Congenital deformities include a long list of disorders which can range from very mild cosmetic abnormalities to very severe and painful conditions which impact a person’s ability to walk. Generally congenital (disorders from birth or childhood) are best treated earlier rather than later. A thorough evaluation and assessment is always necessary to determine the best approach to dealing with this issue. Often it requires a multi-specialty approach in treatment.
Bunions are one of the most common deformities of the foot. In this condition, there is a large bulge on the side of the big toe. It looks like a bump or spur but it is a much more complex condition. This is caused by shifting of the metatarsal bones. These are long bones in the foot which usually are strait and point forward. Sometimes they change position over years causing the bunion to form. Sometimes the smallest bunion hurts badly and the largest bunion doesn’t hurt at all. Bunions are something that often runs in families as a foot type is passed down through the generations. Though shoes don’t necessarily cause bunions they can often accelerate or aggravate the problem. X-rays are required to understand the position, extent and secondary problems associated with bunions. Based on the symptoms, alignment and several other factors a custom-tailored treatment plan is developed. Symptoms often include pain, stiffness, calluses or corns, numbness or tingling, and ingrown nails. There are several treatments which are non-surgical including orthotics, pads, shoe modifications and injections. Sometimes surgery is required to restore the alignment of the toes and reduce the prominence of the bump. There are several types of surgical correction which all have unique recovery courses.
Charcot Marie Tooth
Charcot Marie tooth is a genetic disorder which is characterized by advancing nerve damage to the extremities. In the foot, there is usually numbness and occasionally pain and burning. Hammertoes are most common. Muscles become weak and drop foot disorder is typical. There is wasting of the muscle mass of the calf and foot which make the foot and leg appear very thin or stork like. This will happen to some degree in the hands. Podiatry often helps with bracing and management long term as this disorder has no known cure. A neurologist is also key in helping reduce pain associated with this condition.
Charcot foot or Charcot arthropathy is a condition which causes severe arthritis or bone breakdown which is not painful. There is usually very little warming and can happen without injury. The bones become very brittle and break, fracture and fragment causing a severe deformity. This can happen in any joint but is most common in the feet. The mid foot is most common and leaves a very distinctive round bottom or rocker bottom foot. This is common in diabetes but can happen in those without. In the early stages, it can be mistaken for cellulitis as there is occasionally significant redness and swelling of the foot. An x-ray is necessary to diagnose this condition. Treatment vary from immobilization, specialized shoes or boots, bracing, and occasionally surgical reconstruction.
Haglund’s deformity is an enlargement of the heel bone near the Achilles tendon. This bony prominence can cause pain in the Achilles tendon which often leads to a bursa. This also can cause pain while wearing shoes as it rubs in this area. X-ray is useful in assessing this condition. Treatments include rest, ice, open back shoes, heel lifts, immobilization, shoe modifications, therapy, and orthotics. Occasionally surgical removal of the bony deformity is required treat the problem.
Hammer toe is a generic term for an abnormal bending of the toes. It can occur in single or multiple joints of the toe. This can cause difficulty and pain while wearing shoes. It can also cause corns, calluses, and chafing in the shoes. Toes can curl or cross over each other. It is generally caused by an imbalance of tendons and muscles or can be due to a bony deformity. Hammertoes are generally classified as flexible and rigid types. Hammertoes can be treated with padding, cushioning, shoe modification, straps, or taping. Occasionally surgery is required to rebalance or realign the joints. In severe cases fusion of some of the small joints in the toe is required to stabilize the toe. There are several procedures to correct a hammertoe so a thorough exam is required to help determine which one is best.
Hallux rigidus is a disorder caused by jamming or degeneration of the joint of the big toe. This is typically characterized by pain and aching of the big toe joint. There is occasionally swelling and difficulty wearing shoes. This increases with activity and reduces with rest. It can occasionally be confused with gout. It is most often diagnosed with an x-ray and thorough exam as there are a few variations. Treatments include stiff sole shoes, orthotics, injections, medications, rest and ice. Occasionally there is significant pain and deterioration of the joint requiring surgery. This can vary from removal of bone spurs to complete replacement or fusion of the joint. The type of surgery depends on several factors based on activity requirements, pain level, foot type, and joint condition.
Sometimes referred to as a bunionette, a tailor’s bunion is a prominence of the little toe joint. This is most noticeable on the outside of the foot. It can cause rubbing in the shoes, redness, swelling, calluses and pain. An x-ray is necessary to evaluate the foot as there are several variations of this condition. Most common treatment is non-surgical and consists of changes in shoes, shoe modifications, padding, spacers, or injections. In severe cases surgery is required to reduce pain. There are several types of procedures based on the type of tailor’s bunion but generally realignment of the 5th metatarsal bone is required to reduce the prominence of the bunionette.
Os Trigonum and Accessory Bones
Os trigonum is one type of extra (Accessory bone) that sometimes develops at the back of the ankle. There are other areas of the foot which develop these accessory bones which can cause similar problems. Often accessory bones exist in the foot and the person is unaware they have them as there is no pain or problems. Occasionally an injury or the extraordinary size causes pain or problems wearing shoes. Frequently padding, shoe modifications or orthotics can help reduce or eliminate the pain. In some cases, removal of the accessory bone is necessary to return function back to normal.
Brachymetatarsalgia is a congenital condition where the growth of one of the metatarsals in the foot is disrupted leading to an abnormally short toe. This is generally not painful but in some cases the deformity leads to abnormal function of the foot leading to severe pain. Cosmetic appearance can also be an issue as it can cause the foot to appear unusual. Most cases can be treated with orthotics or modifications of the shoes. Surgery and lengthening of the metatarsal is sometimes necessary to return the foot to its usual functional shape and appearance. This can often be done in one stage but occasionally this has to be done in a series of steps to allow the muscles, tendons, nerves, and arteries to adjust.
Growth Plate Disorders
Severs is a common condition in which there is pain and inflammation of the heel in children approximately 8-14 years old. This is most common in kids who participate in sports and can be quite severe. There are several other areas of the foot and leg in which this can occur. Parents may notice a decreased interest in activities due to the pain. They may also begin to walk strangely. Treatment includes Rest, ice, avoidance of sports, walking boots, physical therapy. X-ray of both feet may be necessary to compare for symmetry. Occasionally an MRI is needed as the growth plates (physis) are not easily visible on standard x-ray.