I have the pleasure of seeing many patients each week, and I think some of the more common questions that I am asked deal with “lumps and bumps” and changes in the appearance of nails and skin.
I would like to discuss each of these situations in a little greater detail.
Lumps and bumps can happen all over the foot. Probably the most common of these is a bunion deformity. A bunion is basically like a variation of a dislocation of your big toe joint.
The big toe starts to drift toward your second toe and sometimes even under your second toe. Then a large bump develops on the side of your big toe joint. This bump starts to become uncomfortable and painful with shoes, walking and exercise.
I guess the funniest way a patient described it to me is”…Honey, even my ugly shoes hurt!”
Many times shoes, custom-made inserts, an injection and padding can help but there are times when this bump needs to be taken off surgically through an outpatient surgical procedure. With new advances instrumentation and technique, people do a light amount of walking the day after surgery with a special shoe or boot.
Other types of lumps and bumps that develop are soft-tissue masses such as a ganglion cyst. A ganglion cyst is a benign cyst filled with a jelly-like material. I typically err on the side of caution and order a test called an MRI to ensure that the cyst is benign. I tell my patients that the more information we can gather about your condition the better we can treat the problem.
After the results of the MRI are known and a ganglion cyst is confirmed on MRI, typical treatment options include draining the cyst, injecting the cyst with steroid or excising the cyst. I will tell you that recurrence rates can be very high with the first two options. Imagine the ganglion cyst is like the portion of balloon that you blow the air through to inflate the balloon. In order to help ensure that the cyst would not come back a stitch needs to be placed around this area prior to excising the cyst.
A funny story about treating ganglion cysts can be found with the Bible. One of the earliest treatment methods for a ganglion cyst was to smack the cyst with the biggest and heaviest book around, the Bible. Can you imagine what would happen in today’s society if you went to the doctor’s office and he/she tried to hit you with a book?
Another bump on the foot is a hammertoe. A hammertoe typically involves the second, third, fourth or fifth toe or even a combination of these toes.
Essentially the toe starts to curl and point toward the ground. This can lead to callus formation on the top of the toe or even the tip of the toe. Most people call this callus a corn.
Hammertoes can be very painful with shoes and walking. Try tapping your finger on a table equivalent to the amount of times you take a step each day. The callus that would form would hurt anytime you grabbed or touched something. Then you would have to factor in that each time you take a step your feet and toes are bearing anywhere from two to five times your body weight.
There are splints that can be worn around the toes to help keep the toes in proper alignment. However, if you take the splint off, your toes will return to their crooked position.
Accommodative shoes with a wide and square toe box can help relieve pressure to the area as well, but sometimes straightening the crooked toe out surgically is your best option. The procedure take about 10 minutes per toe, and you can walk in a special shoe or booth the next day. I typically only recommend this procedure to my patients after other conservative options have been tried and failed.
My wife likes to tell me to exhaust my options, and she is right. Surgery does not have to be the first option all the time. Ask your doctor to try something non-surgical first. The bottom line is that if you notice a lump or bump on your foot, go get it checked out. Lumps and bumps are not natural and should at the minimum be examined by a podiatrist.
The second thing that we are going to discuss is changes in the appearance of the skin and nails. Most commonly this involves a fungal infection of some form. When the fungal infection involves the skin on your feet, we call it tinea pedis or athlete’s foot. This can present as blistering of the skin along the arch or a white discoloration that resembles dry skin along the bottom of our feet or even constant wetness between the toes.
Most commonly this is treated with a gel or cream that can be applied twice daily. There are over-the-counter medicines that can be used, but honestly I have not found them to be as effective as a prescription medication.
Tinea pedis can be cured in about a six week time period. There are times when an oral medication is needed, but I usually reserve this for more severe cases.
When the fungal infection involves the nails, we call it onychomycosis. You have probably seen or know someone with this problem. The toenails become very thick and yellow and are very hard to trim. Most people have seen the commercial of that ugly little guy crawling under the toenail. He is a dermatophyte, the cause of the problem.
There are many ways to treat this problem, and I think I have heard my share of home remedies. I will tell you that soaking in Listerine or tea tree oil and rubbing Vicks Vaporub on your nails will not work.
There are good topical and oral medications that can be used. There is even a topical medication, Formula 3, which I offer my patients that the company who makes the product guarantees that it will get rid of the fungus in your toenails. I’m not sure that there are many other medications that offer a guarantee to fix your problem.
Another option is an oral medication called Lamisil. This medication requires blood-work prior to starting the medication and can have some interactions but is typically safe. Regardless of which way you decide to treat the fungus in your toenails, it will likely take six to 12 months to see complete results because that is how long it takes for a toenail to grow from start to finish.
I think that no matter what type of problem you may be dealing with in your feet, it should be checked out. We lead such active and mobile lifestyles that we need our feet. If you have any questions or concerns, give me a call at JCMG at 556-7724.
