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New Techniques & Custom Surgical Implants Mean Patients Get Back on their Feet Faster

More than one in five adult Americans currently suffer from bunions, and upwards of two-thirds will develop a bunion in their lifetime. For those considering surgery to relieve bunion pain, there is good news from the American College of Foot and Ankle Surgeons (ACFAS) – bunion surgery may not be as bad as you think.

“There is a common misunderstanding among patients considering bunion removal surgery that they won’t be able to walk for weeks or months,” said Alan R. Catanzariti, DPM, FACFAS, a Pittsburgh-based foot and ankle surgeon and Fellow Member of ACFAS. “The reality is that the surgery has changed dramatically in the last 10 years and recovery time is often four to six weeks.”

A bunion, clinically known as a hallux valgus deformity, is visible as a bump on the side of the foot near the base of the big toe and caused by the misalignment of bones in the foot. Bunions begin with the big toe leaning inward toward the second toe. This movement gradually changes the angle of the bones, producing the characteristic bump. As bunions progress, they can become sore, inflamed and increasingly painful, especially if aggravated by tight shoes.

Bunions can often be treated non-surgically with earlier interventions such as wearing shoes with a larger toe box. When bunion pain becomes a daily occurrence or limits a person’s ability to enjoy hobbies or perform a job, surgical intervention can return a patient to optimal function. Anyone experiencing pain or discomfort from a bunion should seek care from a foot and ankle surgeon to discuss treatment options.

“Bunion surgeries have been performed for more than 100 years. Techniques used today ensure minimal pain, earlier and improved mobility and decrease the likelihood that a bunion will return later in life,” said Luke Cicchinelli, DPM, FACFAS, an Arizona foot and ankle surgeon and Fellow Member of ACFAS. “As long as people are realistic about the shoes they’re wearing post-surgery, there is minimal chance that a bunion will return.”

Advances in surgery can be attributed to a number of technological advances, including evolution of fixation devices, anesthetic techniques and orthotics, such as custom walking boots. Information being presented at the ACFAS 73rd Annual Scientific Conference, being held this week in Phoenix, shows that the majority of bunion surgery patients are able to walk independently with a surgical shoe or walking boot following surgery and most can achieve full recovery in six weeks.

The ACFAS Annual Scientific Conference brings together more than 1,400 of the nation’s leading foot and ankle surgeons to explore cutting edge clinical and practice management topics in foot and ankle care. The conference program features 135 expert presenters delivering a variety of evidence-based presentations to highlight practice-changing techniques and clinical discoveries in podiatric surgical care.


Back-to-School Shoe Shopping Tips

Parents: Avoid Kids’ Foot Problems with the Right Shoes

The start of a new school year brings about two certainties: new clothes and new shoes. Unlike in years past, today’s shelves are stocked with a variety of shoe types that run the gamut in style and fit. As such, parents have much more to consider when shopping for back-to-school shoes.

To make things easier at the shoe store, the American College of Foot and Ankle Surgeons (ACFAS) offers helpful guidelines in a quick-reference infographic to help minimize foot problems caused by poorly fitting or worn out shoes.


Shoes Should Fit

Your child’s feet can grow up to two sizes in six months, so you need to account for growth when buying shoes. That does not mean you should buy shoes that are too big—oversized shoes cause the foot to slide forward, putting excessive pressure on the toes. Foot and ankle surgeons suggest a good fit is about a finger’s width from the end of the shoe to the tip of the big toe.

Tight shoes can cause blisters, corns and calluses on your child’s toes, blisters on the back of the heels or worse, ingrown nails, which can become infected. Signs of infection from ingrown nails include pain, redness or fluid draining from the area. If you notice any of these symptoms, schedule an appointment with a foot and ankle surgeon, who can perform a simple, safe in-office procedure to remove the nail.

Shoes Wear Out

Shoes lose their shock absorption over time, so inspect new and old shoes for proper cushioning and arch support. Foot and ankle surgeons caution, worn-out shoes elevate the risk for heel pain, Achilles tendonitis and even ankle sprains and stress fractures. Replace any shoes with wear and tear around the edges of the sole. When buying shoes, check to see that the toe box flexes easily and the shoe does not bend in the middle of the sole.

Children with Flat Feet

Children with flat feet need shoes with a wide toe box, maximum arch support and shock absorption. The best shoes to buy are oxford, lace-up shoes that have enough depth for an orthotic insert, if necessary.



What Is an Ingrown Toenail?

When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This digging in of the nail irritates the skin, often creating pain, redness, swelling and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe is not painful, red, swollen or warm, a nail that curves downward into the skin can progress to an infection.

Ingrown toenail and normal toenail


Causes of ingrown toenails include:

  • Heredity. In many people, the tendency for ingrown toenails is inherited.
  • Trauma. Sometimes an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe or engaging in activities that involve repeated pressure on the toes, such as kicking or running.
  • Improper trimming. The most common cause of ingrown toenails is cutting your nails too short. This encourages the skin next to the nail to fold over the nail.
  • Improperly sized footwear. Ingrown toenails can result from wearing socks and shoes that are tight or short.
  • Nail conditions. Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.


Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if an infection is suspected or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot or poor circulation.

Ingrown toenail before and after treatment

Home Care

If you do not have an infection or any of the above medical conditions, you can soak your foot in room-temperature water (adding Epsom salt may be recommended by your doctor) and gently massage the side of the nail fold to help reduce the inflammation.

Avoid attempting “bathroom surgery.” Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it is time to see a foot and ankle surgeon.

Physician Care

After examining the toe, the foot and ankle surgeon will select the treatment best suited for you. If an infection is present, an oral antibiotic may be prescribed.

Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail. After applying a local anesthetic, the doctor removes part of the nail’s side border. Some nails may become ingrown again, requiring removal of the nail root.

Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.

Preventing Ingrown Toenails

Many cases of ingrown toenails may be prevented by:

  • Proper trimming. Cut toenails in a fairly straight line, and do not cut them too short. You should be able to get your fingernail under the sides and end of the nail.
  • Well-fitting shoes and socks. Do not wear shoes that are short or tight in the toe area. Avoid shoes that are loose because they too cause pressure on the toes, especially when running or walking briskly.