A Tailor's Bunion (Bunionette) is a type of bunion that occurs on the outside of the foot at the base of the little toe. It is a prominence that may be caused by irritation of bone or soft tissue about the lateral aspect of the fifth metatarsal head. Symptoms result from shoe pressure over the bony prominence, local nerve irritation, capsulitis, or a bursa.

Tailor's Bunion is named from clothing tailors sitting with crossed legs.

There is a three to one female to male predominance. They are common in adolescents and adults. Two thirds of patients have significant pes planus (flat feet).

As far as anatomical pathology is concerned, constricting footwear over the lateral 5th metatarsal head yields pain and a bursa. There may be incomplete insertion or development of the transverse metatarsal ligament.

Hyperactive Abductor digiti minimi and Opponens digiti minimi muscles may be present. One may encounter insufficient insertion of the Adductor Hallucis muscle. One may posess a congenital wide 5th metatarsal head.

On clinical presentation, there is pain and irritation at the lateral 5th metatarsal head and prominence. An inflamed bursa may be present. Hyperkeratosis and erythema may be present over the 5th metatarsal head. The 5th toe assumes a varus attitude.

Radiological findings include rotation of the lateral plantar tubercle into a lateral position, increased intermetatarsal angle (IM)(normal 6.47degrees)-People with a tailor's bunion have an IM of 8.71 or greater, increased lateral deviation angle (normal 2.64) people with a tailor's bunion have a lateral deviation of 8.05 degrees, a large dumbbell-shaped 5th metatarsal head, arthritic changes resulting in exostosis (spur) formation at the 5th metatarsophalangeal joint, and any combination of the above conditions.

Type 1 Tailor's Bunion has enlargement of the lateral portion of the 5th metatarsal head. It approximately occurs in 27% of the cases.

Type 2 Tailor's Bunion results in lateral bowing of the diaphysis (shaft) of the 5th metatarsal. This occurs in approximately in 23% of the cases.

Type 3 Tailor's Bunion results in an increase in the 4th-5th intermetarsal angle. This occurs in 50% of the cases. Patients are most symptomatic with this type. Type 4 results from a combination of two or more of the above deformities and is frequently seen in rheumatoid arthritis patients.

Conservative treatments include wearing wide toe box shoes, debridement of lesions. Orthotics may be utilized to control pressure areas and mechanics of the foot. Non Steroidal Anti-Inflammatory Drugs may be taken. Injections may be given.

Surgical Treatment is indicated when conservative treatment fails. It is primarily indicated in special demands like sports. The goal is to decrease the width of the foot and decrease the pain and prominence of the Bunionette.

References

• Banks, Alan S. et al. McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. Philadelphia: Lippincott Williams and Wilkins, 2001.
• Fallat LM, Buckholz J. Analysis of the tailor's bunions by radiographic and anatomical display. J AM Podiatry Assoc 1980;70:597-603.

Overview

Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes.

The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth.

Athlete's foot (tinea pedis) is a common, persistent infection of the foot caused by a dermatophyte, a microscopic fungus that lives on dead tissue of the hair, toenails, and outer skin layers. These fungi thrive in warm, moist environments such as shoes, stockings, and the floors of public showers, locker rooms, and swimming pools. Athlete's foot is transmitted through contact with a cut or abrasion on the plantar surface (bottom) of the foot. In rare cases, the fungus is transmitted from infected animals to humans.

Dermatophyte (skin) infections cause raised, circular pimples or blisters that resemble the lesions caused by ringworm. The infections are named after the part of the body they infect. Tinea pedis, therefore, refers to an infection of the feet.

Incidence and Prevalence

Athlete's foot is most common in men from the teenage years to the early 50s. Prevalence is affected by personal hygiene and daily activity. People with compromised immune systems are at greater risk.

Causes

There are at least four dermatophytes that can cause tineas pedis. The most common is trichophyton rubrum.

