Overlapping toes can occur in any of the toes and can cause extreme irritation if not corrected. Deformities of the toes are common in the pediatric population. Generally they are congenital in nature with both or one of the parents having the same or similar condition and almost never will a child outgrow overlapping toes.
Underlapping toes are also therefore common in adults. The toes most often involved are the fourth and fifth toes. A special form of underlapping toes is called clinodactyly or congenital curly toes. One or more toes may be involved with toes three, four, and five of both feet being most commonly affected.
With weight bearing the problem increases and a folding or curling of the toes results in the formation of callous on the outside of the end of the toe. Tight fitting shoes can aggravate the condition. Any problems that cause pain or discomfort in the toes should be given prompt attention. Ignoring the symptoms can aggravate the condition, and lead to a breakdown of tissue or even infection.
Forefoot supports such as gel toe straighteners, gel toe caps and toe combs are often recommended to keep overlapping toes apart. These effective devices are designed to reduce friction to help relieve the discomfort.
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Mallet toe occurs when the joint at the end of the toe cannot straighten. Excessive rubbing of the mallet toe against the top of the shoe can lead to pain and the development of a corn. The tip of the toe is often turned down against the shoe causing pressure and discomfort. Mallet toes can cause extreme discomfort, and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.
Each of the lesser toes (all but the big toe) has three bones. The deformities, a hammer toe, claw toe, and mallet toe, are all due to abnormal positions of the bones at the joints between the bones. The mallet toe is the deformity where the most distant joint points downward. This is most common in the second toe in patients whose second toe is the longest toe. A painful callous can form at the tip of a mallet toe.
Tight, ill-fitting shoes are the main cause of all these deformities. Anytime the toes are compressed into an abnormal position for any length of time, problems with the feet will follow. There are orthotic devices to help get your feet back into the right position. Comfortable shoes with plenty of room for the toes are a must. If you have chronic pain, surgery may even be necessary to get relief.
People who have a history of cardiovascular disease, stroke or thrombotic episodes (blood clots) are at risk of getting blood clots in their legs (especially between the ankle and upper calf) during extended airplane flights. Developing DVT after a long plane ride is called “economy-class syndrome”. Seating and leg room are particularly cramped for passengers in economy class, thus the name.
DVT is potentially life-threatening. In it, blood clots form in the body’s deep veins, particularly veins in the legs. Sometimes the clot breaks off, travels through the bloodstream before anyone knows that is happening, and obstructs a vessel in the lungs, restricting blood flow. This condition is called pulmonary embolism. This damages tissues and causes poor lung function, which can be fatal. It is very difficult to diagnose by external examination. Symptoms, if they occur, might include muscle tension in the lower leg, a dull ache or sudden painful tear, or a cramp in the calf with swelling and elevated body temperature.
If the clot remains lodged in the legs, very serious damage may occur to the vein, or even to the leg’s entire venous system. Clots can cause tissue damage, skin lesions, ulceration, and possibly removal of the limb. Once you have had one episode, you will have a much higher chance of a repeat event.
Studies in healthy people have shown that wearing “compression stockings” may help minimize the risk of developing DVT after long flights. These stockings put pressure on leg muscles and help return blood flow from the legs to the heart.
Drinking extra water, walking up and down the isles and avoiding alcohol intake are also good advice and just common sense.
Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the big toe, and gets worse with time. Stiff Big Toe is actually a form of degenerative arthritis or wearing out of the cartilage. This joint is called the metatarsophalangeal, or MTP joint. It’s important because it has to bend every time you take a step. Since the most common site of arthritis in the foot, if the joint starts to stiffen, walking can become painful and difficult.
In the MTP joint, as in any joint, the ends of the bones are covered by a smooth articular cartilage. If wear-and-tear or injury damage the articular cartilage, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The result is a stiff big toe, or hallux rigidus.
Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In the beginning, with only minimal motion problems, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus”— where the big toe becomes stiff, or what is sometimes called a “frozen joint.”
Hallux rigidus usually develops in adults between the ages of 30 and 60 years. No one knows why it appears in some people and not others. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.
If you find it difficult to bend your toe up and down or find that you are walking on the outside of your foot because of pain in the toe, see your doctor right away. Hallux rigidus is easier to treat when the condition is caught early. If you wait until you see a bony bump on the top of your foot, the bone spurs will have already developed and the condition will be more difficult to treat.
