Do I Need Surgery for Arthritis in my Big Toe Joint?

Today I had a question from an active 28 year-old named Jennifer. She has a very active 3 year old son she chases about, but she gets pain and stiffness in the big toe joint. She says its worse when she crawls around on the floor kneeling, squatting, and playing with her little boy. She says he's into everything, but she loves watching him learn.

She thought she had a bunion and went to see a foot doctor who told her it was arthritis. And she needed foot surgery right away. Although this assessment was close, it was wrong.

She came in to see me for a second opinion.

Now, I will admit that she does have a little arthritis in the big toe joints. I will admit that one is worse than the other. I will even admit that I (or any foot surgeon) could make it look different on xrays. Maybe even look better on xray. But no guarantee it would feel better. At least not by New Years.

Jennifer has a condition called hallux limitus or hallux rigidus. This happens when there is restricted motion and the big toe doesn't bend up as far as it should. Because of this, the joint starts jamming and develops arthritis. Eventually, bone spurs start to develop on top of the joint. With time it will get worse. The cartilage can even get worn away over time.

Someone recommended that she have joint replacement surgery to put an implant in to replace the worn joint. Good idea, but not when she is committed to taking care of a 3 year old. I recommended she get some super-stiff Dansko Clogs from ZUMFOOT. With these she can walk without pain because the big toe won't be forced to bend and thus it won't jam anymore.

For her this was a good solution. She can can now walk without pain and wait until the timing is better. It won't get worse fast, and she can wait until the little one starts school.

Eventually she will have surgery. But I truly believe that unless the condition is going to get significantly worse, you should have foot surgery when it fits your lifestyle best.

Foot surgery can help many conditions, but the amount of disruption to your daily routine is elective...just like the surgery.


Dr. Christopher Segler is an award winning foot and ankle surgeon with a podiatry practice in Chattanooga. He is the inventor of a patented surgical instrument designed to simplify bunion surgery and flatfoot surgery. He publishes articles teaching other surgeons about his techniques and how to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.

Is it a Foot Sprain or will it need Foot Surgery?

49ers' receiver Arnaz Battle may have an undiagnosed foot injury.

This weekend's football injury report included San Francisco 49ers' receiver Arnaz Battle having a "foot sprain." Right now he is listed as questionable for next week’s game against the Miami Dolphins. The interesting part is that this is first time that Battle has returned to the gridiron action since sustaining a foot sprain back on Oct. 26. All he did was return some punts and he aggravated the injury in the second half.

This smells of a more serious injury.

The classic midfoot injury that needs surgery happens in either a high impact trauma or a lower impact twisting injury. The classic case is sustained in an a car accident. You have your foot on the brake, smack into the car in front of you and all of the force causes the midfoot joints to be dislocate or fracture. The area injured is a collection of joints called Lisfranc’s joint. For trivia buffs, Lisfranc was Napoleon’s surgeon. These injuries are very often misdiagnosed as a “midfoot sprain.”

In 2004, I began a research project to determine how accurately different doctors were able to diagnose Lisfranc’s injuries. The results of that study were quite scary. We found that primary care physicians and emergency room physicians were only able to recognize 1.6 % of all identifiable features of these injuries on x-ray. That means that more than 98% of these injuries could be missed, if not evaluated by a foot and ankle specialist. That may be the case with Battle.

As a result of this research, I won an award from the American College of Foot and Ankle Surgeons. Since that time I have seen many patients that came into the office having been misdiagnosed. In most cases they bring their x-rays from the emergency department. Unfortunately, in many of these cases, the injury is visible. It was just not noticed. In every case, the doctor told the patient that it was just a sprain and would get better. And they didn't. The difficulty is that we know in fact, these will not get better unless appropriately treated.

It can happen in car wrecks, motorcycle accidents, football, running, mountain biking or baseball. The big clue is pain in the mid-foot (above the arch) with swelling or bruising. Bruising on the top of the is a very bad sign. If it happens to you, get checked immediately. Whether you are a pro or a weekend warrior, you can;t afford to be listed as "questionable" for next week!


Dr. Christopher Segler is an author, inventor and award winning foot surgeon with a surgical podiatry practice in Chattanooga. He invented and a patented surgical instrument designed to simplify bunion surgery and midfoot surgery. He publishes articles teaching other foot doctors about his methods to prevent pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.

Mid-Foot Sprains, Pains, and Fractures

The midfoot is a complex area involving 10 different bones coming together to form more than a dozen separate joints. A sprain in this area can result in aching or throbbing midfoot pain, swelling and bruising. Sometimes the pain will start on the top of the foot and go deeper all the way through to the bottom of the arch. This type of injury can interfere with running and has the potential for serious problems if ignored. 

