Ask the Expert: Dr. Scott Ellis, Foot & Ankle Surgeon, Answers Your Questions on Foot Deformities

by Dr. Scott Ellis
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Q1.  Do you know anything about Maffucci syndrome? 

It is a rare disorder in which patients get angiomas or benign tumors involving blood vessels, as well as  enchondromas (benign cartilage tumors), that can affect any bone in the body including the foot.  I have seen cases where isolated enchondromas (i.e., not part of Maffucci syndrome) affect the foot and the treatment is largely non-operative unless a fracture develops in the bone affected.  This condition more commonly occurs in the hands. 

Q2.  I have hammertoe, but I can still move and straighten it.  Is there any way to prevent it from getting worse?

Depending on the case, there are a variety of pads and splints that can help.   These, however, generally do not keep a hammertoe from getting worse.  Tape can be used in a similar fashion to hold the toe down.  The most common cause of hammertoe is an associated bunion.  To that extent, by wearing sensible shoes, avoiding major impact activities, and addressing the bunion, one might be able to keep the hammertoe from getting worse.  We often advise patients to fix a bunion before the second toe becomes very hammered. This might prevent a hammertoe from occurring at all. There is, however, no definitive way of keeping these deformities from getting worse once they develop.  Another approach is to stretch the calf as calf tightness can lead to overload of the forefoot in conditions such as hammertoe. Consult with a physician before you use any pads or splints and about treatment options.

Q3.  I have a bunion on my right foot and it is painful.  How do I know if I need surgery?

This is a very involved question which really requires a lengthy discussion between you and your foot and ankle surgeon.  Pain can mean different things to different people and it can actually occur at different places.  The most common site of pain in a bunion is right on the prominence of the bone itself; however, with the bunion, the other toes can become overloaded and they can hurt as well.  In general, I tell patients to wait on bunion surgery until it is interfering substantially with shoe wear and activities. 

The decision really to perform a bunion surgery is also based upon the understanding of the risks and benefits of the surgery and the recovery process.  No matter what bunion procedure is chosen, the recovery can take multiple months.  One last factor that I tell patients is, when the second toe starts having symptoms, it is probably a sign that the bunion should be addressed.  That is because the results after a second hammertoe surgery are less predictable and it is best to address the bunion before it gets to that point.

Q4.  I had surgery for a bone spur that was growing out of my big toe last year.  Can the bone spur grow back?  Is there anything that I can do to prevent it from growing back?

This question most likely refers to the condition which is called hallux rigidus.  This is when arthritis occurs in the big toe and, most particularly, occurs on the top of the toe.  There is commonly a painful spur that forms at this location.  There is a procedure called a “cheilectomy” that can be used to take the bump off the toe.  This is best used in patients who do not have the most advanced arthritis. 

My experience is that the bump itself usually does not grow back; however, what can happen is further loss of cartilage in the rest of the joint and general pain.  However, stiffness can occur.  There is really nothing that one can do to prevent the spur from growing back other than to say that a lot of pounding activities and activities involving the foot being on tiptoes and/or wearing high heels probably causes more trauma over time to the big toe and probably will lead to faster development of arthritis.

Q5.  I was born with flatfeet and did not have any problems when I was younger.  Now that I am in my 50s, my feet hurt when I walk.  Will surgery help with the pain?

This sounds most likely to be the development of what is called “adult-acquired flatfoot deformity.”  It usually occurs  in people in their 40s or 50s.  Patients generally tell me they have had flatfoot their whole life, but that it has worsened over time.  Weight gain and age can be contributors. Essentially, the arch can no longer take the stress and strain and the arch starts collapsing.  This is probably due to the fact that the ligaments fail and the posterior tibial tendon, which helps support the arch, degenerates and fails as well. 

Dr. Scott Ellis, Foot & Ankle Surgeon

Dr. Scott Ellis, Foot & Ankle Surgeon

The mainstay of early treatment typically involves an orthotic, ankle brace and physical therapy.  When this fails and the patients continue to have pain, flatfoot reconstruction can be recommended.  This is a conversation that you should have with a foot and ankle surgeon. 

