Foot Pain – Dr. Nicholas Campitelli

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Do all bunions require surgery? Not really. The point that I make to all of my patients is to consider fixing it when it’s painful. I do stress, however, that bunions are STRUCTURAL, deformities and will not improve without surgery. Toe spacers, bunion splints, and other contraptions to realign the toe will only work while the patient is wearing them. As soon as it is removed, the deformity will go back to an abnormal position.

A bunion is actually a dislocation of the great toe joint cause the head of the metatarsal to become prominent on the side of the foot. So, it’s basically the “knuckle” (as my patients say!) popping out of the side of the foot. Fixing it involves realigning the joint which in turn straightens the toe and reduces the prominent bump.

The sooner the deformity is fixed, the less likely one is to cause more damage to the cartilage of the joint. If one waits too long, the damage to the cartilage will make it difficult to get a good surgical result because there will be “bone on bone” in the great toe joint which limits motion and causes pain i.e. arthritis.

I’m excited to now offer Minimally invasive bunion surgery to our patients which greatly reduces recovery time and is a better option for many patients. It has allowed me to offer bunion surgery to patients who I normally wouldn’t have considered surgery on.

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Chances are, the bump you’re referring to is arthritis of the big toe joint. Many people will call this a bunion, which it is not. A bunion is a bump on the side of your great toe joint that is the result of a dislocation of the joint. The bump that can occur on top of the big toe joint is the result of arthritis from cartilage erosion in the joint. As the cartilage erodes, bone will rub against bone in the joint causing more bone to form in response to the stress. Fragments can also start to occur which can cause grinding to occur.

Wha causes this?

It’s typically a genetic predisposition that you are born with and it worsens over time.

Treatment

Treatment early in is to reduce the motion to the toe which causes the condition to worsen. This is difficult. Sometimes rigid inserts help but most patients see little relief. Cortisone injections can buy time before the inevitable surgical intervention occurs. Surgery can involve cleaning out the joint, replacing the joint, or fusing it.

Questions? Ask them in the comments section below or search my YouTube channel for more information and surgical videos!

Depending on the procedure performed to correct the deformity, recovery from bunion surgery can take anywhere from 3-6 weeks to 6-8 weeks to recover from. The recovery period is really dependent upon what the patients expectations are or their activity level after surgery. It is important to remember the surgery involves cutting bone to realign a deformed joint and it takes bone 6-8 weeks to repair itself. Your foot will be swollen for several months after surgery but again this is dependent on the activity level as well as the procedure that is needed to fix the deformity. Click here to see before and after images of bunion surgery.

Ankle pain can be very difficult for a patient to describe to their physician. It is also very difficult for general practitioners to adequately diagnose ankle arthritis if they are not proficient in performing an ankle and foot examination. Ankle arthritis will cause pain with dorsiflexion (moving foot upwards) and plantar flexion (moving foot downwards) due to the bone spurs that form around the ankle joint. The more severe the arthritis becomes, the more cartilage will erode and you will end up with “bone on bone”. When cartilage is destroyed, it cannot be “repaired” and bone articulating on bone will create more pain and inflammation. The longer this occurs the more irreversible the damage to the joint becomes.

Arthritic ankle joint

Early treatment can consist of cortisone injections into the joint to reduce the soft tissue inflammation that occurs in the initial stages of arthritis. If injections fail and the condition continues to worsen, ankle arthroscopy to clean out the soft tissue inflammation and synovitis as well as any bony fragments that may be within the joint.

When conservative treatment fails, fusing the ankle joint is the next step. This is performed to stop motion to the ankle joint and reduce pain. While one would think the motion is needed to walk normal, pain from the grinding and limited mobility will be worse in regards to trying to walk normal. Many patients resume normal walking after the joint is fused compared to how they were walking prior to the surgery with pain and limping from the arthritis.

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A bunion is a dislocated big toe joint that results in the head of the metatarsal becoming prominent appearing as bump on inside of the big toe.

While shoes and activity can aggravate a bunion, the cause is mostly genetic. So if your mom or dad had a bunion that’s most likely where yours came from.

Initial treatment consists of wearing wider shoes to help reduce pressure on the bump and toe spacers to realign the big toe while walking. Bunion splints can realign the toe while wearing it but the joint will return to it’s dislocated state when the splint is removed. A splint can NOT fix a bunion.

The only way to reduce a bunion deformity is through surgical correction. This involves cutting the metatarsal bone to realign the joint which reduces the bump. Depending on the type of procedure performed the recovery period can be 3-6 weeks or 6-9 weeks.

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Plantar fasciitis (formally referred to as heel spur syndrome) is a painful overuse condition of the soft tissue and muscle that originates on heel bone and extends out into the arch. The pain typically is worse in the morning or upon arising after sitting for a period of rest.

Plantar fasciitis is an inflammatory condition that causes extreme pain to the bottom or plantar surface of the heel. The plantar fascia is a thick band of tissue arising on the heel bone and extends out into the arch of the foot. Plantar fasciitis used to be referred to as heel spurs but it is now known that the spur is an incidental finding and is not the cause of pain and does not need to be surgically removed.

When conservative treatment (stretching, night splints, anti-inflammatories, orthotics, and shoe gear modifications) fail, surgical release of the plantar fascia is indicated. This is a simple outpatient surgical procedure, when performed endoscopically, that takes approximately 5 minutes to perform and has a relatively fast recovery being that only two tiny incisions are performed.

Immediately after surgery the patient is placed into a walking boot and given crutches. The crutches are typically only needed for the first 24-48 hours. After 1-2 days the patient is then allowed to walk in the walking boot as tolerated. The sutures are removed in 10-14 days and the patient is able to return to activity as tolerated at this point.

This procedure as dramatically decreased the recovery time for those patients who previously would have had an open plantar fascia release. Endoscopic plantar fascial release is reserved for those who have failed conservative treatment for plantar fasciitis for several months.

See Video below on how the technique is performed.

The image below shows how the punch biopsy is performed. An injection is administered to numb the skin. A sterile instrument is used to take a 3mm portion of skin from the involved area. The skin is then sent to pathology where it is examined under a microscope to diagnose the condition.

A nerve injury as a result of an accident left this patient with a drop foot and contracted ankle making it difficult for her to even do simple tasks. After two years of limping and trying to function with braces, she elected to attempt a surgical reconstruction. Our team was able to reconstruct her ankle allowing her to walk normal again. Watch Audrey’s story below!

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Is it a good idea to keep having your ingrown toenail fixed while getting your pedicure done? Probably not. The risk of developing a toenail fungus or even a severely infected ingrown toenail greatly increases by having someone pick at the side of your toenail.

The Foot Doc Blog – Leading Blog on foot and ankle pain

Do Bunions Require Surgery?

What’s this “bump” on top of my big toe?

Wha causes this?

Treatment

How long does it take to recover from bunion surgery?

What can be done about arthritis in the ankle? | Dr. Nicholas Campitelli | Podiatrist Akron Ohio

How to treat bunions

What does it feel like to have plantar fasciitis?

Plantar Fasciitis Treatment with Surgical Release EPF | Dr. Nicholas Campitelli

Skin rash on the leg? A simple punch biopsy can easily diagnose the problem.

Learning to walk again: How reconstructive ankle surgery allowed this patient to walk normal.

Can a Pedicure Fix an Ingrown Toenail?

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