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Foot Care Q&A: Part 1

by Joy Pape, RN, BSN, CDE, WOCN, CFCN

6. What is the treatment for bunions?

Bunions occur when the big toe angles in toward the other toes, causing the joint at the base of the big toe to protrude. The resulting bump at the base of the big toe can make it difficult to find shoes that fit. Bunions can also be painful and interfere with walking.

Dr. Wu: In general, we advise patients to switch to more comfortable footwear, specifically with a wider toe box. Pointed and high-heeled shoes are not recommended, because both force the bunion to rub against the front part of the footwear. Arch supports or other forms of orthotics that transfer force off the area of the bunion can also be helpful. People who develop corns and calluses from bunions may want to see a foot doctor to have them trimmed and may benefit from toe padding to help prevent further irritation. There are numerous bunion splints and toe straighteners on the market. If the bunion is stiff and rigid, a splint will have little to no effect, and surgery is usually indicated. If the bunion can be straightened, a bunion splint and toe straighteners will help a little more, but the bunion will return very quickly after the splint is removed, and there is no evidence to support the long-term success of bunion splints.

Dennis Janisse: The solution for bunions is the same as that for hammertoes: wearing proper footwear. There are always surgical solutions for these. I’m not sure why people would opt for that, but they do.

Dr. Beauchamp: Bunions are treated based on a comprehensive evaluation. The degree of the deformity, level of pain, cosmesis [desire for a more normal appearance of the joint], and whether a person is an appropriate candidate for surgery all enter into the decision-making process for bunion treatment. Wide footwear, orthotic therapy, padding and splinting with periodic care, surgery, as well as no treatment at all can be appropriate forms of therapy based on the individual’s symptoms and needs.

Dr. Scheffler: These, like hammertoes, increase the risk of getting a wound. Treatment strategies are surgery, wearing properly fitting shoes, and/or pads.

7. What do you recommend for diabetic peripheral neuropathy?

Diabetic peripheral neuropathy is nerve damage in the feet, legs, hands, and/or arms due to diabetes. Typical symptoms of peripheral neuropathy include numbness, tingling, a pins-and-needles sensation, and pain.

Dr. Beauchamp: Diabetic neuropathy can be a very difficult problem to treat. I start all my patients off with the two mainstays of all diabetic therapy, diet and exercise. Once blood glucose is under control, I will first try something like Metanx [a nutritional supplement sold by prescription]. This has helped some of my patients with mild to moderate symptoms. I like that I’m not introducing anything more than a vitamin complex, which is less likely to interact with other medicines, of which older people tend to be on more and more. If that doesn’t work, I’ll move them to Lyrica [pregabalin, a prescription drug approved to treat diabetic nerve pain] and notify their family practice doctor about what we’re doing. Most have been very helpful working in conjunction with me in trying to solve their peripheral neuropathy.

Dr. Wu: There is really no cure for diabetic peripheral neuropathy, though patients who have it can minimize the problem by keeping their blood glucose level under control. Antidepressants or anticonvulsant medicines are sometimes used to help reduce pain and discomfort. More recent medicines that are FDA-approved for diabetic peripheral neuropathy include pregabalin (an anticonvulsant), and duloxetine (brand name Cymbalta, an antidepressant). However none of these treatments improves sensation in the feet.

Dr. Smukler: When it comes to pain, I used to use capsaicin [sold as an over-the-counter ointment or cream], but there are better [prescription] medicines and creams now, such as Voltaren Gel (diclofenac, a nonsteroidal anti-inflammatory drug), Lidoderm (lidocaine patches), and Flector Patches (another form of diclofenac). Physical therapy can be helpful. Heat can be helpful, but it’s not something patients should do on their own. They need specific recommendations and supervision from their health-care provider, because if you have peripheral neuropathy, you are at risk for not feeling the heat and getting burned.

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