SINGAPORE - Few parts of our body are treated as badly as the feet, especially when they are stuffed into very high heels or ill-fitting and uncomfortable shoes.
And while they can put up with a lot, problems can develop and the resulting toe deformity could make the simple act of wearing shoes a difficult or painful one.
The most common toe problem is a bunion, also known as hallux valgus.
A bunion is a structural deformity of the bones, which results when the big toe is angled towards the second toe, creating a bony bulge at the joint of the big toe.
A bunionette is a bunion of the little toe, which is the same problem at the little or fifth toe joint.
In many cases, however, bunions can be tolerated.
Dr Tan Ken Jin, a consultant at the division of foot and ankle surgery at the National University Hospital, said: "If you have no symptoms and no pain, you can just leave it alone.
"We correct bunions for pain, not as a cosmetic problem."
Bunions can be painful, especially if they rub against the side of a shoe and become inflamed.
They also broaden the feet, making it difficult for someone with a bunion to find footwear that fits, and numbness could occur over any of the toes, said Dr Tan.
Lesser toe deformities
When a bunion worsens, it may cause associated problems in the so-called lesser toes, such as hammer toes, claw toes and crossover toes, said Dr Tan.
"More than 50 per cent of the time, people with lesser toe deformities have an underlying reason - that is, bunions," said Dr Tan.
One such deformity is the hammer toe, so-called because the abnormal bend at the middle joint makes it look like one. From the side, it looks like an upside-down V.
There is also the crossover toe, which, as the name suggests, occurs when one toe crosses over another.
Also common is the claw toe. This is a toe that is bent upward from the joint at the ball of the foot and downward at the middle joint towards the sole, such that it resembles a claw.
"Before claw toes develop, most patients have pain under the ball of the foot. This is called metatarsalgia. Often, it precedes the clawing," said Dr Chong Keen Wai of The OrthoKlinic at Gleneagles Medical Centre.
How it happens
How it happens
It may seem obvious that poor-fitting shoes are the cause of bunions, but they are not the only culprits.
"It's not something that we fully understand but there's a genetic component to why people get bunions," said Dr Tan.
"If your mother has a bunion, there's a chance you can get it. I've seen a 12-year-old with bunions and they couldn't have been from wearing shoes."
Then, there are people who wear tight shoes, but never seem the worse for it, said Dr Tan.
Nevertheless, wearing ill-fitting shoes and arthritis (joint inflammation) have been associated with getting bunions.
Doctors also believe that people with flat feet are more prone to bunions, said Dr Tan.
But if nothing is done about them, bunions will progressively worsen over time. And they are permanent.
What the surgery entails
Dr Chong said people with toe deformities should consult a podiatrist first.
"These health-care workers can help to give advice on footwear modifications and use devices to reduce pressure on the painful areas," he said.
"These measures do not correct the deformity but they work by accommodating the deformities."
If non-surgical treatments do not bring relief, surgery may be necessary.
These days, surgery does not mean shaving down the bunion.
"That has been proven not to work as the problem will come back again," said Dr Tan.
A bunion is not like a tumour that can simply be removed, he said. "The bony protrusion happens because the big toe has shifted outward," said Dr Tan.
The bone is misaligned, so to correct a bunion, it has to be realigned. This is done through a surgical operation, where a part of the bone may be removed to straighten the big toe.
This is usually done through day surgery at a non-subsidised rate of $7,000 to $8,000.
Casts are also no longer necessary as they were in the past.
Dr Tan said: "We supply a pair of modified shoes which patients have to wear for four to six weeks.
"Some patients have gone back to work after four days wearing those shoes."
What you can do
Devices such as splints and toe separators can provide temporary relief from pain and deformity, said Dr Tan.
Otherwise, avoid wearing narrow shoes and choose shoes with a wider toe box.
While it may be hard to avoid heels, limit the time you spend in them and try not to wear high heels of three to four inches.
"With high heels, the pressure is concentrated in the forefoot. It's like you are walking on tiptoe. When you land, the foot will jam into the toe box so your toes will be squeezed together," said Dr Tan.
He added: "People with tight calf muscles walk with more pressure on the forefoot and this may aggravate the symptoms of bunions."
To do a calf stretch to relieve tight calf muscles, stand straight facing the wall. Place the forefoot of one leg against the wall while resting the heel on the floor, said Dr Tan.
Push the forefoot towards the wall and hold this position for up to 30 seconds as long as you feel comfortable doing it.
Then, repeat the exercise on the other foot.
You can do this once in the morning and once in the evening, or at least once a day, said Dr Tan.
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