Dr. Scott Ellis is a foot and ankle surgeon at Hospital for Special Surgery. He performs a variety of surgical procedures, including foot and ankle fusion, total ankle replacement, along with bunion and adult flatfoot reconstruction. He also surgically treats foot and ankle fractures and their long term sequelae.

 

Next week Dr. Steve Lee, Hand Surgeon, will answer questions on nerve injury and compression in the upper extremity. Write your questions below or email socialmediacontact@hss.edu.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Tom says:

HI dr ellis,

After an ankle fusion is healed [union] and pt continues to have pain what could be the cause and why?

HSS on the Move says:

Hi Tom,

Thank you for your question about ankle fusion. Dr. Andrew Elliott, Orthopedic Surgeon, says, “An ankle fusion removes the ankle motion. That motion and stress has to be taken up by other joints and bones, and that is usually why people can feel pain and discomfort after a successful fusion. It is best to consult with your physician for an accurate diagnosis.”

Moises says:

i just had surgery on my left ankle , i feel like my blood isn”t circulating accurately because of the splint feeling too tight. Can i loosen the splint?

HSS on the Move says:

Hi Moises, thank you for your question. Dr. Ellis says, “This is a question that should be addressed directly to the surgeon that performed the surgery. If too tight, it can cause pressure to build up and cause “compartment syndrome.” Call your surgeon quickly and see if he or she would like to have you come in to see you or would recommend loosening the splint.”

Jayne Rutigliano says:

I am sorry, but I need to know if any of you doctors know of an orthopaedic surgeon in the New York city or Long Island area that
would specialilze in surgery for a recurrence of an enchondroma on the toe. My friends son has this, its very painful and we cannot
find a dr. who has performed these. I hope you can help. thank you, Jayne

HSS on the Move says:

Hi Jayne, We’re sorry to hear about your friend’s son. We have confirmed that our foot and ankle service does treat enchondroma. Please contact our Physician Referral Service to pursue an appointment. They can be reached at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp.

Joseph Duggan says:

I HAVE HALLUX RIGIDUS IN MY RIGHT FOOT. IT IS AFFECTING MY WALKING I AM 72 YEARS OLD AND OTHERWISE IN GOOD HEALTH. DO YOU HAVE DOCTORS WHO TREAT THIS CONDITION?

HSS on the Move says:

Hi Joseph, Please contact our Physician Referral Service to make an appointment. They can be reached at 877-606-1555 or you can visit them online at https://www.hss.edu/secure/prs-appointment-request.asp

teena says:

Hi I had a sprained ankle over a month ago. .I got x rays n the doctor said it was bruised badly so told me to keep it wrapped up..After over a month now my swelling went down but ankle still hurts bad n if I stand on my feet for 2 long the sprained foot starts swelling again. .. what should I do??

HSS on the Move says:

Hi Teena, thank you for reaching out. It is best for you to consult with your treating physician to get a better diagnosis. If you wish to receive care at HSS, please consult our Physician Referral Service at 877-606-1555 for further assistance.

Lisa Baechle Torres says:

Hello Dr. Ellis, I am your patient for the last few years. I have been diagnosed with postural tibial tendinitis, which is causing A LOT of pain. I understand rehab will be six months. I am a teacher and have to be in walking and standing condition by Sept. 1st. I have been requesting an app’t. for months and still don’t have a date. Can you work me into your busy schedule? Lisa T.

HSS on the Move says:

Hi Lisa, thank you for reaching out. It is best for you to consult with Dr. Ellis’ office for further assistance.

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April 19, 2014 at 12:00 pm

The NHL playoffs are underway, and having a strong abdominal and core muscle strength is important for keeping players in top form. Gregory Reinhardt, HSS Physical Therapist, says: "While skating, the activation of a hockey player's oblique muscles is crucial for their ability to constantly push off from their skates." To read more about core strength for hockey players, visit http://hss.edu/onthemove/core-strength-for-hockey-players/.

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