A bunion is a deformity causing an enlargement of bone on the side of the foot just behind the big toe. There is usually also a deviation of the big toe which may lean against the 2nd toe or cross over or under this toe. They can develop slowly over years. However, the tendency to develop a bunion can be present at birth. Frequently bunions are hereditary as other members of the family may have similar problems. Arthritic changes or injury can also cause them. Footgear could easily increase the deformity but rarely are the only cause. It is severe shoes that usually makes the condition more painful in women.

Although bunion surgery is the most common first thought of treatment for this condition, there are also many other ways to aid a patient suffering from a painful bunion. Shoe changes as well as custom made shoes are possible for those people who are not surgical candidates. Anti-inflammatory medications can also be used. Most importantly, getting to the cause of the bunion, which includes abnormal foot function, is critical. Without treating this underlying abnormal foot function the possibility of return of bunion after a surgical procedure is considerable. Treatment options, therefore, can also include the fabrication of custom made orthotic devices to be worn inside shoes to change the way the foot functions. Orthotic devices can be used prior to surgery in attempt to reduce discomfort non-surgically, or after a surgical procedure to help maintain the result.

Unfortunately, bunion surgery is the only way to eliminate the deformity and to return the foot and the joint to a more normal function and appearance. Bunion surgery however is not one simple procedure. There are a variety of procedures that can be used to correct a bunion and evaluation of x-rays is one key to determining the best form of surgical correction for any given patient. In our office we do the very best to explain to the patient their condition, the type of correction that would be necessary, and the extent of discomfort or disability that the patient may experience following a bunionectomy.

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A build up of hard tissue over a joint or bony enlargement in the foot can be quite painful. Your body attempts to build up this tissue trying to protect itself from forces of pressures from either the shoe, ground, or shearing forces from abnormal foot function. Corns and calluses can develop at almost any age. These conditions are caused by pressure coming from two directions at the same time. One direction is most frequently either the ground or the shoe itself. The other direction of force usually comes from the underlying bone structure. The normal process of aging as well as excessive activity and sports can also reduce the protective padding of the foot allowing more pressure on the underlying bony structures and creating corns and calluses.

At times these underlying bone deformities may be very obvious as in the case of hammertoes, and at other times less obvious as the bone structure may be well inside the foot. Fortunately there are multiple forms of treatment for this condition.

Reduction in the thickness of this abnormal tissue can produce significant relief. Unfortunately this relief is usually short lived and therefore the patient who uses this form of treatment becomes a more regular patient for this care. Changes in shoes or activity or protection from the forces creating the pressure can also help relieve discomfort. At times, surgical treatment is necessary to move, remove, or reshape the bony abnormality causing the condition. These surgical procedures can be very simple and can be performed in a surgical center allowing the patient to return home immediately. For some conditions surgery can even be performed in the office.

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Problems with nails including thickening, discoloration and ingrowing are some of the more common conditions seen by podiatrists. These conditions can be one-time conditions created by shoe pressure or inappropriate cutting of the nail. However, nail is produced by a group of cells called the nail matrix which lies behind the nail plate itself. This nail matrix can become deformed or abnormal, therefore producing a nail with abnormal shape. Since this nail does not get along with the shape of the toe, ingrowing and infection can result. Fungus is also an extremely common problem involving nails especially in Florida, and can be more common in diabetics and patients with reduced circulation to their feet.

Treatment for nail problems varies. For some patients with conditions not allowing more aggressive care such as diabetes and poor circulation, routine cutting of the nail may be the best form of treatment. Podiatrists are uniquely trained in this area and have a large amount of experience in performing nail care safely and efficiently. Medications both oral and topical are available to treat varying types of nail disease especially fungus.

Surgical treatment of ingrowing nail can include a simple procedure such as removal of the offending portion of nail which produces a significantly longer period of relief than just regular nail cutting, but podiatry also affords the patient the capabilities of a fairly simple non-disabling procedure which allows us to remove any amount of nail and destroy the cells that makes the nail grow. This produces a permanent elimination of the nail problem. This procedure can usually be performed in the office under local anesthesia and carries with it little or no discomfort. With the exception of the need to wear an open shoe the patient can usually return to work or school the next day.

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Surprisingly, heel pain is the most common condition seen by podiatrists today. Although x-rays may reveal a heel spur it is important for patients to understand that heel spurs are the result of their problem and not the cause. The spur, which can be seen on x-ray, points forward at the toes and not downward at the ground.

Below the surface of the skin on the bottom of the foot there is a very firm piece of tissue known to doctors as the plantar fascia. This fascia stretches from just in front of the weight-baring surface of the heel forward to the ball of the foot. Patients who may be carrying more weight than they should being either over weight or in an occupation that requires carrying weight, are more prone to this condition. In addition, abnormal foot function which increases the distance between the heel and the ball of the foot will pull on the fascia creating inflammation When the foot is not weight baring this fascia has an opportunity to heal and this is the reason that patients with this condition are more likely to have more pain 1st step put of bed in the morning or after periods of rest.

This condition, commonly known as plantar fasciitis, can be treated in a large number of ways. It is our desire to present to you many possible treatments both surgical and non-surgical for heel pain and come to a decision of the type of treatment that would best suit your needs. I am a great believer in using surgery as a final resort and not a first form of treatment for this condition. Custom made orthotics, which prevent the elongation of the foot, can be extremely effective at eliminating this pain without the use of surgery or medications. In the acute stages of the condition both oral and injectable anti-inflammatories are available to produce temporary relief of pain. As time progresses patients will hear more and more about extra corporeal shock wave therapy. This is the use of a machine, which attempts to strengthen the bond between the plantar fascia and the heel bone. Although not always completely successful this type of therapy has the advantage of being totally non-invasive not requiring any incision into the foot at all. Recovery time is greatly reduced. Dr. Blass is certified and trained in the use of one of the best shock wave therapy machines, the Ossitron.

