Walking and Your Feet

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes . The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Varus. Bunions can also lead to other toe deformities, such as hammertoe.

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult--all contributing to chronic pain.

Bunions have been with mankind since the beginning of time. Undoubtedly they have received more attention since shoes have become a vital part of our fashion. It is generally recognized that those who have a bunion deformity most probably inherited the tendency from an earlier generation. So often people are told "don't have anything done until you can't stand the pain"! This is a misconception! Our rule of thumb is that when it becomes obvious that you have a bunion, that is the time to correct it!

Treatment for Bunions

Certainly the goal in bunion treatment is to limit the deformity and to stop the progression if it has already begun. This can only be done in the very beginning stages. When it is seen that the deformity is beginning in children and young adults, often the use of a good custom orthotic will stop the progression of the deformity. Also wearing shoes that do not irritate the deformity is also wise.

Surgical Treatment

The greatest hurdle that people with bunion deformities have to overcome is history. In most instances, these people have had a relative with the same deformity who years ago had surgery and they remember the pain and the weeks and months in casts and on crutches. They also remember that after going through all of this pain and suffering, in many instances the bunion came back.

The good news is that in the past 10 years new techniques and better instrumentation have been developed. Bunion correction of today involves the use of micro instruments with precise cuts in the bone to correct the deformity, thus limiting the rate of re-occurrence. The old days of the doctor saying "I'm going to have to break the bone and reset" it are gone. If anyone says that to you, run as fast as you can! Gone are the days of casts and crutches and wheel chairs post-operatively. Only in the most severe cases must the patient be "non-weight bearing". In most cases, the patients at the Ford Center can resume a fairly normal lifestyle in days or weeks rather than months.

At the Ford Center for Foot Surgery, the procedures are done with I.V. sedation administered by one of our qualified anesthesiologists. We also use a regional anesthetic which is much safer than a general anesthetic. We can do this because we do not use tournequets when we do foot surgery. This minimizes post operative pain as well as the risk of blood clots. The net result of this is that the patient is awake and can walk within minutes following the surgery but their foot is numb for 18 - 20 hours.

The procedure itself is accomplished through an incision on the inside of the foot, thus there are no unsightly scars. The capsule of the joint is exposed and is opened revealing the "bump" on the side of the metatarsal bone. The over growth of bone is removed. Next a very precise "V" cut is made in the bone from one side to the other and the end or head of the bone is moved over. This narrows the foot back down to its normal width. To maintain this, a small screw is placed in the bone to secure the correction. The skin and soft tissues are then sutured and the foot bandaged. The foot is then placed in a post op shoe that will be worn for several weeks.

As a general rule, our patients return to comfortable shoes in 2 to 3 weeks.

About 67 million adults in this country have discovered that walking is one of the most fun, natural, and inexpensive ways of keeping your health—and your feet—in top shape. Walking can be enjoyed almost anywhere, any time, and year around. It's also a good way to get exercise, particularly for people who are out-of-shape.

According to the American Podiatric Medical Association, exercise offers a host of benefits. Walking helps control weight, blood sugar, and cholesterol levels. A brisk walk can burn up to 100 calories per mile or 300 calories per hour. Walking also improves cardiovascular fitness. As an aerobic exercise, walking gets the heart beating faster to transport oxygen-rich blood from the lungs to the muscles. The heart and lungs grow more efficient with a regular walking regimen, reducing blood pressure and the resting heart rate. Walking is also a central element of medical rehabilitation for a wide array of health problems. For example, recovery from a heart attack can be facilitated by a regular walking regimen. Additionally, walking creates an overall feeling of well-being, and can relieve depression, anxiety, and stress by producing endorphins, the body's natural tranquilizer. A brisk walk will relax you and also stimulate your thinking.

To gain the most health benefit from walking, it is important to pay attention to your feet. Shoes that don't fit properly or provide adequate support, lack of stretching, and improper gait can lead to foot injuries or pain. The most common foot problems are blisters, corns, calluses, and plantar fasciitis.

Walking Shoes

The only equipment you need to enjoy walking for fitness is a good pair of shoes. But before you can shop for the best shoe for your foot, you need to identify the natural inclination of your foot and gait. There are three basic foot types:

  • Pronators are people with relatively flat feet, caused by low arches, which generally leads to overpronation, or a gait in which the ankle rolls inward excessively. People with this foot type need motion control shoes that offer support for mid-foot. Motion-control shoes are more rigid and built on a straight last. These are generally board-lasted shoes, which have a piece of cardboard running the length of the shoe for greater stability. Look for sturdy uppers for added stability and avoid shoes with a lot of cushioning or highly curved toes. Also look for a reinforced heel counter to maintain foot support and stability.
  • Supinators are people with high arches, which can lead to underpronation that places too much weight on the outsides of the feet. People with this foot type need stability shoes designed for extra shock absorption and often having a curved or semi-curved last. A slip-lasted shoe is also recommended, because the sewn seam runs the length of the shoe  giving it greater flexibility. Also look for shoes that are reinforced around the ankle and heel to stabilize the foot and extra cushioning under the ball of the foot.
  • People with normal feet can wear any type of walking shoe, although a curved last is generally preferred.

When you walk, the natural motion of your foot rolls gradually from the heel to the toe, with your foot bending at the ball on each step. That's why it is important for walking shoes to have enough flexibility in just the right places.  A good walking shoe should give a little when you twist it and bend at the ball of the foot. When you put the shoe on a flat surface and push on the toe the heel should come up off the surface. If it does, the shoe has the curvature you need to conform to your movement during walking.  Make sure the heel is low and not too wide. A slight undercut in the heel will help your foot begin its roll from the heel through the step.

Here are some other important tips for buying a good pair of walking shoes:

  • Shop at the end of the day when your feet are slightly swollen to get a good fit.
  • Try on shoes with the socks you will wear when walking. If you use an orthotic, bring that to the store when you try on shoes as well.
  • Have your feet measured standing up and fit your shoes to the larger of your two feet.
  • Be sure there is enough room in the toe box for your toes to wiggle and about a half inch between your toes and the end of the shoe.
  • Take time when shopping to try on different brands and walk around the store in each pair. Be sure to walk on a hard surface, not just on carpeting. Let your foot be the guide to the fit, not the shoe size or style.
  • Look for lightweight, breathable materials for greater comfort.
  • Run your hand all over and inside the shoes to feel for any seams or catches that might irritate your foot.
  • Choose shoes that lace for better foot stability and control.
  • Make sure your heel fits snugly and does not tend toward slipping out of the shoe.
  • Wear your walking shoes only for walking to extend their life. Consider buying two pairs and rotating your wear to give each pair time to breath between walks.
  • Replace walking shoes after every 300 to 600 miles, depending on how hard you are on your shoes.