Women’s feet undergo a lot of stress sometimes more so than their male counterparts. This is partly because of inherited foot types and also poor shoe gear choices. The most common foot problems for women are bunions, neuromas, ankle sprains, and heel pain. This educational article will go through these the first two conditions and will explain how to treat them conservatively without surgery.
What is a bunion?
A bunion deformity is a lump that develops on the inside of the foot near the big toe joint. This bump can be very painful and usually results in a great toe that crosses over/under the adjacent little toes. The condition causes pain because the pressure on the great toe joint is being stressed by the deforming forces of the bunion. Also, there is a nerve that typically runs right across the bump and can get irritated. Patients will typically complain of a sharp burning pain at the site of the bump and sometimes shooting pain into the foot. My female patients will often say “I cannot wear my heels for more than ten minutes.”.
How do we develop a bunion?
A lot of the problem is our inherited familial characteristics. Nine times out of ten if I ask a patient if their mother has a bunion they say “Yes!”. Or they will say “No but my aunt and grandmother do!”. There is no solid clinical research that proves this but as doctors we see common trends and this is one of them. For women, shoes can cause/exacerbate a bunion deformity. The narrow toe box of a high heel can press the great toe against the adjacent little toes and in turn causes stress at the big toe joint. This consistent stress can lead to the development of a bunion after a period of time. Obesity can also create a bunion since the excess weight causes stress to the big toe joint resulting in deforming forces which result in a bunion. When you combine factors such as obesity and poor shoe choices you will increase your likelihood of developing a bunion.
How do we treat a bunion?
Conservatively speaking, we can help to decrease symptoms and slow down the progression of a bunion deformity. We cannot choose our family so there is no stopping our inherited foot types. What we can do is look at our family history and see whether or not we should look to the children in the family. If we can treat a young child with preventative measures then we can reduce the risk of a bunion formation in their future. This can be done simply by fabricating custom orthotics. Custom orthotics are made of specialized materials that are custom molded to the bottom of both feet and they help to maintain the proper alignment of the foot. These are very different than Dr. Scholl’s inserts and the various inserts that you can get at running shoe stores and storefronts that make inserts.
When the foot is properly aligned there is less stress to the foot and therefore deforming forces that could cause a bunion are reduced. The orthotics can be made for both children and adults. In adults with bunions the orthotic is used for the same reasons. Preventing further progression of the bunion and also decreasing symptoms by lowering the stress to the foot. Another easy way to help treat your bunion is wearing proper shoes. I mentioned above that narrow tapered shoes cause deforming stress to the great toe which can result in a bunion. The simple answer for this problem would be to not wear shoes that are tapered at the toe box. My female patients generally do not like this bit of advice but it is a simple answer to a big problem. Padding the bunion can also help to reduce symptoms and is a fairly easy solution as well.
What is a neuroma?
A neuroma is in its simplest terms is a swollen nerve. There are several nerves in the foot and in-between our toe bones and these nerves run between these bones. The nerves can undergo stress and can create symptoms such as burning and tingling at the toes. Women will often say they feel like there is a lump inside the ball of their foot. Pressure on the lump will exhibit shooting pain or sometimes numbness. Oher symptoms include cramping, tingling and burning to the area. My female patients will tell me that their feet will hurt even more in snug fitting shoes.
How do you get a neuroma?
The neuroma will typically develop in the same way a bunion does. Abnormal forces from either poor shoes or an inherited foot type will cause stress to the foot and then will affect the nerves. The nerve is stressed and therefore becomes inflamed. This inflammation is what causes all the symptoms to occur. Tight shoes press the toe bones together causing continuous damage to the nerve and will make a neuroma worse in time. High heels will also result in increased pressure to the ball of the foot which can cause further aggravation to the nerve. This is why women who suffer from a neuroma will typically choose to wear flats to avoid the pressure.
How do we treat the neuroma?
Decreasing the inflammation of the nerve is the main goal of conservative care. We can accomplish this goal by giving the patient over the counter NSAIDS (Iburprofen, Motrin, Aleve). We can administer a local cortisone injection to the site of the neuroma which will help to reduce inflammation. Custom orthotics can be used to remove pressure from the ball of the foot to prevent stress to the area of pain. Also, the corrected alignment of the foot can result in less stress to the nerve by properly distributing the weight of the foot. The quickest fix for this problem is a change in shoes. Try to wear shoes that do not strangle the foot. The less pressure you place on the foot the less stress their is on the inflamed nerve. Padding to the bottom of the foot can also help with relieving symptoms.
The big factor that causes women to experience these types of foot problems is poor shoe choices. Society has certain demands on women to wear very bad shoe gear. High heels and flip flops are two types of shoes that wreak havoc on a woman’s foot structure and function. High heels has been proven through research to increase the pressure to the ball of foot to a very high degree. This high pressure causes all the aforementioned stresses to the foot which will result in pain. Flip flops simply do not provide any kind of support and stress the whole foot and up the leg. Stress fractures are quite common while wearing simple flip flops. In the next educational article we will be covering ankle sprains and heel pain as it related to women’s foot health.