Big Toe Pain and Tom’s Story
This is Tom’s story and his ongoing stiff toe joint painWhen things don’t go to plan what do you need to know? Throughout, clinician comment will elaborate on the story line. Please read the other cases on ConsultingFootPain as these paint a different picture starting with the Introductory article.
I joined Tom two months after surgery in a UK National Health Service Hospital. Tom was 70 at the time of surgery.
Getting big toe surgery right
It might sound all very obvious, do we get big toe surgery right first time. Indeed yes this does happen.This series covers different patient stories taken from their own words. All had stiff big toe joint pain. Some have worked, others less so. This is Leah’s story.
Stiff Toes and Patient Stories
Medical jargon is often hard to follow but when it comes to surgery and the painful stiff toe it is a good idea to have some background knowledge. What better way than for that information to come from patient’s own reflections.
What you really need to know after bunion surgery?
When a colleague (HFP) sought this question, she was generous and mentioned her surgeon was busy and thought it an oversight. I am both an ex-patient and a foot surgeon, and I’m afraid I have to disagree. We often confuse nice with good, and all clinicians have a blip – but then don’t we all? So we have a patient leaving the hospital after bunion surgery. No post-operative information is apparent, so what does she do? Call a friend! This, in fact, is Facebook and jolly good it is as there is a heap of friendly advice.
How does surgery impact our lives?
It may seem simple to accept a risk from surgery is low in percentage terms but in this article I explore a new phenomena to may patients and that is actual impact should a perceived low risk actually arise. A number of different complications and problems are discussed and the impact this has should it arise is highlighted with examples and supplementary papers.
The stiff big toe joint explained
Our task as clinicians is to prevent worsening of the painful bunion – hallux valgus or stiff toe known as hallux limitus. Long term failure to act means the joint fails to work.
Protect your bunion
simple protection can be of great assistance in preventing later problems
Hallux Valgus known as bunion
In this brief introduction we distinguish between hallux valgus and the term bunion.
Podiatry as an Inspiring Career
The breadth of options following qualification is not only considerable but podiatry is a profession with a job at the end of study. There is something for everyone, mature and young, and it is one profession that does not have a gender issue.
Caught Out with Cancer
Cancer is something which affects any part of the body but being caught out may not always be the doctor’s fault. In this article I am using the abbreviation ‘S.M.ART’ which will be explained at the end. But how could we call be fooled by the story of my father’s sudden death from bowel cancer. Who was to blame?
A naval bone and the Duke of Edinburgh?
Nothing can be more exciting than see someone in pain make a recovery. Rachel wanted to undertake the prestigious Duke of Edinburgh Award that had been going as long as I had been living. The conditions for the awards are activity based and she was aiming for the Silver element. At 17 years of age this lovely student was not doing so well with her foot, and in particular her arch.
Time to challenge the flat foot
Flat foot is not necessarily abnormal and yet unwary people are exposed to sales techniques based on the supposition that the arch should be a specific shape. I have a look more closely at the myths surrounding the flat foot and discuss pronation.
Barefoot Kick off your Shoes
There are 2 riders to bare feet activity permission based on existing problems assessing the ground for safety. As usual the author likes to delve into the internet and see what makes sound advice and what is fake news! This article is more than barefeet though. It looks again at information from the internet and asks HOW VALUABLE or ACCURATE is it?
The Irritating Little Toe
In this self-help article, the irritating little toe problem is discussed. Usually the problem will settle within a week of self prescribed care. I have chosen this subject as the condition is slightly different from the usual fungal infection affecting the toe. Before panicking and thinking you are unclean read this article from ConsultingFootPain.
Cancer and the foot
The fifth commonest skin cancer is the melanoma according to the Marsden Hospital (London) but other forms of cancer exist and the foot is as much a target as other parts of the body. The Mayo Clinic in the US suggests only 1% of cancers affect bone. Peeling information off the internet needs interpretation and in reality the foot is a low target for cancer.
Five conditions in feet caused by cancer treatment
e know that certain chemotherapies can affect the feet from preventing us from carrying out normal routines, especially particularly after having surgery for cancer. Some of these side effects exhibited can be painful. Clinicians supporting patients with cancer aim to minimise such complications from therapy.
Getting the best from clinical information
ITelling a story is powerful and better expressed than many clinicians can offer. There is a balance between downplaying risks and the impact of having a particular treatment. Today it is the patient who must decide which pathway to travel.
