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Bunions, high arches, heel fissures, shin splints

by STELLA
(MELBOURNE, AUSTRALIA)

Hi,

Thanks for your website, I have found it really informative so far.

I regularly see a podiatrist in Australia, but I have a number of issues with my feet, which makes me wonder if I am doomed:

-Small feet
-high arch
-Hallufix Bunion (early stage)
-Tailors Bunion
-Heel fissures
-dry skin
- shin splints (probably a result of no supportive shoe in sight)
-tendency for big toe nail to become ingrown
-strange little toe nail with visible blood vessels (two dark lines), which bleed if toe nail is cut too short.
-Badly sprained ankle when I was young, which did not receive the correct podiatric medical treatment and care. Right ankle now looks different to left ankle.

-It is pretty hard to find supportive court shoes suitable for the office in my shoe size, so for most of my adult life I have compromised with a size EUR 36 shoe, which is a whole size too big.
-I have recently had custom Orthotics made, which I had never considered before, but I am glad I did this. I have a R and L half orthotic, but wonder if I need to full orthotic to give my foot the support it needs.
-I get pain underneath my toes by the end of the day.
- Would a bunion night or day splint help to realign my hallufix valgus and Tailors Bunion?
- Would a heel cup help to treat my heel fissures?

I have made lots of effort to find suitable shoes but finding shoes in my size is not easy.

Any advice you could give would be appreciated. The company I work for (Celgene) has an office in Summit New Jersey, so perhaps one day I will be able to visit your podiatry clinic.

Thank you
Stella

RESPONSE

Hi Stella,

If you were a patient of mine, with all these foot and ankle problems you have, I could limit my practice to just you. Kidding of course, but let me assure you that you are not the only person walking the face of the earth with a multitude of foot issues. It is not as uncommon as you might think.

To start with, do other family members have a similar foot structure to you, particularly high arches? If so ok, if not, have you ever been worked up for any neurological conditions?

Sometimes very high arched feet can be the result of neurological issues that may have gone undiagnosed. Please keep in mind that I am making my comments without the luxury of actually examining you.

Had you not already received custom orthotics I would have suggested them first. The problem with high arched feet is that body weight is not evenly distributed, thus putting more pressure on the heel and the ball of the foot. I would venture to guess that with your new orthotics, the larger sized shoes that you are forced to wear, may actually be more comfortable.

Part of the problem with a high arched foot is that it is considered a poor shock absorber. One of the functions of the foot, besides taking you from point A to point B is to also absorb the shock of the heel hitting the ground. High arched feet are notoriously poor at doing this. This may account for your shin splints.

There are materials that can be built into the orthotic to absorb shock. Speak to your podiatrist about whether or not those materials are already in your orthotic, or possibly be added.

There is nothing you can do about the remnants of your sprained ankle, at this point.

The blood vessels in the nail area of your toe is something you have to live with and just be careful when the nail is cut; filing it instead might be a better idea.

Chronic ingrown nails can be treated with a surgical procedure that is done in the office, at least here in the U.S., not sure about Australia.

Dry skin can lead to cracked heels. Assuming you are not diabetic and there are no other issues like your thyroid, you just have to hydrate them on a regular basis, like twice a day with lotion in order to keep them hydrated. A heel cup should be helpful, as well as avoiding shoes with no back to them, like sandals and clogs.

As far as your bunions go, if they do not hurt, leave them alone. I do not know how old you are so it is difficult to give you further guidance.

There is no harm in trying a bunion splint, particularly if the bunions are small.

I think I have covered all of your issues. In summary, wearing a good pair of orthotics is probably the best thing you can do to mitigate a lot of your issues. If you are comfortable in the present pair, I am not sure a pair of full length orthotics will be any better, plus you run the risk of crowding your toes and perhaps aggravating your bunion and tailor bunion.

Marc Mitnick DPM
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