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About Orthopaedic Surgery

Foot

Anatomy | Bunions | Plantar Fasciitis | Morton's Neuroma

Anatomy
The bones of the foot consist of the tarsal bones, the metatarsal bones and the phalanges of the toes. The weight of the body is supported by the calcaneus in the back of the foot and the metatarsal heads and toes in the front of the foot. The metatarsal heads are connected to the heel by a dense, thick fibrous tissue called the plantar fascia. top

Bunions
A prominence on the top and inside portion of the metatarsal bone of the great toe (See Foot Anatomy) is called a bunion. It can cause pain and can make for a problem with shoe wear. The bunion is usually accompanied by, and largely caused by, angulation of the big toe toward the outside of the foot, called hallux valgus, thus making the head of the metatarsal more prominent and subject to pressure. This increase in pressure will contribute to the formation of the bunion, as there is an increase in the size of the bump due to the body's response to injury to a bone by laying down even more bone. The angulation of the big toe can be worse in people who have a wide foot due to an angulation of the first metatarsal toward the inside of the foot, causing tightness of the muscles which draw the big toe laterally. As people age, the ligaments of the foot stretch out, causing the foot to widen, and resulting in the development of bunions in the elderly.
Rheumatoid arthritis may also cause foot deformity, and a resultant bunion.

Treatment of bunions starts with good footwear. The shoe should be wide enough to protect the bunion from excessive pressure and to prevent the big toe from being pushed over. Pads can be worn over the bunion to protect the overlying skin. Night splints can be worn to encourage the big toe to stay straight, although their effectiveness is uncertain.

If the above treatments are not satisfactory, surgical treatment of the bunion may be required. If the problem is merely the presence of a bump, without toe deformity, simply excising the bunion can be done. Most often, addressing the toe deformity and the wide foot are necessary. This entails not only removing the bunion, but cutting the metatarsal, usually at the end adjacent to the big toe, but sometimes at the base, and moving the end of the metatarsal laterally, thus decreasing the prominence of the metatarsal head and the muscle forces on the big toe. If significant arthritis has developed, a joint replacement can be considered. Following surgery, swelling of the foot can persist for several months, but results are usually quite satisfactory. top

Plantar Fasciitis
The attachment of the plantar fascia to the heel (see Foot Anatomy) can become inflamed from the forces of weight bearing which are applied to this area, both from direct pressure under the heel, as well as from tension on the plantar fascia as it acts as a tether between the front of the foot and the heel. Tenderness directly at the attachment under the heel is the significant physical finding. There may be a bone spur seen under the heel, but this may or may not play a role in the condition.

Treatment consists of decreasing the forces on the affected area. Cushions or heel cups, orthotics, physical therapy, and cortisone injections into the affected area are usually effective. If not, surgical release of the plantar fascia from the heel can be considered. top

Morton's Neuroma
Pain in a toe or under the ball of the foot can be caused by the formation of scar around one of the nerves to the toe in question. The digital nerves, as they pass into the toes, pass under the ligament connecting the metatarsal heads together (see Foot Anatomy). Chronic pressure on a nerve under this intermetatarsal ligament can cause injury, with the formation of a neuroma, or enlargement of the nerve. This is worsened by the stretching of the nerve under the ligament caused by high-heeled shoes. When the neuroma is pinched between the fingers, pinching between the metatarsal heads, or has pressure applied on it by squeezing the metatarsal heads together, pain results.

Treatment should consist of decreasing the pressure applied to this area. Use of a low-heeled shoe usually helps, as does the use of a metatarsal pad behind the ball of foot. Injections of local anesthetic and cortisone into the neuroma may be tried as well, but often, surgical removal of the neuroma is required. This will result in numbness of the involved toes, but usually alleviates the pain. top

NOTE: The information on this site is informational only and is not intended to be medical advice. NO ANSWERS TO MEDICAL QUESTIONS WILL BE GIVEN BY E-MAIL OR OTHER CORRESPONDENCE. Contact your physician for advice about specific medical conditions.

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