The most common way for an injury of midfoot to occur, is trauma. But it doesn’t have to be the hit-the-foot-with-a-hammer sort of trauma. For a runner, this sort of injury happens when twisting the foot while stepping in a pothole, accidentally stepping off the shoulder, or tripping over a root on a trail run. 

Fortunately, this sort of injury is rare from running. However it is common in other accidents. The classic midfoot injury is sustained in an automobile accident while braking. You have your foot on the brake, smack into the car in front of you and all of the force causes the midfoot joints to be dislocated or fractured.  The area most often injured is actually a collection of joints called Lisfranc’s joint. For trivia buffs, Lisfranc was Napoleon’s surgeon. These injuries are often misdiagnosed as a “midfoot sprain.”

In 2004, I began a research project in order to determine how accurately different doctors are able to diagnose Lisfranc’s injuries. The results of that study were quite frightening. We found that primary care physicians and emergency room physicians were only able to recognize 1.6 % of the identifiable features of these injuries on x-ray. That means that more than 98% of these injuries could be missed if not evaluated by a foot and ankle specialist. 

As a result of this research, I won an award from the American College of Foot and Ankle Surgeons.  Since that time I have seen many patients that came into the office having been misdiagnosed. In most cases they bring their x-rays from the emergency department and the injury is visible. It was just not noticed. In every case, the doctor told the patient that it was just a sprain and would get better.

The difficulty is that we know in fact, these will not get better unless appropriately treated.

Pain and tenderness on the top of the foot is relatively common in runners, but this is more often related to irritation of the tendons on top of the foot. This common problem is not that serious, and is easily treated. 

In contrast, pain that is worse when standing and twisting the foot, or when running, is worrisome. Any associated bruising is always a concern and may signal a much more significant injury. Without appropriate treatment, continued pain and rapid development of arthritis, with associated destruction of the joints in the midfoot, can occur. This can result in significant disability. 

Anytime you have had an injury where you were involved in an accident, stepped off a curb of wrong or stepped into a pothole while running, you should be aware of this possibility. Do not run if you have continued pain. If you are a runner and suspect that you may have a midfoot sprain, it is critical to get evaluated by an expert in foot and ankle care. That way you can get back on the road as quickly and safely as possible.

Dr. Christopher Segler is an author, inventor and award winning foot surgeon with a surgical podiatry practice in Chattanooga. He invented and a patented surgical instrument designed to simplify midfoot fracture surgery and reconstructive flatfoot surgery. He also publishes articles teaching other foot doctors about his methods to prevent pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.AnkleCenter.com.

What are the Best Shoes for Nurses?

In between cases I wandered into the doctor’s lounge adjacent to the O.R. I got something to eat and sat down.  From over my shoulder I heard, “do you mind if I ask you a question?”  It was Amy, the scrub nurse I had been working with all morning.  “You see I have this heel pain…”

I listened to her story, about how her heels first hurt when she gets out of bed. About how they don’t usually bother her while she is standing during surgery, but how she gets this sharp pain after she sits down for a break and then gets up and starts walking again. She seemed somewhat frustrated because it had been going on for about two months. 

I looked at her yellow Crocks, that likely used to be bright, long before being splattered with saline, blood and iodine. I paused and said, “So let me guess. You got your Crocs about six months ago.”  And quick came the reply, “how did you know!” 

Well I am not a psychic, palm reader, sole reader, nor any kind of magician, other than a podiatrist. The fact is, its just math. It seems that Crocs will only withstand about 3-4 months of being compressed between a nurse (working hard on his/her feet all day) and the hospital floor (hard as concrete, quite literally). Four months of use plus two months of abuse, past the life of the shoe, equals plantar fasciitis. This was also about the third or fourth time I had a similar exchange with a nurse complaining of heel pain in the hospital. 

The fact is nurses work hard. Up, down, charting, giving meds, dressing wounds, hanging IV’s, putting Mr. Jones’s nasal cannula back in nose instead of his eyebrow, busy, busy all the time. The shoes that nurses wear must be prepared for a world class beating. And not all shoes are created equal. 

The Croslite material (the only material in Crocs) is quite similar to the cushioning midsole of a running shoe.  As a marathon runner and Ironman triathlete I can say that the stuff does not last forever. I am always advising patients (who are also runners) how to tell if the midsole is worn out.  And when it is...time to donate them to a less fortunate recipient at the Chattanooga Community Kitchen. 

Does that mean Crocs are bad? Nope. It just means they are soft and don’t last real long. I will however, say that if you are on the wards, walking fast all day, they are worse than if you are mostly standing (like in the O.R.). If you have any foot or ankle instability, such as flatfeet, bunions or tendinitis, you are at risk of aggravating those problems. If you have high arches you are safe.

One other potential concern is the little air vents in the toe box.  There have been many incidences with sharps, so watch the toes around needles, scalpels and other falling pointed things.  My understanding is that some facilities have actually instituted policies against Crocs, due to safety concerns.

