As more people experience painful problems with their feet, podiatrists are recommending they consider a range of nonsurgical treatments before choosing to go under the knife.
Many patients have a misconception that most foot ailments can only be treated with surgery, experts say. Instead, depending on the severity of the problem, nearly all foot ailments can be treated without surgery, they say. Among these are bunions, plantar fasciitis, hammertoes and metatarsalgia, or pain in the ball of the foot.
Treatment techniques include ultrasound-guided injections that deliver anti-inflammatory drugs to the precise site of the pain and shock wave therapy that promotes soft-tissue healing. Some treatments, such as insoles that redistribute the pressure on the foot and physical therapy, aim to address the cause of the foot problems, which can help prevent them from recurring.
“I think people come in wanting surgery because they want a quick fix and want to be back to normal,” says Norman Turner, an orthopedic surgeon at the Mayo Clinic in Rochester, Minn. “Unfortunately, in most cases surgery isn’t a quick fix because it can take just as long, or longer, to get back on your feet.”
When Floria Antell, 76, developed a bunion on her left foot two years ago, her podiatrist suggested a surgical procedure that involved cutting out part of a bone in her foot and resting for eight weeks. But Ms. Antell, who does Pilates three times a week and walks her dog 2 miles a day, didn’t want to spend months on the couch.
Another physician referred her to the Nonsurgical Foot and Ankle Service at New York’s Hospital for Special Surgery. Rock Positano, the director of the clinic, told Ms. Antell to wear wider shoes. He prescribed custom foot insoles intended to relieve the pressure on her bunion and help correct her flat feet, which he says were making the bunion worse. Dr. Positano also gave her anti-inflammatory medicine and shock wave therapy. Ms. Antell says she didn’t have to give up her daily walks and exercise regimen and after six months of treatment considered herself “fully healed.”
“It was so important to me that I didn’t have to be in bed for months, but I also learned how to take care of my feet better,” Ms. Antell says.
Doctors say foot ailments are becoming more common, especially as the population ages and people remain physically active for more years. “Just compare what people in their 60s and 70s do today with what our grandparents did when they were that age,” says Dr. Turner, of the Mayo Clinic. Walking on hard surfaces, such as concrete, is hard on the joints, and the growing incidence of obesity creates more wear and tear, he adds.
All surgeries carry risks of complications, such as infection, Dr. Turner says. And even when nonsurgical treatments don’t fully fix a problem, they often delay the need for surgery, which is helpful because some surgical procedures don’t last forever, he adds.
Artificial ankle replacements, for example, can wear out. And problems like bunions can reappear years later if the cause, which is often linked to poor walking patterns, isn’t corrected.
Foot insoles and physical therapy are generally the first line of treatment, says Dr. Positano. Many issues stem from what he calls a “pathological foot type,” such as flat feet or too-high arches, which cause people to put too much pressure on parts of the foot.
Foot insoles, or orthotics, can change the foot type by putting stresses in different areas, balancing it differently or working as a cushion. Ankle braces are also frequently used temporarily to take pressure off the ankle.
A type of shock wave therapy called extracorporeal pulse activation treatment, or EPAT, is increasingly popular in the world of sports medicine and is now often used for foot problems like plantar fasciitis, tendinitis and shin splints. During the procedure, the doctor applies gel to the affected area and massages it with a special wandlike device that delivers acoustic pressure to the area and stimulates the blood flow to accelerate healing of injured tissues.
For issues such as arthritic big toes, ankle problems and heel pain, ultrasound-guided injections are another option. “The ultrasound-guided injections are very precise,” making the treatment more effective, Dr. Positano says.
Physical therapy is helpful both as treatment and for preventing ailments, Dr. Turner says. Touching the toes and stretching the Achilles tendon and hamstring keep the body limber and ward off injuries. Something as simple as standing on one foot at a time strengthens balance, which will minimize the tendency to roll and create ankle strain.
To keep the foot itself flexible, Dr. Turner recommends people trace the letters of the alphabet with their feet. In the course of making the shapes of A to Z, the foot will go through the entire range of motion.
Another popular strengthening exercise uses TheraBands, the resistance tool popular with athletes and dancers. People should sit on the floor with their legs straight out in front. Wrap a TheraBand around the sole of the foot then flex and point. Moving against the band’s resistance is good for the muscles in the sole and the top of the foot.
Christopher Hubbard, chief of the foot and ankle service at Mount Sinai Beth Israel in New York, says roughly 90% of common foot ailments can be treated without surgery.
“There are some issues, like tendon tear, that lead to a progressive deformity with the foot that needs surgery,” he says. “But even in these cases, there is almost always some issue that can be treated initially through nonsurgical means.”
By Angela Chen, September 1, 2015
Original source: National College of Physicians Journal of Medicine