Transcription:
Do You Suffer From Ingrown Toenails or Hammertoes?

Melanie Cole (Host):  Foot pain can be extremely bothersome and can really affect your quality of life. My guest today is Dr. David Wood. He’s the Aspirus Grand View physician that specializes in podiatry. Welcome to the show, Dr. Wood. So let’s talk about some foot problems that really affect our quality of life, and let’s start with hammertoes. What are they, and how do we even know if we have them?  

Dr. David Wood (Guest):  Hammertoes are pretty easily visible by just looking at your toe. Anything that’s not straight is considered a hammertoe. Usually, they [knuckle off] in the air and it rubs in your shoes and you get corns and calluses. That’s the most common problem with hammertoes. That’s usually when they lead to pain, as you get a corn on top of the toe, or on the very [distal] bottom planar aspect of the toe. You get a corn or callus which becomes symptomatic.  

Melanie: What is the cause of hammertoes? 

Dr. Wood:  Hammertoes are caused by a lot of different causes. You can have a stroke and have a hammertoe. Improper shoe gear can cause hammertoes. But usually they’re hereditary and genetic.  

Melanie:  What do we do about them? From what I understand, they can be extremely painful. They can affect whether you can wear, as a woman, heels or what type of shoewear you have to wear. What do you do about them? 

Dr. Wood:  Well, especially with a corn or callous, we usually shave it off, and then we try some pads for conservative treatment. There are some different types of pads that help hold the toes straight, which can make it more comfortable. The problem is, you’re going to wear the pads all the time, all day long in order to get relief from hammertoe. The other treatments would be the surgical correction, which nowadays, with modern technology improved, you put an implant in the toe, which straightens up the toe and holds it straight, and the results last a long time. 

Melanie:  Do the type of shoes, especially women wear, do they really make our feet bad? Is that a myth, high heels and that sort of thing, or do they really do damage to our feet? 

Dr. Wood:  It’s definitely not a myth. They really do damage to our feet. If you think about it, your feet across the toe areas is actually pretty wide, and when you jam your foot into a pointy shoe or a high-heeled pointy shoe, this causes all kinds of pressure on them. It squeezes the toes together and can definitely lead to hammertoes and bunions and painful corns and calluses, along with blisters.  

Melanie:  What people don’t also realize, Dr. Wood, is that because that’s our base of support, if your feet are thrown off, then it can start to affect the rest of your body, your knees and even your lower back.  

Dr. Wood:  Absolutely.You start walking differently, and it causes malalignments of your knees and your back and your hips, and you can get discomforts there too. 

Melanie:  Absolutely. Now, what other foot issues, like ingrown toenails? We’ve heard about those. What do you do about them? They hurt a lot. 

Dr. Wood:  Ingrown toenails are very common, and improper cutting of the nail can lead to it. But again, they’re usually also hereditary. You see a lot of young kids with them because of the hereditary nature of them, although they are easily fixed in the office. It’s actually a simple procedure. We anesthetize the toe, which is the worst part of it, the injection. After it has numbed up, we just take out a little sliver of the nail along the side that’s ingrown. you take that out, and we usually use a little chemical to kill the root of that little sliver so that little sliver does not grow back. And it’s roughly 85-90 percent successful. It takes about five minutes to do. After we’re done, we just wrap it up, and the next day, you can do anything you want. But basically, the downtime is just the day that it’s done.  

Melanie:  What about pedicures? Do they cause or affect -- because there’s part infection going on? Is there anything to pedicures? Do we check out where we get a pedicure first? 

Dr. Wood:  Well, I’ve never had a pedicure still, but a lot of my patients do. I would just make sure if they’re using an instrument that they’re being sterilized. Otherwise, you possibly could get different infections from the instruments if they’re not sterilized. But otherwise, I think they’re safe as long as the instruments are sterilized. 

Melanie:  What about bunions? This is another common condition that seems to worsen, Dr. Wood, over time. Tell us about bunions and what’s going on. Is there surgery for them that can correct them?  Do they come back? 

Dr. Wood:  Bunions are caused by a muscle imbalance, which again, is usually hereditary, but there are other causes, such as neuromuscular diseases, strokes, sometimes, rheumatoid arthritis, different types of arthritises. They get larger and larger. They progressively get worse. Storetreatmentusually does not work that well. But sometimes, people can get into orthotics, which will slow down the progression of the bunions but will not actually treat it. Usually, it’s surgically removed. Depending on the severity of the bunions, it can take four to six weeks to heal, andcare afterwards, or if they’re really severe, you might have to be on crutches anywhere from 8 to 10 weeks and severity of the bunion. Recurrence rate is low, but over time, because that muscle balance is still usually there, they do slowly reoccur.  

