shortsighted treatments cause problems? No. At least, not immediately. But they can delay seeking early treatment, which is where we can do the best work. If the bunion progresses to a more aggressive deformity, more aggressive treatment will be required.
“I heard that surgery doesn’t work.”
Because they’re not completely correct. Not with today’s more advanced procedures.
I am not sure there is anything in medicine that is guaranteed. There are surgical procedure choices that have a lower success rate. Some procedures exchange a quicker recovery for a lower amount of correction.
But while some of the legacy procedures (another name for “old”) had a re-occurrence rate that should make us cringe, they are like watching “Mad Men” when compared to today’s standards. Anybody doing a five martini lunch these days? Newer procedures tend to be much more comprehensive and successful in the long term.
BACK IN THE DAY
The days of just removing “the bump,” limited implants, or reliance on “soft tissue balancing” are in the rear view mirror. The new standard corrects the rotation of the 1st metatarsal, positions those pesky little sesamoid bones (headlights) under the 1st metatarsal, closes the separation between the metatarsals, and minimizes re-occurrence.
Understand that surgery is for relief of pain and a better quality of life. The goal is not just to provide better cosmetics but to relieve pain and restore activity. The list of “can’t-dos” should outnumber the “can-dos” to merit surgical consideration.
What are some good gifts for feet?
When people are being honest, most say they want gifts that are useful and practical. Given that the loved ones in your life likely use their feet to walk—and probably would prefer they are healthy and pain-free—you may want to give them podiatric gifts. Now, it would be weird to give someone a custom orthotic device but there are more realistic options like:
- Socks. No matter the time of year, sock choices are important for reducing the risk of fungal and bacterial infections. We recommend Woolie Boolie or SmartWool socks for optimal warmth and protection in cold weather.
- Moisturizers. Dry heels that become fissured and cracked can be quite painful. We sell moisturizing creams at our office to prevent this from happening.
- Ice-circulating pumps. One of the bedrocks of successful injury recovery is reducing inflammation. Ice-circulating pumps are perfect for this.
- Selfie-sticks. This may seem like an odd choice, but these are great for diabetic relatives who cannot inspect the bottoms of their feet any other way.
Feel free to take a look at our list of products that are able to help you or a loved one with any foot complications.
Remember, if you need foot care services, our office is here for you.
How does diabetes affect my feet?
There are many connections between diabetes and the health of your feet. Given the wide-ranging effects this disease has on your body, this shouldn’t be particularly surprising. When you observe these signs of diabetes in your lower limbs, you need to understand that you are at risk for serious medical complications. You can feel “OK” while running blood sugar but don’t be fooled; bad things are happening. It may take 5-10 years for these complications to become noticeable.
Some of the effects diabetes has on foot health include:
- Skin changes. Specific skin changes from diabetes includes excessive dryness, loss of hair, thinning, and loss of stretch (called tugor).
- Neuropathy. Elevated blood sugar levels cause nerve damage. The first effect is a loss a decrease in sensation. It can then progress to pain without a cause.
- Poor circulation. Restricted blood flow from diabetes contributes to ulceration and risk for Charcot foot, a dangerous collapse of the foot structure. Remember, what is happening in your foot is also happening in your heart.
- Calluses. Diabetic individuals are subject to more frequent callus buildup. This becomes a major concern when they break down and become ulcers.
- Foot ulcers. Ulcers are tissue breakdown, which is a leading cause of limb amputation. This is the endgame when all the above occur (the perfect storm)
Issues that might not seem that important, or perhaps would not be a major concern for an otherwise healthy individual, can potentially become more serious when left unaddressed. Do not let this happen to you!
What is the best way to describe my symptoms to you?
The first “rule” of how to describe symptoms is simply to be honest and be open. If something is bothering you, don’t be afraid to say so. Any information you offer might be instrumental in determining what is wrong.
While describing your symptoms, some things to keep in mind include:
- Intensity – Let us know, on a scale of 1-10, how strong is your pain. A “0” is no pain at all, whereas a “10” means that you are unable to walk. If daily activity can be completed, the pain is not a “10” and if exercising cannot be continued, it is not a “3.” This is important because a “3” is going to be treated differently than an “8.”
