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Posts for: June, 2015

By contactus@rebyfootcare.com
June 15, 2015
Category: Uncategorized

     A TAILOR'S BUNION is a bump on the outside of the foot (just behind the little toe).  It is an enlargement (either a truly enlarged bone or a relative enlargment) of the head of the fifth metatarsal bone.  There are five metatarsal bones, one behind each toe.  The heads, or ends of these bones make up the "ball" of the foot.  A bunion is an enlargrment of the first metatarsal head, often accompanied by a turning or shifting of the big toe towards the smaller toes.  A TAILOR'S BUNION Is basically the reverse.  The fifth metatarsal head is enlarged, and the little toe often moves in toward the other toes.

     Tailor's Bunion deformity is also sometimes called a "bunionette" and may be an actual enlargement of the bone (where the head is larger on the outside) or a "relative enlargmenet."  This means the fifth metatarsal may not actually be bigger, it may just look bigger because the entire fifth metatarsal is deviated OR there may be a bend or splaying of the fifth metatarsal.  In other words, the bone may be normal at the base, near the center of the foot, but there may be a bend in the bone causing it to bow outwardly.  The name "Tailor's Bunion" is one case where the deformity is NOT named after a doctor, as many deformities or surgical procedures are named.  Instead, it is called a TAILOR'S Bunion, because years ago, people who tailored clothing sat barefoot in a crossed leg position.  This put pressure on the side of the little toe, causing it to push in, and causing back pressure on the fifth metatatarsal pushing it out.  

    Treatment for a tailor's bunion is usually surgical.  While no treatment may be needed if there is no pain, ulceration, or other associated deformity, in many cases there is pain over the "bump."  In mild cases, an ostectomy or removal of just the "bump" can be performed.  This is in those rare cases where the bone is actually enlarged and there is little or no deviation or bend in the bone.  In most cases, an osteotomy is needed.  Defined sometimes as a "surgical fracture", an osteotomy is when a cut is made in the bone, the head (containing the "bunion") is moved in (closer to the fourth metatarsal) and held in place with a pin, screw, or other form of fixation.  In very severe cases, where the entire fifth metatarsal is out of position, it may be necessary to make the bone cut at the base of the bone.  In older individuals, patients with diabetes and ulcerations that may not be candidate for an osteotomy, the entire fifth metatarsal head can be removed.  This is not advisable for young, healthy individuals, as the cosmetic result is often not as good, and it is possible to regrow the bone. 

      Conservative treatments for this condition are not often effective long-term, but can include padding, wider shoes, injections of steroid solutions into the soft tissue (bursa) which may be inflamed and painful, the use of oral anti-inflammatory medications, and orthotic devices (especially if pain is plantar or on the bottom of the foot rather than just the side).  

      Tailor's bunion deformity is a common condition.  The condition may or may not be painful, and treatment is usually dependent on the severity of the deformity and symptoms.

 

 

Richard S. Eby, DPM
EbyFootCare and Laser Center

7348 East Brainerd Road'

Chattanooga, TN.  37421

(423)-760-3115

www.rebyfootcare.com


By contactus@rebyfootcare.com
June 07, 2015
Category: Uncategorized

  Excessive PRONATION can be a problem for children as well as adults.  Pronation is a triplane motion of the foot.  This means that when standing up, the foot normally goes through a motion described as pronation, and it occurs in all 3 body planes.  The arch typically lowers, the front part of the foot turns out a little, and the heel tends to evert (or turn so that it rolls out from under the ankle).  All of this is NORMAL - to a degree!  In order for the foot to adjust to uneven surfaces when it hits the ground, the foot is supposed to PRONATE, and then STOP PRONATING, and then SUPINATE - or start going the other way.  The arch should raise, the heel go back under the ankle, and the front of the foot rotate IN to make it a rigid lever to help push the body forward.  No one is 100% normal, but many people pronate or flatten out the foot TOO much when they stand, and this leads to what is often called a FLAT FOOT.   In adults, excessive pronation can lead to heel pain (plantar fasciitis), bunions, hammertoes, arch strain, and a whole host of other secondary problems.  

   There are many adults who pronate or flatten out their feet too much when they walk.  This starts in childhood.  Babies typically have a bulge of fat in the arch of the foot making all of them look like they have flat feet.  As they mature, this fat in the arch area should reduce, and the young child's foot  should take on the appearance of an adult foot, only smaller.  Some children have what looks like a very flat foot WEIGHTBEARING AND NON-WEIGHTBEARING.  This means the foot looks flat whether they are sitting or standing.  This is known as a RIGID FLATFOOT DEFORMITY.  Other children look normal when sitting, but when they stand, the arch lowers, their heels turn out from under the ankle, and they turn the front of the foot out.  This is known as a FLEXIBLE FLATFOOT DEFORMITY.  Not every child with flat feet (also known as pes valgus or pes planus) needs treatment.  The degree of the deformity is important, how the child walks, and whether or not there is any pain are imporatant considerations. 

   Custom orthotic devices are usually the first line of treatment for symptomatic and/or painful flat feet in kids.  Not all kids will say they hurt.  Some will not want to participate in sports, get tired easily, or seem to just be lazy.  If they relate LEG pain, especially cramping at night after they have had a busy day of activity, they may be suffering from this problem.  When in doubt, the best bet is to get it checked out.  A Podiatrist can evaluate the child's lower extremities ( feet, legs, knees, and hips) to see what may be abnormal.  If a hip, leg, or knee problem is found, referral to a Pediatric Orthopedist may be indicated.  If the problem is with the foot or ankle primarily, a custom foot orthotic may solve the problem.  The earlier this is instituted, the better.  If this does NOT resolve the problem - and I have seen cases where it completely eliminated the problem on ONE foot, but with deformity and/or pain remaining on the other foot - it may be necessary to consider surgery.  Unlike in adults, particularly in the FLEXIBLE FLATFOOT, soft tissue procedures may correct the deformity without resorting to osseous or bone procedures (often called osteotomies or arthrodesis - where bones are cut and repositioned or fusions of joints performed).  The use of implantable devices - once called a STA-PEG procedure, where a plastic plug or peg was placed in the foot to act as an "internal orthotic" - can be done successfully in many children, as long as significant arthritic changes have not occurred and the patient is young enough for the device to limit pronation successfully.    Secondary procedures, such as Achilles tendon lengthenings may also be needed, but the goal is to avoid surgery whenever possible.  In very young children, where there is an internal or external rotational problem in the lower limb, casting can also be instituted to attempt to turn the foot either OUT or IN, and there are also devices that can help with this, if used carefully and judiciously, in children that are not walking yet.  

   Excessive pronation or FLAT FEET can be considered borderline, mild, moderate, or severe.  It takes a skilled practitioner to determine the degree of the deformity, the necessity of treatment  and type of treatment that is necessary not only to resolve any presenting symptoms, but to reduce the likelihood of further problems as the child matures.  There are many adults with severe flat feet and secondary arthritic changes in the feet and ankles where the problem could have been prevented by recognizing and treating the problem when the patient was a child.  

 

Richard S. Eby, DPM

Eby FootCare and Laser Center

www.rebyfootcare.com

(423) 760-3115