Category: Abnormal Toes

Have you noticed that two of your toes have come out of line? Perhaps where they used to line up normally alongside one another, they’re now moving apart from one another like a ‘V’. This is actually something we refer to as the ‘V Sign’, and more often than not, it’s linked to a plantar plate injury at the ball of your foot. Because plantar plate injuries can not only cause a fair bit of tenderness but also interfere with the alignment of the toes which can worsen over time, our team at Perform Podiatry thought we’d get you familiar with the ins and outs of plantar plate tears, so you know what to look out for!

The Basics: What is Your Plantar Plate?

The plantar plate ligament is a thick band which runs across all of the toe joints at the ball of the foot, attaching to and connecting all five toes. The plantar plate works to protect the ends of the metatarsals (long bones of the foot), helps to absorb impact from heavy loads, stabilises the ball of the foot and keeps the joints (and toes) from separating, among other functions.

What Causes a Plantar Plate Tear?

Plantar plate tears or injuries occur when this ligament is damaged, usually from too much pressure on the ball of the foot. It usually occurs at the second metatarsal because it’s often the longest, and so takes on the most force when the toes bend during walking. Other causes and contributing factors may include:

• Flat (rolled in) feet
• Bunions and hammertoes
• Short first metatarsal bone (and hence longer second metatarsal bone)
• Repetitive high-impact activity such as running
• Climbing stairs and similar actions that put pressure on the ball of the foot

What Does it Feel Like?

Generally, those with an injury to the plantar plate experience pain and tenderness at the ball of the foot in the affected regions. There may be some swelling and the feeling that you’re walking directly on the bone. Because the plantar plate ligament is damaged, it won’t be able to maintain the usual alignment at the ball of the foot, and the toes may drift apart, creating that ‘V’ sign. In our clinical experience, we’ve seen many patients who have previously sustained plantar plate injuries that didn’t even realise there was a serious problem. We notice the ‘V’ sign and then discover that some time ago, the patient did experience some tenderness at the ball of their foot but ignored it, thinking they had just over-exercised or had a long day on their feet and it would go away on its own. While the painful symptoms did settle, the alignment and positioning of their toes were never treated or corrected, leaving their toes in the ‘V’ position, and affecting the alignment of the rest of the toes around them.

What Should You Do?

Our approach to treatment at Perform Podiatry not only focuses on settling your painful symptoms, but also to correct the alignment of the toes and to reduce the risk of re-injury in the future. That’s why we conduct a thorough biomechanical assessment to address the causes of the injury in the first place and treat those too. Often we use strapping to help control the position of the toes, padding to alleviate pressure away from the affected toes, and orthotics to help control the position of the foot with every step to alleviate pressure and address any abnormal foot biomechanics that may have caused the problem in the first place. During your recovery, we’ll talk about your shoes to make sure they’re helping and not hindering your recovery, and we’ll look at what else is going on with your feet, such as bunions, that may be part of the problem. The good news is that with proper care, plantar plate injuries are very treatable and you can be out of pain and have your toes back in line relatively simply, following the treatment plan and recommendations from our team. If you notice a ‘V’ sign from a previous injury, we may even be able to help with that too, before the alignment of your toes worsens. Our podiatrists are experts in the biomechanical function and alignment of the feet and legs, and love seeing our patients back at their best and doing the things they love! To book an appointment, give us a call on 09 523 2333 or book online!

  We’ve been seeing a lot of patients with ingrown toenails lately. From kids to adults alike – we’ve even quickly removed ingrown toenails from kids at 6 months old. That’s right – your nails don’t discriminate against age. We thought we’d highlight 3 recent cases because we find that a lot of people (definitely not all) tend to fall into these categories.   Case One: “It’ll be all good, bro” As the title may suggest, this was a classic kiwi male. Hard worker, on his feet all day, works in both steel capped boots and gumboots. He first noticed his ingrown toenail developing a few months ago. Yes, that’s right – months ago. He felt a bit of pain but shrugged it away, thinking it’ll go away on its own. It didn’t. One side of the nail pierced the surrounding skin. The toe became swollen. In the following month, it developed a minor infection. Because of the swelling, the other nail edge started growing into the skin too. It bled. It was irritated when he wore shoes and at work. But being a trooper, he persevered. Until 2.5 months after he first noticed a little bit of pain, he came in to see us.   Case Two: The fashionable businesswoman She came in to see us approximately two weeks after her pain began in her big toe. She tried cutting it and controlling it herself, but to no avail. The toe was red, swollen and has a small amount of yellow exudate as it had developed a minor infection. She wears pointy shoes to work and continued to do so for the last two weeks – but when she’d sit down at her desk she would take them off to get some relief for her toe. She also took lots of painkillers. The trigger for her to come in to see us was because the pain got so uncomfortable that even a sheet on her toe at night started causing her pain.   Case Three: The young footy legend This 11-year-old superstar came in with his mum because his toe was red, swollen and very painful. So much so that he couldn’t kick the ball anymore without yelling out in pain. The pain had started 7-10 days ago he guessed. He also doesn’t cut his nails – he ‘picks’ them.   The lessons If you can relate to any of these people, don’t worry. You are most definitely not alone. There are a few takeaway points here:

• Self-management can be more difficult than you think once the nail has grown into the skin. Because the edge of the nail can be so deep down there, even if you cut most of the nail, very often a small nail spicule is left that keep irritating the skin and prevents it from healing. This very often happens when the nail is ‘picked’ off.
• Don’t wait for ingrown toenails to get worse before coming in to see your Podiatrist. The longer the problem, the harder it becomes to get the offending nail edge out (though don’t worry, we’ve got all the right tools to do it).
• If you wait too long, the swelling of the toe can cause the other edge to become ingrown too because of the increased pressure from the skin.
• Performing daily activities will only get harder and you don’t have to put up with that.
• See your Podiatrist. Now. If you have an ingrown toenail.

