What are Bunions and Hammertoes?
w/Dr. Jeffrey B. Klein, DPM
July 15th, 2022
On our recent Head to Total Podcast, we spoke about common foot problems with Dr. Jeffrey B. Klein, Podiatrist with Mendelson Kornblum orthopedics, and Synergy Health Partners. His comments follow here.
The Truth About Bunions
“One of the most common conditions we see in our office is bunions. A bunion is an angulation type of biomechanical problem that deforms the front of the foot. The big toe starts to angle towards the little toe and the base of the big toe where the metatarsal had become enlarged and splays outward. This causes a bump in this area that could be rather painful and difficult to fit into shoes. Bunions run in families and can be a very painful condition. Bunions are not caused by issues that can be aggravated by shoes.
There are many different options for painful and non-painful bunions. First of all, get rid of all those shoes that cause irritation of redness in the area. “A three toed shoe quote or a shoe that does not fit the shape of your foot will aggravate the bunion. There are different types of pads that we used to help with bunion pain as well as biomechanical three dimensional printed and three dimensional scanned Orthotics. anti-inflammatories and Cortisone sometimes are used to help with the pain. Controlling foot function with a custom made biomechanical orthotic can help to slow down or stop the progression of these deformities.
A bunionette or Tailor’s bunion is a bony protuberance or bump at the base of the little toe in the area of the metatarsal head. This can also be painful and progressive and are treated in much the same way bunions are treated. Conservative or surgical.
When the big toe goes towards the second toe it can push on the second toe and cause a contracture or a hammer toe which rubs on shoes and can become very painful. T there are both surgical and nonsurgical options for hammertoes. Orthotics can also help.
In adults Orthotics can control a foot deformity or the biomechanics helping them to get rid of pain. In children orthotics can actually correct a foot or leg deformity.
Variations on the Bunion
“A bunionette is a bony protuberance or a biomechanical problem where the bone in the little toe is prominent. These used to be called ‘tailor’s bunions’ because tailors who used sewing machines with a foot pedal and pushed on it with the side of their foot used to have a lot of pain in that area.
“One of the ways you get hammertoes is from how you walk. It’s widespread that people who have very flat feet or very high arched feet will get hammertoes. There are different treatments for that, depending on the shoes you wear and the activities you do.
“Sometimes people will get bursitis, which is like an inflammation of the soft tissue just above the bone on a hammertoe. And that can be very painful and cause burning or aching-type pain. Sometimes, we’ll drain the bursa or the inflammation in that area, debride, or get rid of the corn.
“Our last resort is surgery, where sometimes we’ll straighten the toe by releasing a tendon. There is a tendon on the bottom of the foot that, in certain conditions, can be released in the office, reducing or getting rid of the hammer toes and killing the pain. Otherwise, we have to do a bony procedure, where we’ll get rid of a portion of the knuckle or the joint of the toe.
When to use Orthotics
“Orthotics are biomechanical devices that we make by scanning a foot placed in a particular position. We call it the neutral subtalar joint position. And that’s what the studies show that our feet function best with. As a side note, whenever you walk, you’re putting two to three times your body weight on each heel; if you’re wearing a high heel shoe, or a spike heel, in particular, you’re throwing that forward to the front of your foot. So that’s going to aggravate the bunions, the tailor’s bunions, and the hammertoes.
“In younger children, orthotics can control and correct how they walk for specific conditions. As they grow, it puts their feet in the proper position, so they grow into that position, but for most adults, orthotics won’t correct the problem; they just control it.
The Dreaded Foot Fungus
“A thickened, discolored yellow toenail is one type of condition seen very commonly in many different kinds of people of all ages. In the years of my early practice, it was usually seen in senior citizens. Now I have adolescents, teenagers, and senior citizens that come into the office with yellowed, thick toenails that can sometimes be painful and occasionally painless.
“It usually starts by bumping your toe or dropping something on it. Especially in summer, when people tend to wear sandals. The nail then lifts slightly, and a fungus gets under the nail. This generally happens slowly and will cause the nail to be thick, discolored, sometimes very hard, and sometimes crumbly. It can spread from nail to nail, from foot to foot, and from family member to family member.
“For your typical foot fungus that is not that painful or not painful at all, there are two options that patients have. One is an oral medication taken by mouth for three months and has a very high success rate.
“The other thing to do for that is a topical treatment or an antifungal nail lacquer. These are painted onto your nails around twice a day, and that can help or make it go away.
“Always remember, if you choose to use a public shower, you should wear a pair of sandals or flip flops in the shower, so you try to limit the amount of fungus that you could pick up.”
To listen to Dr. Klein’s full podcast, click here.