So, if they take away my beloved Crocs, what will I wear? I would suggest something good for your feet. If you have flat feet, wear athletic shoes with stability or motion control features.  If you have high arches, wear cushioning running shoes or something with a rocker sole that will decrease stress in the big toe joint. If I had to pick one shoe for nurses, I would pick Dansko clogs. To see more choices than you could ever want, click on our recommended running shoe list. Or visit the experts at ZUMFOOT, for something healthy and fashionable.  Remember...you nurses deliver all of the care that actually happens. You need your feet to take of the rest of us. Treat your feet as well as you treat your patients.

Dr. Christopher Segler is a nationally recognized award winning foot and ankle surgeon practicing in Chattanooga Tennessee. He is the inventor of a patented surgical instrument designed to simplify bunion surgery. He has published articles teaching other surgeons about his techniques about how to decrease pain after bunion surgery. You can request a FREE copy of his new book about common causes of foot pain at http:www.anklecenter.com.

Secrets to Finding a Qualified Bunion Surgeon

Anyone who is considering surgery, whether bunion surgery or brain surgery, has a potentially stressful and serious decision to make. It is important that you, as a patient considering surgery, make the right decision. By asking the right questions, and with a little footwork (no pun intended) you should be able to find a well qualified bunion surgeon who can help you, correct the bunion, relieve your pain, and get you back to all the activities that help you enjoy life on your feet.

   
Before I begin, I’ll start  with a qualification that I myself am a bunion surgeon. I have been awarded a United States Patent for an instrument and technique which I invented to to simplify complicated bunion surgery and I have also published original research in medical journals teaching other foot surgeons how to reduce or eliminate pain after bunion surgery.  I’ve also been invited to lecture and present my research on the new advances that I developed at multiple medical conferences in the United States, Canada, and New Zealand.

  
Having said that, there are many doctors like me in virtually every area of the United States who are well qualified to perform your bunion surgery.  The goal is to help you discern the real qualifications from deceptive ones.  This way, you will be able to determine for yourself, whether or not your surgeon is likely to provide you the outcome you want...no bunions and enjoyment of life.

 
Board Qualification 

This is actually the area where most of the deception lies. The foot surgeons held to the highest standard with the most hours of training and most extensive board qualification testing are affiliated with the American Board of Podiatric Surgery. There are other “board certifications” such as the American Board of Foot Surgery and the American Board of Multiple Specialties in Podiatry.  While the other boards “sound official,” they are rarely accepted as proof of competence by hospital committees.

Training 

Your surgeon should have three years of foot and ankle surgical training in residency after medical school. The more training, the more experience with a wide range of surgical techniques. There is a reason they say doctors are “in practice,” and the more practice the better.

 
Research 

Making certain your surgeon has experience with medical research, (particular in the areas of your particular problem) will ensure that he/she is interested in finding ways to perform better.  A history “in practice” alone is not enough to indicate your surgeon has the skill you are looking for. Research is what separates leaders from followers.  The leaders are always out in front and aware of the latest advances in technique. 

Awards 

Less than 1% of all surgeons will have won awards for advancing the field of surgery.  If you find one, you likely have a winner for sure. Check their website or search the internet for evidence that they are at the top of their field. 

 
Creativity 

Surgery is a science and an art. Creatively looking at new ways to solve problems is always a useful trait in a surgeon. If you can, find a surgeon who has demonstrated innovative thinking such as patenting a surgical instrument or has patented techniques that improve surgical outcomes. 

 
Authority 

It is no coincidence that the word “authority” starts with “author.”  Those that write books, publish articles in medical journals and use their writing skills to educate other surgeons always stay on top of their game.  All you need to do is search the surgeon’s name on Google.  If they are a winner, you will have many hits.  
Surgery should be a great experience because it will be the start of your recovery, and the start of a new more active, more enjoyable life. The time you spend researching your surgeon will be time well spent. 

Dr. Christopher Segler is a nationally recognized award winning foot and ankle surgeon practicing in Chattanooga Tennessee. He is the inventor of a patented surgical instrument designed to simplify bunion surgery. He has published articles teaching other surgeons about his techniques about how to decrease pain after bunion surgery. You can request a FREE copy of his new book about common causes of foot pain at http:www.anklecenter.com.

Why Bunions Hurt More in When its Cold

As the seasons change and cold weather arrives, sandals and flip flops get tossed aside. Women start digging around in the back of their closets trying to find some suitable cold weather shoes. Many of them will venture out in search of those perfect new fall shoes to match their new wardrobe. Many are switching from open toed sandals to boots and shoes. Shoe stores get an influx of women with bunions shopping for fashionable yet healthy shoes at this time of year. 

