Hands & Feet, Fingers & Toes
We certainly put our hands and feet through their paces. We pound pavements and keyboards and rely on our digits for almost all our daily activities. But even a tiny blister on a heel or a painful corn between the toes can stop us in our tracks. Not to mention that carpal tunnel or a case of trigger finger that can seriously affect our ability to work.
corns & calluses
These husky things are basically the same, explains Dr. Katie Hoang, a podiatrist with Foot Healers Podiatrist Clinic, except a corn usually has a nucleus and is on the toe rather then elsewhere on the foot. Both are caused by pressure. “The body protects itself from pressure by putting down tissue as a buffer,” Hoang says. This could occur where the shoes rub, where toes rub together, or on the tip of a hammer toe. Older feet are more prone because there tends to be less fat on the bones, she says.
Although the tissue is dead and corns and calluses typically don’t bleed, they can be painful, and Hoang cautions that care should be taken with home remedies. She does not recommend over-the-counter callus removers because these contain acid, which can cause ulcerations. A pumice stone or emery board can be helpful, and a doctor’s office can ‘shave’ a callus or corn with a scalpel in a matter of minutes. But unless the deformity that is causing the problem is addressed with something like hammer toe surgery or bone spur removal, calluses and corns likely will reoccur. At the very least, wearing wider shoes with a bigger toe box can minimize discomfort.
Bunions are a common problem when it comes to feet, and the deformity is hereditary, says Dr. Michael Horwitz, CEO of Feet for Life Podiatry and SafetyFix Medical Technologies. The problem is exacerbated by tight shoes, and although a bunion’s impact can be lessened by shoe-stretching, sometimes surgery is necessary. Bunions occur most often at the great toe joint. “When the toe flexes, there’s a jamming effect, which creates a painful ache when you walk,” Horwitz explains.
While many shoe repair stores can stretch most shoes, Horwitz says surgery to correct bunions is relatively simple. “Done through a small incision, the bone is cut in a very exacting manner and repositioned so that there is no longer any prominence,” he explains. Although hardware isn’t always necessary, in many cases a screw is implanted. “In the past, the hardware has been left in the foot,” Horwitz says. “But we don’t really know what the long-term effects are of having metal in the body. The good news is that the latest treatment can involve a removable screw.” Recuperation time is minimal; a patient can be back in tennis shoes after three weeks, he says.
Although in severe cases, swollen feet can be a sign of something serious, most swelling is benign and, according to Dr. Matthew Breeden, SLUCare physician, comes from age-related ‘venous insufficiency.’ “As we get older, our veins have more trouble getting blood away from the extremities,” Breeden explains. While arteries have their own muscles to move the blood through, veins rely on nearby skeletal muscles. And although veins have valves to stop blood going back down, Breeden says the valves tend to lose their integrity with advancing years.
This problem is made worse if a person is on their feet all day; pregnant women and overweight people also are more prone. “Blood pools,” Breeden says, “but swelling can be alleviated quickly by simply elevating the feet.” He says there isn’t much truth to the idea that eating salty foods causes puffy feet, unless there’s something else going on that relates to either heart or kidney function.
Breeden cautions that swelling to the extent that putting on shoes is difficult, or swelling that reaches up the calf toward the knee, needs attention. “In the worst case, these can be signs of heart failure or liver disease,” he says. “And if the swelling is accompanied by chest pain or shortness of breath, you should see a doctor immediately.”
Dr. Michael Weiss, a podiatrist at Washington University School of Medicine, cautions that chronic venous insufficiency can lead to chronic venous disease. This condition is marked by enlarged veins, skin discoloration and skin ulcers. “The longer swelling hangs around, the worse it is,” Weiss says. He recommends compression socks, which can be bought from medical supply stores, he says, or—in the case of extra snug varieties—prescribed by a doctor. “The sock needs to act like your muscles and keep the flow of blood from going back down,” he says.
Weiss stresses, however, that it’s important to determine if one or both feet are swollen, since swelling in just one could indicate either a broken bone, or—more dangerous—a clot in a calf. “A clot needs to be addressed right away,” he says, “because 10 percent will move up to the thigh, and half of those will go up into the lungs.” He adds that warmth and tenderness on the back of the leg could indicate a clot, but a true diagnosis can be made only with a venous Doppler ultrasound.
Stenosing tenosynovitis, or trigger finger, is caused by any work or hobby that requires repetitive gripping or grabbing. It can affect the thumb and the middle and index fingers, and in severe cases, results in the digit getting stuck in a bent position.
Dr. Daniel Gruener, medical director of St. Louis Clinical Trials, says a finger can stay locked indefinitely, or can be snapped back, “popping like the trigger of a gun.” The condition, he notes, is a result of inflammation of the tendons. “Usually, a tendon glides smoothly through the sheath of tissue that covers it, but if the sheath becomes inflamed, it causes scarring and thickening, impeding the tendon’s passage,” he explains. “The popping or clicking sound is the tendon being drawn through the blockage.”
Gruener says he blames the increase in cases on technology—specifically keyboard use and scrolling over smartphone screens. Women are more likely to suffer than men, but Gruener says it’s not known why. Diabetes is a risk factor, as well. And if you have trigger finger once, you are more likely to have it again. In severe cases, surgery is necessary. However, there are effective measures that can help avoid the need for surgery. The first thing Gruener recommends is to rest the finger for three or four weeks. During that time, ice it or soak it in warm water daily and wear a night splint to keep the finger straight. Physical therapy exercises can help loosen a thickened tendon sheath, and anti-inflammatory drugs like Aleve and Motrin can lessen pain. Ninety percent of patients, Gruener says, benefit from steroid injections. (For diabetics, that number reduces to 50 percent). ‘Percutaneous release,’ meanwhile, uses an inserted needle, guided via ultrasound machine, to break apart the blockage. “It’s not as bad as it sounds,” Gruener says.
Surgery, as a last resort, is an outpatient procedure involving local anesthesia and a small incision at the base of the finger.
carpal tunnel syndrome
Contrary to popular belief, Dr. Shawn Kutnik of Archway Orthopedics and Hand Surgery, says increased computer use is not at the root of carpal tunnel syndrome. “There is some argument among our ranks, but there’s no research that backs it up,” he says. The carpal tunnel is a thick, fibrous passageway of ligaments and bones at the base of the hand that houses the median nerve. When this nerve is compressed, Kutnik explains, there is increased pressure, which causes numbness and tingling in the thumb, middle and index fingers. In the condition’s early stages, this happens more often at night, causing the hand to ‘fall asleep.’ As it progresses, the symptoms occur during the day as well, eventually leading to a deep ache at the base of the palm, with pain radiation to the fingers and up the arm.
Women are three times more likely than men to have the syndrome (possibly because the tunnel itself is smaller), and those with diabetes and autoimmune and endocrine disorders also are more prone. Again, there’s increased risk among those who do a lot of gripping and lifting, but Kutnik says still, 40 percent of sufferers have no contributing risk factors.
The good news is that a simple wrist splint worn at night can be an effective solution, and if surgery is required to relieve pressure on the nerve, it’s a simple 15-minute procedure done with a local anesthetic or regional block. “I do thousands of them,” he says.