What should you ask from a fact sheet?
If you have read my short article Getting the best from clinical information here is the follow-up article offering a little more meat. What should you ask from a fact sheet? The answer must be equally simple. Factsheets should be well written, have few spelling mistakes and be easy to read. They should be laid out well and ideally not photocopied to death. Well, presented factsheets show the clinician cares as much about you as the information that is offered.
Pain and prevention of blisters
The skin, footwear and terrain play major parts in causing blisters in the normal foot without complicated skin problems. Take care of this and you are half way there.
Jo’ Bunion Surgery
My first post back in 2013 was written around Jo’s bunion surgery. It is as relevant today as it was then even though I now longer practice surgery myself.
Understanding ganglions in feet
The nuisance factor behind ganglia and swellings is the potential for pain associated with trapped nerves producing sharp electric shock pains that can shoot into the foot or up the leg. Infections are not common but cause ascending pain and must be investigated and managed. Deeper bursae do well from injections where they form part of normal anatomy. These are called an anatomical bursa. Tethered down with strapping can help or they can be protected by foam and gel padding.
Biopsy in the foot
There are several techniques available to the surgeon. We can shave the top to acquire a sample or we can punch a section out using a small punch. The last technique is excisional biopsy, often used as part of treatment. Shave, punch and excisional biopsy are the different techniques. Biopsy is designed as a diagnostic method of test for abnormal skin cells.
Biomechanics and the foot orthosis
In the USA, from the sixties, the earlier designs were based around a popular subject called ‘biomechanics’. This was a pseudo term but became a significant part of the podiatric medicine degree course in the USA. Much of this pseudo-science involved measurements with protractors (tractographs) and in build error ‘eyesight’ assessment which led to assumptions with a predilection for the concept of wedging. The foot orthosis (F.O.), as it was called, tried to separate itself from the older insole and appliance. A google search today will still confuse the terms.
Smelly feet and the home truth
Poor hygiene adds to the build-up of skin squares offering greater bacterial opportunity. However, increased sweating requires increased temperature, exercise and stress affected by medical drugs and chemicals as in foods. Increased sweating may require medical intervention. One condition that is less common is pitted keratolysis; lysis means breaking down.
A career in Podiatric Medicine
Most podiatrists are only too happy to speak to school leavers and students about the profession of podiatry. Contact the practice and ask if you can attend a clinic
Podiatry as a career choice?
Like a flying carpet from the Arabian Nights of old, I was transformed along a landscape that threw up new opportunities; it was an unchartered journey, unlike today. Like many friends and colleagues, I did not leave school knowing about podiatry. Our career’s office at school failed to mention this, and I was heading for a failed destiny. By chance, I was redirected as many have been.
Avoiding Death by PowerPoint
Well, it is simple. Good speakers feel that PowerPoint makes people lazy, leading to a lack of being prepared. I thought it was a good topic as conference season is starting to warm up for some. Preparation is everything and of course, your talk looks better for those slides. I am a strong proponent of PowerPoint, but I have to say it is poorly used more than it is used well. In preparing this short article I have adopted the term Death by PowerPoint because it really can kill what could be a good talk. A few tips might not go amiss.
Foot cramp is there a cause?
Salt is not just sodium chloride but calcium, potassium, magnesium. These chemicals are also known as electrolytes which are important for nerve conduction and health muscle function. One myth cramp was to eat a banana because this had potassium, a significant body salt. Athletes had their blood levels measured based on their loss of water in sweat and, hence, salt loss. The findings showed little difference between those who suffered cramp and those that don’t.
What is a foot orthosis?
A podiatric consultation is wise for medical foot problems (diabetes, rheumatoid, psoriatic arthritis, compound arch pain, or deformity). High-performance athletes are best consulting a podiatrist with a sports interest as the market is broad and confusing for laypeople.
Urine Holds the Secrets of Health
In the past, physicians would hold up a sample of urine to the light and declare all manner of diagnoses. As a podiatrist in training, colour became a prodigious indicator of so many aspects of medical assessment – the colour of the lips for oxygen exchange, the skin and blemishes for cancer, the colour of the nail bed for heart and lung as well as kidney disease. In every case, subtle colour changes might have played a part from the yellowing features created by jaundice and hence a sign of liver malfunction to the loss of pigment in black skin – vitiligo. When it came to body waste, it was easy to assume this had nothing to do with the podiatrist…
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