As a foot and ankle surgeon, I notice more women seeking relief for painful bunions every autumn. Many women experience a sudden increase in pain from bunions and hammertoes, that haven't been painful in quite some time. This has much more to do with shoes than weather. The reason for this is simple. Warmer weather typically lends itself to open toe, nonrestrictive shoes and flip flops. As soon as the mercury drops, people start stuffing those feet into tight shoes.  This is often compounded by the desire to be fashion concious. Buying new shoes to match a Fall wardrobe adds the pain associated with break-in to the equation. New shoes never feel as good as ones. Any area of pressure has to be worn in to the shoes. 

As a result, I see an increase of women in my podiatry office this time of year. Many of my female bunion patients are in agony and describe a constant, throbbing or burning pain in the feet. For most it is worse with activity, but some even continue to experience pain after they take their shoes off in the evening.

A combination of factors cause them to seek treatment. For many, the changing weather seems to aggravate the foot pain. More women inquire about bunion and hammertoe surgery in the fall because they are also less busy than in summer months. Many also realize that they are closer to meeting their insurance deductibles. That means that the surgery will be at a much lower out of pocket expense than after the first of the year.

Even though many people start to realize that surgery does make more financial sense toward the end of the year, I always explain that surgery should be a last resort treatment, even for women with painful bunions. Often times, other treatments will help. For many women, something as simple as wearing shoes with wide toe box can drastically reduce bunion pain. For those withbunions complicated by flat feet or instability, custom shoe inserts can help keep the problem from getting worse. There are also gel and foam pads as well as anti-inflammatory medications that might provide pain relief.

Only when when the pain from the bunion interferes with a woman's daily activities, it's time to seriously consider surgical correction. Not only is this my opinion, but also the recommendation of the guidelines set forth by the American College of Foot and Ankle Surgeons. If the bunion becomes inflamed, ice it, wear sensible shoes and try to avoid shoes with seems or stitching over the bump. 

Dr. Christopher Segler is an author, inventor and nationally recognized award winning foot and ankle surgeon. He is the inventor of the patented Tarsal Joint Distractor, which is a surgical instrument designed to simplify bunion surgery. He has also conducted peer-reviewed research and published articles teaching other surgeons about his techniques about how todecrease pain after bunion surgery. You can request a FREE copy of his new book about common causes of foot pain athttp:www.anklecenter.com.

Can Bunion Surgery Be Pain Free?

When anyone has suffered from painful bunions and starts to think about bunion surgery, they always ask me...is bunion surgery painful? Bunion surgery does not have to be painful. With the obvious disclaimer that any surgery certainly can be painful, it does not have to be. There are many techniques the properly trained and skilled foot surgeon can use to ensure that you have as little discomfort as possible related to your bunion correction surgery.

First, make sure your bunion surgeon will provide local anesthesia before your surgery starts. This is important because making the foot completely numb before the procedure starts will help to ensure that you do not experience the “anesthesia awareness” that has recently been reported on it the news. This is the situation where someone might be unconscious for the surgery, but still actually feel pain. If your foot is numb because it has been made numb with local anesthetics before the procedure begins, this can prevent that otherwise rare occurrence. In addition, make sure that your surgeon utilizes (so you will benefit from) all of the latest developments in post-operative pain reduction.

For example, while in Surgical Residency, I worked on research related to a simple, effective, low-cost method of reducing pain following bunion surgery. In that study, 95.92% of bunion surgery patients reported taking less pain medicine and believed that there pain much less than had the “pain pump” not been placed in the surgical site and used in their foot surgery cases. I published the secrets on this technique in a medical journal called Ambulatory Surgery in order to teach other foot surgeons how to make bunion surgery a better experience for their patients.

You should also make sure that you have access to other postoperative pain reducing techniques such as cryotherapy. This is a very simple device that circulates temperature controlled cooling through a special pad incorporated into the dressings applied at the time of surgery. By continually icing and cooling the surgical site for first couple of days after surgery, patients have less pain, less swelling, and recover faster.

Post-operative pain is not just an unpleasant annoyance, but it is also generally unhealthy. Pain can actually impede wound healing and stall your recovery. For these reasons, your foot surgeon should use every single available effective method to make sure that your bunion surgery goes smoothly and with as little discomfort as possible.

Your feet are critically important to your ability to enjoy everything from walks on the beach to dancing at the charity ball. You should only expect the very best performance from your surgeon when considering corrective foot surgery. It is important to not only imagine what your life would be like without the pain from bunions, but also to think about how simple bunion surgery could be if you chose a surgeon who would help ensure the fastest most comfortable surgery possible.

Dr. Christopher Segler is an award winning foot and ankle surgeon with a podiatry practice in Chattanooga. He is the inventor of a patented surgical instrument designed to simplify bunion surgery and flatfoot surgery. He publishes articles teaching other surgeons about his techniques and how to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.