- Location – As a podiatrist, it’s expected that you are coming in for foot pain, but sharing the actual location, as specifically as possible, will help ensure your issue is diagnosed correctly.
- Quality – Not all pain is equal! “Sharp” pain is often an indication of an acute injury, whereas “dull” pain usually indicates a chronic condition. Burning, tingling, and even “no pain” (numbness) is all important to know.
- Timing – Be sure to tell us how long the issue has been around, and be as specific as possible. Some symptoms are more prominent after rest, at the end of activity, only when standing, or when sitting.
When can I wear normal shoes after foot and ankle surgery?
If the procedure only involves soft tissue (neuromas, joint cleanup procedure, and ganglions), it may be 2-3 weeks before an athletic shoe can be worn. If bone healing is involved (joint fusion or osteotomy) it may take 4-8 weeks to return to an athletic shoe. Of course, we can only provide a very rough estimate unless we see you here in our office, but this does provide a starting point.
What can we use orthotics to treat?
What makes a bunion hurt?
When the foot becomes wider than the shoe, there’s gonna be trouble in River City. Bunion starts with a capital B and that rhymes with T, and that spells Trouble. If you are a fan of musicals you know what I am talking about.
The argument between the foot and a shoe usually has the shoe winning.
The initial symptoms from a bunion are a result from pressure on the 1st metatarsal. This looks like a bump on the inside of the joint.
In this early stage a bunion may only hurt when wearing shoes that are narrower than the foot. I am talking about those Saturday night or Sunday morning dress shoes. Understand that shoes do not create this problem but they do make it worse. Running shoes – especially Altra (brand name) – and sandals will help. Shoes with softer material also help.
In the moderate bunion stage, there is a collision between the 1st and 2nd toe. This may hurt or burn like having your hand squeezed while wearing a large ring.
Another potential cause of pain is a bursa. This is the body’s version of a protective airbag. A fluid filled sac will inflate to protect the bone from impact, and can change its size depending on the level of irritation. Once the bursa becomes inflamed, there will be pain without any shoe pressure. A nerve runs over the bursa or prominent bone and can become irritated. Watch for a burning, electrical, or tingling feeling that goes to the tip of the toe.
So far the discomfort is from pressure and soft tissue.
In the advanced stage, the big toe continues to migrate towards the second toe. Eventually, the big guy pushes the second toe over until it dislocates or develops an ulcer.
There is a bigger, badder pain that is lurking around the corner. This type of pain will appear as the joint wears out – the dreaded arthritis. The deformity creates the arthritis; not the other way around. Joint damage happens with both type of bunions, but is far more aggressive with hallux limitus that limits upward motion.
This is not a problem that pops up overnight. It takes years or decades to occur.
The end stage Bunion hurts just to look at it. The foot is pointed north and the big toe is pointed east.
How to make a bunion STOP hurting.
This comes down to Protection versus Correction.
In the first and second stage of a bunion deformity, the answer may be simple. If you remove a person from an argument, the argument ends. Let’s leave the foot alone and change the environment around the foot. So we have shoe selection and shoe modification as the easy answer. If there is adequate room and protection (wider, deeper, softer) the pressure may go away.
If you have an aggressive bunion deformity, take a look at your shoes. You may notice that the shoe has changed over the deformity. Remember that shoes are made for normal feet and bunions are not normal. Shoes can be modified and stretched to create a little more breathing room. My Hail Mary shoes are Altras, Hoka One One, extra depth therapeutic/diabetic shoes, Crocs, and sandals.
The wonderful people at Goodman Shoes will be a great help in this area. I may be your Go To Foot Doc but they are your Go To Shoe Store.
The last thing I want to hear is a patient’s activities have reduced or stopped due to foot deformity and discomfort. Foot problems are the top reason people stop their exercise programs. Besides a quality of life issue (can’t walk in the park, walk the dogs, play with grandkids) this will lead to a major fail in your health down the road. Every day of activity that is lost is 2 steps closer to the grave.
Bunions are a progressive problem – albeit extremely slow. The other treatment option is correction. This is where the foot is changed to fit into a normal shoe. There are numerous procedures for the great toe joint with each carrying their own recovery time. This is an individual decision and general recommendations cannot be given without examination. This is one area that I strongly recommend that you stay away from on YouTube – for obvious reasons.