We’re happy to say that for all of these particular cases and the many others like them, we were able to safely remove the offending nail edge and get everyone pain-free and back on their feet. For some, we did this conservatively and without anaesthetic, and for others, we performed a minor ingrown toenail surgery where we also applied a chemical to permanently stop the side of the nail from growing back. If you’re suffering from ingrown toenails, come in and see our expert team at Perform Podiatry! Proudly providing expert care to Remuera and the surrounds. Give us a call on 09 523 2333

Summer is fast approaching which means it’s time to whip out the sandals and open-toed shoes! Usually along with this seasonal change, we see an influx of particular issues and concerns flooding into our clinic. Today we thought we’d talk about a big one of these – bunions!

What is a bunion and how does it occur?

We see a fair few women (and occasionally men!) who have noticed that bump on the big toe developing and getting bigger – which for some begins to impact on the kinds of shoes they are able to fit and comfortably wear. Mostly, they’re unhappy with the way their feet are starting to look. A bunion, or as we medically call it Hallux Abducto Valgus (HAV), describes an altered alignment of the big toe joint where the long metatarsal bone points outwards and the phalanx (toe bone) points inwards towards the other toes which creates a bulge on the inside of the foot at the joint. Bunions are very much progressive, meaning they worsen over time. But once the bunion starts forming, it will likely progress unless something changes (meaning you change it!). While in the early stages a bunion may remain relatively flexible, over time the surrounding ligaments and tissues adapt, shorten and lengthen accordingly. This is why over time, the bunion can become fixed in its position.

What causes bunions?

Think of anything that squeezes the toes or puts greater pressure and force through the big toe joint – that could be a cause! Generally, bunions are thought of as having some genetic predisposition, meaning the run in the family, are more common in women than men (probably because of the tight narrow shoes), and are thought to be linked with a mechanical instability at the big toe joint. Other contributing factors include:

• Poorly fitting footwear – especially when it’s too tight across the front of the foot!
• Regularly wearing high heels
• Flat feet
• Increasing age
• History of injury to the big toe joint
• Arthritic conditions

What are the signs and symptoms?

Aside from the obvious change in appearance (protrusion) of the big toe joint, you may also experience:

• Pain at the big toe joint
• Redness
• Swelling
• Thickened skin around the big toe joint
• Pain on bending the toe
• The bigger toe pushing into the lesser toes (which may begin to overlap the lesser toes)

 How can we help treat bunions?

Because bunions get progressively worse over time, starting to work on bunions early is key! In order to know what we can do to help you with your bunions and the best course of action, we start by a thorough assessment of the joints, the surrounding structures and importantly how much motion and flexibility there is through the joint. After this assessment, we’ll be able to thoroughly explain your options and how you can get the best results. Part of the assessment will be identifying factors contributing to the progressional of your bunions, including any foot biomechanics that causes increased loading through your big toe joint, and correcting those biomechanics. We’ll also go over all your footwear and foot care needs. Just because you may currently have a bunion doesn’t mean that there aren’t shoes out there that can still make your feet look and feel great! Come in and have a chat with our friendly team today! 09 523 2333

Does your second toe seem to be looking out of place? Moving away from another toe like a ‘V’ shape? You might have a plantar plate tear!   If you can feel pain and swelling particularly beneath the second toe joint at the ball of your foot (also known as your second metatarsophalangeal joint), then there’s a fair chance you could have done some damage to your plantar plate. After all, it is thought of as being the most common cause of pain beneath this joint – though a plantar plate injury can affect any of the toes! So what is a plantar plate? A plantar plate is a thickened ligament band/structure that runs across the bottom of the toe joints at the ball of the foot, connecting the toes together. Because of this connection, it works to:

• Stabilise these joints (called the metatarsophalangeal joints)
• Resist abnormal spreading of the toes
• Resist hyperextending the joints
• Take on the loads we bear when walking so there is less pressure on the ends of the metatarsal bones themselves

  And what causes the plantar plate to get injured? The cause of a plantar plate injury can vary but is often associated with increased pressure that overloads the joints at the ball of the foot. This causes the plantar plate to be disrupted at that joint, leaving the toe to ‘pop up’ or move away from the others. Causes can include increased pressure from abnormal foot biomechanics such as flat feet, bunions or a long 2^nd metatarsal bone, among others. Non-biomechanical causes may include pressure from ill-fitting footwear or high heels and as a result of trauma. So what are the symptoms? Symptoms of a plantar plate tear may include:

• A ‘V’ shape between two toes (often the 2^nd and 3^rd toes)
• Pain at the affected toe joint
• Swelling
• The feeling that you’re walking on the bone
• Clawing of the toes

And the treatment? Treatment is specific to the degree of injury and begins by reducing the initial painful symptoms (pain, swelling). The focus is then on effectively healing and repairing the injury, stopping it from progressing to a tear of the plantar plate and minimising the risk of the injury happening again in the future! At Perform Podiatry, we are expert in foot biomechanics and sports medicine. We conduct a thorough biomechanical analysis to get a complete picture of what’s going on with your feet and the best solution going forward to ensure this doesn’t happen again! We understand that in this fast paced world we can’t stop everything when we get injured so tailor all treatments to meet your life. Give us a call and chat to our friendly team today!