Signs and Symptoms

There are four common forms of athlete's foot:

1. The most common is an annoying, persistent itching of the skin on the sole of the foot or between the toes (often the fourth and fifth toes). As the infection progresses, the skin grows soft. The center of the infection is inflamed and sensitive to the touch. Gradually, the edges of the infected area become milky white and the skin begins to peel. There may also be a slight watery discharge.
2. In the ulcerative type, the peeling skin becomes worse. Large cracks develop in the skin, making the patient susceptible to secondary bacterial infections. The infection can be transmitted to other parts of the body by scratching, or contamination of clothing or bedding.
3. The third type of tinea infection is often called "moccasin foot." In this type, a red rash spreads across the lower portion of the foot in the pattern of a moccasin. The skin in this region gradually becomes dense, white, and scaly.
4. The fourth form of tinea pedis is inflammatory or vesicular, in which a series of raised bumps or ridges develops under the skin on the bottom of the foot, typically in the region of the metatarsal heads. Itching is intense and there is less peeling of the skin.

People with acute tinea infections may develop similar outbreaks on their hands, typically on the palms. This trichophyde reaction, also known as tineas manuum, is an immune system response to fungal antigens (antibodies that fight the fungal infection).

Diagnosis

Diagnosis is made by visual observation of the symptoms. The podiatrist eliminates the possibility of a bacterial infection by performing a microscopic examination of skin scrapings to determine the type of fungus causing the infection. Other tests include growing a fungal culture from skin scrapings and examining the patient's foot under an ultraviolet light.

Treatment

Tinea infections may disappear spontaneously or persist for years. They are difficult to eliminate and often recur. Best results usually are obtained with early treatment before the fungal infection establishes itself firmly. Antifungal drugs may be used to fight the infection.

If the infection is bacterial, a course of oral antibiotics may be prescribed.

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.

Fungal infection of the toenails is also known as onychomycosis. It is a common health problem that many of its sufferers do not know they have because the infection can be present for many years without causing any pain.

Onychomycosis is an infection of the plate and soft nail bed under the toenail, and is caused by dirt, debris, and different types of fungi.

Fungus attacks the nail and thrives on the nail's protein matter, keratin. Once this occurs, the nail will thicken, become discolored, foul smelling, and may even detach from the nail bed or deteriorate.

If ignored, the infection can spread to other toenails, the fingernails, and the skin. Its spread could also impair your ability to walk.

Proper foot hygiene and regular inspection of the feet and toes are the best ways to prevent this condition.

You should also:

• Keep your bath or shower area clean
• Wear shower shoes whenever possible, in public showering facilities
• Wash your feet with soap and water every day
• Dry your feet well, particularly between the toes
• Always wear clean socks
• Change shoes after two days to give them time to dry out
• Use a foot powder daily
• Properly disinfect pedicure tools and do not apply polish to any nails suspected of infection
• Nails should be trimmed short and straight across
• Visit your podiatrist annually

Treatment may vary depending on the nature of your infection. Your podiatrist may devise a treatment plan that includes one or all of the following:

• Debridement (removal of diseased nail matter)
• Prescription of an oral or topical medication
• In severe cases, removal of the diseased nail

For more information on this subject, or to schedule an appointment with a footDrHorsley Podiatrist, please call (877) 372-6048

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.

Black toe is a black discoloration beneath one or more toenails. It is usually caused by trauma resulting in bleeding under the nail plate. Swelling usually occurs and the nail could fall off.

There are numerous causes for a bruised toe, or black toenail. The main reasons for this are: their feet are unstable in their shoes and they are pronating and elongating (when weight is placed on the feet they stretch longer). The second reason would be that the shoe is improperly sized and fitted and the foot is sliding forward in the shoe. The third reason is a toe box that does not match the shape of the toe region on the foot. If the toe box is too narrow in height and it actually puts a downward pressure on top of the toenails, then eventually, over a long period of time, this can bruise the toenail and also make it turn black.

It is very common with runners to see black toenails. Their feet slide forward to the front of the shoe and the ends of the toes hit the front of the toe box of the boot. This can push the toenail backwards and bruise the root area from which the nail grows (the matrix).

The toenail will progressively turn black until it falls off, and a new toenail will start to grow underneath the old bruised toenail. This can take up to three to six months. If bleeding and pressure continues to build beneath the nail it is recommended that you seek the help of your podiatrist.

For more information on this subject, or to schedule an appointment with a footDrHorsley Podiatrist, please call (877) 372-6048 (Toll Free)

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.