L. Bruce Ford, DPM, DABPS
2321 Pyramid Way, Suite B
Sparks, NV 89431
(775) 331-1919
Pain Management for Conditions
A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes . The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Varus. Bunions can also lead to other toe deformities, such as hammertoe.
Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult--all contributing to chronic pain.
Bunions have been with mankind since the beginning of time. Undoubtedly they have received more attention since shoes have become a vital part of our fashion. It is generally recognized that those who have a bunion deformity most probably inherited the tendency from an earlier generation. So often people are told "don't have anything done until you can't stand the pain"! This is a misconception! Our rule of thumb is that when it becomes obvious that you have a bunion, that is the time to correct it!
Treatment for Bunions
Certainly the goal in bunion treatment is to limit the deformity and to stop the progression if it has already begun. This can only be done in the very beginning stages. When it is seen that the deformity is beginning in children and young adults, often the use of a good custom orthotic will stop the progression of the deformity. Also wearing shoes that do not irritate the deformity is also wise.
Surgical Treatment
The greatest hurdle that people with bunion deformities have to overcome is history. In most instances, these people have had a relative with the same deformity who years ago had surgery and they remember the pain and the weeks and months in casts and on crutches. They also remember that after going through all of this pain and suffering, in many instances the bunion came back.
The good news is that in the past 10 years new techniques and better instrumentation have been developed. Bunion correction of today involves the use of micro instruments with precise cuts in the bone to correct the deformity, thus limiting the rate of re-occurrence. The old days of the doctor saying "I'm going to have to break the bone and reset" it are gone. If anyone says that to you, run as fast as you can! Gone are the days of casts and crutches and wheel chairs post-operatively. Only in the most severe cases must the patient be "non-weight bearing". In most cases, the patients at the Ford Center can resume a fairly normal lifestyle in days or weeks rather than months.
At the Ford Center for Foot Surgery, the procedures are done with I.V. sedation administered by one of our qualified anesthesiologists. We also use a regional anesthetic which is much safer than a general anesthetic. We can do this because we do not use tournequets when we do foot surgery. This minimizes post operative pain as well as the risk of blood clots. The net result of this is that the patient is awake and can walk within minutes following the surgery but their foot is numb for 18 - 20 hours.
The procedure itself is accomplished through an incision on the inside of the foot, thus there are no unsightly scars. The capsule of the joint is exposed and is opened revealing the "bump" on the side of the metatarsal bone. The over growth of bone is removed. Next a very precise "V" cut is made in the bone from one side to the other and the end or head of the bone is moved over. This narrows the foot back down to its normal width. To maintain this, a small screw is placed in the bone to secure the correction. The skin and soft tissues are then sutured and the foot bandaged. The foot is then placed in a post op shoe that will be worn for several weeks.
As a general rule, our patients return to comfortable shoes in 2 to 3 weeks.
Ankle Pain
Arch Pain
Arthritis
Ball of the Foot Pain
Bunions
Heel Pain
Metatarsalgia
Top of the Foot Pain
Note: For any foot condition, please consult your physician before taking any medication for pain management.
Ankle pain
Recurring or persistent (chronic) pain on the outer side of the ankle often develops after an injury, such as a sprained ankle.
The American Orthopaedic Foot and Ankle Society identifies both conservative and surgical treatment methods to alleviate this pain. Conservative treatments include:
- Anti-inflammatory medications, such as aspirin or ibuprofen to reduce swelling.
- Physical therapy, including tilt-board exercises directed at strengthening the muscles, restoring range of motion, and increasing the perception of joint position.
- An ankle brace or other support.
- An injection of a steroid medication.
- In the case of a fracture, immobilization to allow the bone to heal.
Almost half of all people who sprain their ankle once will experience additional ankle sprains and/or chronic pain. You can help prevent chronic pain from developing by following these simple steps:
- Follow your doctor's instructions carefully and complete the prescribed physical rehabilitation program.
- Do not return to activity until cleared by your physician.
- When you do return to sports, use an ankle brace rather than taping the ankle. Bracing is more effective than taping in preventing ankle sprains.
- If you wear hi-top shoes, be sure to lace them properly and completely.
Arch pain
Plantar fasciitis is an inflammation of a thick, fibrous ligament in the arch of the foot. The plantar fascia (arch of the foot) attaches into the heel bone and fans out toward the ball of the foot, attaching into the base of the toes. If this ligament is stretched excessively it will become inflamed and begin to cause pain.
The main emphasis for treatment of arch pain is to reduce the forces that are causing the plantar fascia to stretch excessively. This includes calf muscle stretching, over the counter arch supports, and orthotics. Oral anti-inflammatory medications may be useful in controlling the pain.
Additionally, cortisone injections may be recommended for the treatment of plantar fasciitis.
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Arthritis
Arthritis in the foot and ankle can be treated in many ways, including:
- Physical therapy and exercise.
- Orthotics or specially prescribed shoes.
- Foot soaks/paraffin baths.
- Ice packs.
- Massages.
- Over-the-counter anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen products.
- Prescription nonsteroidal anti-inflammatory medications.
- Vitamins B6, B12, and folic acid.
Ball of the foot pain
Calluses are the most common source of pain on the ball of the foot. Treatment consists of periodic trimming or shaving the callus, padding the shoes to remove the pressure, using shoe orthotics, or, in severe cases, surgery.
Pain in the ball of the foot not associated with calluses can be a result of inflammation of a tendon in the toe, arthritis, inflammation of the joint, or a neuroma. Stiffness in the big toe and big toe joint (Hallux Limitus and Hallux Rigidus) and sesamoiditis, an inflammation of two small bones under the big toe joint, are also conditions that lead to pain in the ball of the foot.
While treatments vary based on the condition and individual case, techniques for reducing pain in the ball of the foot include:
- Physical therapy and exercise.
- Over-the-counter or prescription pain and/or anti-inflammatory medications.
- Orthotics or specially prescribed corrective shoes.
- Cortisone injections.
- Proper shoe wear.
Bunions
Most bunions can be treated without surgery by wearing protective pads to cushion the painful area, and by wearing properly-fitted shoes.
Bunion surgery, known as a bunionectomy, realigns the bone, ligaments, tendons, and nerves so the big toe can be brought back to its correct position. Many bunion surgeries are performed on a same-day, outpatient basis. However, a long recovery is common and may include persistent swelling and stiffness.
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Heel pain
Plantar fasciitis is commonly traced to an inflammation of the ligament that stretches across the bottom of the foot. The condition can usually be treated effectively with conservative measures, such as use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy.
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Metatarsalgia
Foot pain in the ball of the foot, the area between the arch and toes, is generally referred to as metatarsalgia. The pain centers on one or more of the five bones (metatarsals) in this mid-portion of the foot.
A simple change of shoes may solve the problem. In more severe cases, podiatrists may prescribe a custom orthotic device to make sure the foot structures are in their proper position.
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Top of the foot pain
There are several causes of pain on the top of the foot. The quality of the pain and its location helps podiatrists determine the cause.
Managing pain on the top of the foot can be aided by:
- A period of limiting activity.
- Below-the-knee walking casts.
- Functional orthotics.
- Oral anti-inflammatory medications.
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