Melanie:  What do you do for bunions? When you say surgery, what does that involve? 

Dr. Wood:  Well, it involves an incision over the top of the joint. You open up the joint. You shave off the actual bunions itself with a saw. But then, you’ve got to realign the metatarsal, that bone there, and so you’re going to make some cuts in order to slide it over towards the second metatarsal, which is your second toe, into a more corrected position. Ideally, you want to get an angle of less than eight degrees between the first and the second metatarsal. And also, you want to contain a congruent joint so the toes still move up and down when you ambulate. And we usually fix it with either a wire or a screw or two, or like stuff to fix it. Surgery for a bunion, it usually takes about an hour to do. Outpatient surgery, anesthesia is usually a [MAC] with a local. You’ve got a recovery room for an hour or so and you’re able to go home. 

Melanie:  And really then, you see a difference in the way your foot looks, right? Because once you’ve shaved off that bunion and taken care of it and fixed up that bone so it goes more straight, your foot looks a little bit straighter, right? That big toe kind of heads forward instead of off to the side the way it did. 

Dr. Wood:  Exactly. It’s definitely straighter. Actually, your foot is going to be a little bit narrower, because you don’t have the big bunions sticking out the side of the foot. You might even change a shoe size. And the toe should be straighter and not putting pressure on the second toe. Otherwise, the bunion gets severe enough, it will put pressure on the second toe and cause that to displace and turn into a hammertoe.  

Melanie:  Wow! Now, what about something like heel spurs? There are so many foot problems, Dr. Wood. We could go on for a long time. But let’s try and hit a few more. With heel spurs -- painful, similar to plantar fasciitis. What are they and what do you do about those?  

Dr. Wood:  Well, the heel spurs are actually related to plantar fasciitis. Usually, you have plantar fasciitis first; your body’s response to the pain in the heel is to create a bone spur or an extra bone. Nowadays, bone spurs at the bottom of the heel are not removed because it’s a soft tissue problem. The plantar fasciitis is the actual pain, so it’s treated with a conservative treatment, and conservative treatment works 95 percent of the time. That would be consisting of orthotics, stretching exercises, injections, physical therapies, decrease in activities, anti-inflammatories. 

Melanie:  So what about things, like you mentioned earlier, corns and calluses? And I hear people say, “I’m going to the podiatrist to have my calluses removed.” How do we develop calluses? Because some people don’t develop them, do they? And some people develop them at an alarming rate. 

Dr. Wood:  Yeah. Calluses are usually due to pressure, and you see them at the bottom of the foot. And as we get older, we lose that fat pad, that cushion you have underneath the ball of your foot and when you lose that cushion, you end up causing increased pressure there. There’s no cushion to absorb it, so pressure can cause the callus to form. The thing is, when you remove them, you shave them off in the office here, they reform because the pressure is still there, within a month or so.  

Melanie:  So that’s something you have to just kind of continually keep having removed? 

Dr. Wood:  Right. You could do it sometimes on your own if you use a file or a pumice stone. You can that and you can keep them somewhat under control. And you can wear appropriate shoe gear with maybe an extra layer of cushion in your shoes. It can also help absorb some of the pressure. 

Melanie:  In just the last minute, Dr. Wood, if you would, please give us your best advice for people with their feet to protect their feet and take care of their feet and why they should come to Aspirus and see you. 

Dr. Wood:  Well, first and most of it is to protect your feet by actually avoiding barefoot. Barefoot leads to all kinds of different injuries, soft tissue injuries. It’s easier to get plantar fasciitis when you’re barefoot. Most importantly, wear a sock in a shoe, or at least a slipper on the house and definitely wear good shoes, good quality shoes outdoors. It’s important to have them treated, because once you have foot pain, it’s like it hurts all over because they can lead to knee problems, back, everything. It’s important to see a podiatrist if you have significant discomfort that’s not resolving with just regular rest and anti-inflammatories, so you can make the proper diagnosis and help you move along and enjoy your life.  

Melanie: Proper foot care is so important. Thank you so much for being with us. You’re listening to Aspirus Health Talk. For more information, you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thank you so much for listening.