Patient Education


A bunion (hallux valgus) is a deformity characterized by lateral deviation of the great toe, often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe (metatarsophalangeal joint). As the great toe (hallux) turns in toward the second toe (angulation) the tissues surrounding the joint may become swollen and tender.

The term is used to refer to the pathological bump on the side of the great toe joint. The bump is partly due to the swollen bursal sac and/or an osseous (bony) anomaly on the mesophalangeal joint (where the first metatarsal bone and hallux meet). The larger part of the bump is a normal part of the head of first metatarsal bone that has tilted sideways to stick out at its top.


The symptoms of bunions include irritated skin around the bunion, pain when walking, joint redness and pain, and possible shift of the big toe toward the other toes. Blisters may form more easily around the site of the bunion as well.

Having bunions can also make it harder to find shoes that fit properly; bunions may force a person to have to buy a larger size shoe to accommodate the width the bunion creates. When bunion deformity becomes severe enough, the foot can hurt in different places even without the constriction of shoes because it then becomes a mechanical function problem of the forefoot.

Treatment and Prevention

Bunions may be treated conservatively with changes in shoe gear, different orthotics (accommodative padding and shielding), rest, ice, and medications. These sorts of treatments address symptoms more than they correct the actual deformity. Surgery may be necessary if discomfort is severe enough or when correction of the deformity is desired.


A hammer toe or contracted toe is a deformity of the proximalinterphalangeal joint of the second, third, or fourth toe causing it to be permanently bent, resembling a hammer. Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problems. It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot-Marie-Tooth disease or diabetes


In many cases, conservative treatment consisting of physical therapy and new shoes with soft, spacious toe boxes is enough to resolve the condition, while in more severe or longstanding cases orthopedic surgery may be necessary to correct the deformity. The patient’s doctor may also prescribe some toe exercises that can be done at home to stretch and strengthen the muscles. For example, the individual can gently stretch the toes manually, or use the toes to pick things up off the floor. While watching television or reading, one can put a towel flat under the feet and use the toes to crumple it. The doctor can also prescribe a brace that pushes down on the toes to force them to stretch out their muscles.


A diabetic foot is a foot that exhibits any pathology that results directly from diabetes mellitus or any long-term (or "chronic") complication of diabetes mellitus.Presence of several characteristic diabetic foot pathologies is called diabetic foot syndrome. The most serious foot complications in diabetes are:

  • Diabetic foot ulceration. It occurs in 15% of all patients with diabetes and precedes 84% of all diabetes-related lower leg amputations.
  • Diabetic foot infections
  • Neuropathic osteoarthropathy of the foot


Prevention is by frequent podiatric examination, good foot hygiene, diabetic socks and shoes, and avoiding injury. If you are a diabetic, you should be particularly alert to any problems you may be having with your feet. It is very important for diabetics with neuropathy to take necessary precautions to prevent injury and keep their feet healthy. If you have diabetes and are experiencing a foot problem, immediately consult your foot doctor.


Foot ulcers in diabetes require multidisciplinary assessment, usually by diabetes specialists and surgeons. Treatment consists of appropriate bandages, antibiotics (against staphylococcus, streptococcus and anaerobe strains), debridement and arterial revascularisation.


Plantar fasciitis is a painful inflammatory process of the plantar fascia, the connective tissue on the sole of the foot. It is often caused by overuse of the plantar fascia or arch tendon of the foot. It is a very common condition and can be difficult to treat if not looked after properly.


With plantar fasciitis, the bottom of your foot usually hurts near the inside of the foot where the heel and arch meet. The pain is often acute either first thing in the morning or after a long rest, because while resting the plantar fascia contracts back to its original shape. As the day progresses and the plantar fascia continues to be stretched, the pain often subsides.


We generally recommend treating plantar fasciitis conservatively at first with non-invasive interventions to help the foot get better. These include:

  • Rest the feet and avoid running or walking on hard surfaces.
  • Ice the heel and take over-the-counter pain medications like Motrin, Advil or Aleve.
  • Do calf stretches and towel stretches first thing in the morning and periodically throughout the day.
  • Wear shoes with good arch support, cushioned soles, heel cups or shoe inserts (orthotics).

If these steps don’t help, we may recommend splints to wear at night or steroid injections. Surgery is only performed as a last resort.


Achilles tendonitis is an inflammation of the Achilles tendon, generally caused by overuse of the affected limb and is more common among athletes training in under less than ideal conditions. Micro-tears in the tendon often accumulate over time during intense athletic injury and can leave the sufferer vulnerable to a complete rupture of the tendon.


  • Pain, tenderness or swelling in the Achilles tendon area.
  • Decreased strength and range of motion.
  • Stiffness that decreases after warming up.


We generally advise our patients suffering from Achilles tendonitis to:

  • Rest the leg and foot and avoid any intense physical activity for 6-12 weeks.
  • Wear shoes with good arch support, cushioned soles, heel cups or shoe inserts (orthotics).
  • Reduce pain by icing the injury and taking over-the-counter pain medications like Motrin, Advil or Aleve.
  • Do gentle stretches of the Achilles tendon are every day.

If your tendon stiffens when you sleep, we may recommend wearing a night brace to keep your foot flexed. In more severe cases, we may suggest a walking boot for 4-6 weeks to allow the tendon to heal. We only suggest surgery to a patients if they have not improved after more than 6 months of consistent treatment.


Heel pain is a common condition in which weight bearing on the heel causes extreme discomfort. There are two different categories of heel pain. The first is caused by over-use repetitive stress, which refers to a soreness resulting from too much impact on a specific area of the foot. This condition, often referred to as "heel pain syndrome," can be caused by shoes with heels that are too low, a thinned out fat pad in the heel area, or from a sudden increase in activity.

Plantar fasciitis (see above), a very common diagnosis of heel pain, is usually caused from a biomechancial problem, such as over-pronation, or flat feet. Heel spurs also are a common cause of heel pain, occurring in 70% of patients with plantar fasciitis.


To properly treat heel pain, you must absorb shock, provide cushioning and elevate the heel to transfer pressure. This can be accomplished with a heel cup, heel cradle, or an orthotic designed with materials that will absorb shock forces. The treatment of heel spurs is the same as the treatment for plantar fasciitis (see above), since the conditions are related.