Many patients present to my clinic complaining of bunion pain. These patients range in age from adolescents all the way to my geriatric population. There is no predilection for age, gender, body weight, race, or any other factor - yet they can be painful and are quite often progressive. The major factor playing a role in development is genetics. When coupled with biomechanics, bunion formation is inevitable in most patients. Consequently, their formation is not necessarily preventable.

Progressive conditions are dynamic. In this case, the formation of a bunion is just the start of a process of deviation of bones from their original position into a buckled one. This means when a patient notices the bump near their great toe, almost always that bump does not stay the same size forever. It will grow, the great toe will shift position over time, and symptoms may eventually emerge as a painful sore great toe that becomes bothersome even without shoes on.

Understanding what a bunion is, why it progresses, and what the symptoms are can be revealing. Who will get a bunion? Why do they get worse with time? What you can do to slow that progression? We will get into all of that and more.

There are varied treatments for bunions, from conservative to surgical. In this episode we will stick with a broad overview of the deformity and touch on conservative methods of management. I will dive deeper into surgical treatments in subsequent podcast episodes for patients or clinicians who want to understand more about corrective measures.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Pronation is a complex triplanar motion: eversion of the heel, abduction of the foot, and dorsiflexion of the ankle. Supination is the reverse motions: inversion of the heel, adduction of the foot, and plantarflexion of the ankle. These motions occur at specific phases of gait, the cycle of taking a step.

Pronation is critical for proper shock absorption and adaptation to uneven terrain. Supination is the process of reversing the foot from a mobile adapter to a rigid lever to allow efficient propulsion. When either motion is excessive, prolonged, or unrestricted, specific pathological conditions may follow. Often a condition seemingly unrelated to foot motion can be traced back to an excess of either motion. For example, stress fractures occur more commonly in a supinated foot.

These motions are dynamic, and required for efficient gait. When evaluating a foot type, the static position is one part of the equation. The foot as it functions dynamically is the other. A pronated foot may supinate excessively, slightly, or not at all. Likewise for the supinated foot. It is this complex series of movements that we study when evaluating foot pathology.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Plantar Fasciitis is one of the most common conditions I see in my clinic. Roughly 1 in 10 people will experience this in their lifetime, making it extraordinarily prevalent. There can be confusion as to how the condition evolves, but I will say it mainly has to do with form and function. By that I mean our feet were not designed for the surfaces we walk on each day. This can be corroborated by the fact that a majority of sufferers spend inordinate amount of time on hard surfaces. Think teachers, warehouse workers, nurses. Not to mention the runners and athletes who can be sidelined when the condition develops.

The majority of patients I see have tried resting, over the counter pain medications, changing their shoes and possibly some stretching. I have to assume a great deal of patients have success with this. However many do not, causing them to come limping into the office seeking professional help.

We begin with evaluating precipitating events, avoiding these activities and modifying shoe gear appropriately. NSAIDs, a rigorous stretching routine, and occasionally corticosteroid injections are used initially. Shoe inserts that are appropriate for a patients foot type and activity are also instituted. The majority of patients will obtain relief with these techniques. For stubborn cases a physical therapist is brought on to aid in pain reduction and reversal of the factors that led to fasciitis developing. In more refractory cases surgery may be required.

Surgical methods vary among practitioners but most have very high success rates.

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.