People with diabetes have a 15 times greater risk of lower limb amputation than non-diabetic individuals. In many cases, the direct cause of amputation is obscure, although varying degrees of peripheral neuropathy, peripheral vascular disease, trauma, infection, and impaired wound healing are implicated. Foot ulceration, gangrene, and amputation result from the synergy of these underlying factors when effective preventive interventions have not been applied in a timely manner.
Patient education regarding foot hygiene, nail care and proper footwear is crucial to preventing amputation. Injury can lead to ulcer formation, which is usually the beginning of a problem. Adherence to a systematic regimen of diagnosis and classification can improve communication between family physicians and diabetes sub-specialists and facilitate appropriate treatment of complications. This team approach may ultimately lead to a reduction in lower extremity amputations related to diabetes.
Warts are actually benign tumors of the epidermis caused by a virus. The virus responsible is the human papillomavirus (HPV), a double-stranded DNA virus. The virus resides in the bottom layer of the epidermis and replicates into almost normal-looking skin.
Contrary to popular belief, warts do not have “roots”. They only grow in the top layer of skin, the epidermis. When they grow down, they displace the second layer of skin, the dermis. They do not grow into the dermis. The underside of a wart is actually smooth.
Salicylic acid is a very common and effective over-the-counter treatment, but requires consistent application every day. They best way to use salicylic acid is to first pare the wart with a blade, pumice stone, emery board, or small scrub brush. Soaking the wart in warm water will aid in the absorption of the medicine. Salicylic acid is applied to the wart and allowed to dry. Normal surrounding skin may be protected with petroleum jelly. Occluding the treated wart with a band-aid or piece of tape also improves the absorption of the medicine. This procedure should be repeated daily ideally around shower or bath time. Salicylic acid can be found in several forms including a thick oil, or incorporated into an adhesive plaster form.
Cryotherapy is another effective treatment of warts. Liquid nitrogen as a spray or on a cotton swab is applied to the wart freezes and kills the effected cells. The connective tissue is not destroyed; therefore, the lesion usually heals without significant scarring. The human papillomavirus is not killed by cryotherapy and is released into the surrounding tissue allowing the immune system to kill it. A blister typically forms on the site treated, crusts over, and falls off. Since blisters are painful to walk on, cryotherapy is not a first choice for warts on the bottom of the foot.
Excessive pressure on a particular area of the foot may cause a corn to form. A corn is a growth of skin protein or a toughening of the outer layers of the skin. Soft corns are nodules that grow between the toes, most often the fourth and fifth toes. Perspiration causes soft corns to break down and become extremely tender. It may be difficult to distinguish soft corns from athlete’s foot.
Hard corns generally occur on the sole of the foot or the top of the toe. Hard corns frequently are tender and have a clear, hard center when shaved. This distinguishes them from warts, which are not very tender and may bleed slightly when shaved.
Corn plasters, which are felt pads containing 40% salicylic acid, are available without a doctor’s order for hard corns. They may be effective in treating corns by eating away at the skin’s surface. To relieve pressure on toes, try Silopos toe sleeves, polymer gel (such as Cushlin Gel), foam padding or lamb’s wool.
Erythromelalgia, or EM, is a rare disorder that can occur at any age and affects both genders. The cause of EM is usually unknown but sometimes is secondary to other medical conditions including autoimmune, neurologic or blood disorders. Lupus, polycythemia vera and multiple sclerosis are examples. Some people with EM have other family members with the disease. Recently, an EM gene was identified as were several mutations to this gene. Apparently each affected family carries a different mutation.
Symptoms of EM include hands or feet that are very red to purple in color, are perhaps swollen, hot to the touch, and have burning pain. The intensity of the symptoms varies from person to person. Some notice a continual burning pain while others are troubled with “flare-ups” or episodes lasting from minutes to days in length.
Warm temperatures seem to be the most frequent trigger for EM episodes. Flare-ups are provoked by heat and exercise, and symptoms are relieved by cooling and elevating the affected extremities. Others have found that foods, spices like MSG, beverages (particularly alcohol) and some drugs can make EM symptoms worse.