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A neuroma is a fairly common condition which results from inflammation of the nerve that supplies the toes. Frequently there is a lump of tissue surrounding this nerve which increases the pressure and causes the discomfort. Compression of the foot side to side, standing on the ball of the foot, squatting and high heel narrow toed shoes can increase the discomfort.

The discomfort caused by a neuroma can be surprisingly varied. Some people get tingling, numbness, or shooting pains into the toes. Others feel a sharp burning or tingling on the bottom of the foot. Many of them can actually feel the mass or feel a clicking sensation or a lump in the ball of the foot.

There are a large number of treatments for neuromas. In many cases a neuroma can respond to injection therapy to reduce the inflammation There are also injections available in an attempt to shrink down the size the mass. Orthotics once again can be an effective way at reducing the force on a neuroma and produce some relief. A variety of surgeries for neuromas including removal of the mass is also available. Once again this is a surgical procedure that can be performed in an outpatient surgical setting.

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Diabetes is a systemic disease. It affects both circulation and nerve supply. It is an extremely common condition, which is becoming more and more common as years go by. Diabetes can cause nerve and circulation problems in the foot which can lead to rather grave consequences including ulceration, infection, gangrene, and amputation.

The best offense against diabetes is a good defense. Learning how to prevent injury to the foot and simple daily methods of observing the foot and caring for the foot of a diabetic can greatly decrease the risks involved. It is our desire to educate our patients with diabetes to avoid problems.

Custom made or therapeutic shoes can also be very effective in avoiding injury to the foot. In recent years Medicare has realized this and in many cases will actually pay for custom-made shoes and or inserts for Diabetes. If the condition causes nerve or circulation damage routine care, which is normally not covered by Medicare, is covered for the Diabetic patient with these problems. Dr. Blass will work with your family doctor or Endocrinologist to improve your mobility, decrease your discomfort and decrease the possibilities of complications.

The smallest opening in the skin can lead to larger and more serious wounds or infections. These conditions are best treated as early as possible. Dr. Blass is trained in wound care and management and is closely linked to other providers in wound care centers and vascular surgeons who can revascularize a foot. Diabetics should be cautioned to avoid barefoot walking and the use of medicated corn pads or corn removal products. These products contain an acid, which can create significantly more damage than the conditions they try to treat.

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Many patients visit a podiatrist with a primary complaint of flat feet. Interestingly enough this term is frequently improperly used. A true flat foot is flat whether it is on the ground or in the air and this foot rarely has extensive problems early in life.

The far more common condition is a foot that has an excellent arch when it is not standing, however, that arch rolls over and flattens or lowers when the patient is on their feet. This condition can cause foot fatigue, leg fatigue, low back pain and a variety of localized conditions including corns, calluses, and aggravations of preexisting conditions such as bunions. Tendonitis, joint changes, and overall fatigue can be caused or aggravated by this excessive pronation, making it one of most damaging common foot problems.

The best form of treatment for this problem is a custom made arch support or orthotic to be worn in shoes. Although orthotics are available in pharmacies, shoe stores, magazines and the internet, the problem with these devices are all basically the same. Most of them are flexible and therefore will not support the average patient, they are purchased in shoe sizes which makes the clearly wrong supposition that everybody who has the same size foot has the same problem. They are also purchased as a pair and it rare that a patient has 2 feet that are identical. For this reason the best form of orthotics are custom made to full examination and plaster casting molds taken of each foot. This has always been one of Dr. Blass’ favorite forms of treatment for patients as it can produce extensive relief for a patient without creating disability. We can frequently avoid pills, injections, and surgeries. Although orthotics are not guaranteed, the success rate for many podiatric conditions is very high. Standard orthotics are made to be worn in more sensible shoes, but there is the possibility of creating orthotics that can be worn in almost any type of shoe including the possibility of fabrication of a custom made sandal.

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Many conditions that if left untreated can cause problems in adults can be seen and treated in their early stages in children. The normal process of growing is not painful and therefore, foot or leg pain or abnormal walking patterns deserve an examination by a podiatrist. Many problems that we are told will be outgrown as children age, do not disappear but produce problems in later life.

Most commonly, one thinks of foot care in children as involving the care of ingrown toenails or warts. Although we are thoroughly versed in the multiple forms of treatment for warts and ingrown nails, we strongly feel that many of the problems that occur in later life can be prevented if caught early enough. Orthotics which have been discussed in other sections of this web site can be exceptionally effective in children. As a painless method of treatment they are usually well tolerated by children. Dr. Blass has worn orthotics since childhood and his own son, now 6 feet tall, has been wearing orthotics since he was three years old and he still benefits from them today.

Although children unfortunately will outgrow orthotics, the laboratory that we use offers an insurance plan which makes this financially feasible for the average family. Foot conditions start at an early age and Dr. Blass is more than happy to examine children of any age in attempt to delay or avoid future problems.

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There are 26 bones in each foot and multiple joints, tendons, ligaments, and muscles all of which can be damaged by injury. Rapid diagnosis and treatment can often be the difference between a short term problem, and long term pain and disability created by delay.

Full x-ray facilities are available in each office as well as the ability to use a variety of treatments from minimal splints to casts or surgical correction if necessary. Patients have rapid access to scanning and MRI evaluation using the best of facilities through University Community Hospital and other imaging centers.