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Dr. Brandon Macy
Podiatrist - Clark, NJ
1114 Raritan Road
Clark, NJ 07066




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By Brandon Macy, D.P.M.
September 11, 2014
Category: Foot Pain


It seems like almost everybody has or knows somebody who has a foot problem: bunions, hammertoes, corns, calluses, ingrown toenails, heel pain, arch pain, warts, ingrown toenails, athlete’s foot, fungal toenails, tendonitis, arthritis, gout, neuromas and more.  Many people “know” or think they know these problems were caused by things such as tight shoes, worn out shoes,  weight gain, working on their feet all day on hard floors, having a preference for being barefoot —all things that they can or wish they could control.

In reality, these types of factors are more aggravating or complicating factors—triggers for a problem or issues that make a given problem worse or more difficult to treat.  What is more common is that many problems were destined to occur or were “accidents waiting to happen” based on an underlying condition.  The key to knowing how to treat a given problem is to understand why it is there in the first place.  Let us look beneath the surface.

Athlete’s foot is a fungal infection of the skin.  We’re all exposed to fungus, even if we don’t go to public pools or locker rooms at health clubs.  Living in the same household, some alwill get it and others not.  Why?  Likely an inherent resistance or susceptibility in our immune systems: genetics.

Gout is an arthritic disease where dietary and other factors can trigger an acute arthritic attack on a given joint.  The body has a difficult time processing food rich in purines, resulting in elevated uric acid levels: genetics.

A majority of the other lower extremity problems are also genetically related, but in a different way.  Each of our bodies is a “walking machine”.  The engineering design of our entire skeleton (not just the feet) is what determines how and how efficiently we walk or run.  The architects, engineers, and construction workers who built these “walking machines” were our parents.  Yes, something else to blame or credit them for.  We stand, walk run and function biomechanically according to how we were built by our parents.  Of course, serious injuries and other external issues can change things, but it all starts with how we were built.

Feet that are unstable or flatten out too much can lead to a large percentage of our problems and deformities:   BunionshammertoesPlantar Fasciitis (heel spurs)Achilles tendonitis, and more occur as a direct result of biomechanical abnormalities. 

Patients often wonder why a problem occurs on one foot and not the other.  Asymmetrical deformities often happen because the body is asymmetrical, something we’ll usually notice in people with a curvature of the spine (scoliosis) which results in a tilt of the pelvis that causes one leg to act as if it is longer than the other. Asymmetrical foot function is the result.

Ingrown toenails?  Very often in patients who have bunion deformities, the big toe squeezes against the 2nd toe and over time, there is pressure on the side of the toenail to curl in  or get irritated with a lot of walking. Gait is also altered so that the other side of the nail gets chronic pressure with walking. 

Thickened and/or fungal nails?  Injury to the toenail, which can sometimes be chronic in nature due to the toe naturally bending up or from a bunion deformity can cause the nails to be damaged.  Such damage can cause the nail to thicken and often become a portal of entry for fungal infections.

Many patients have said to me that they believe their bunions and hammertoes were caused by wearing shoes which were too tight.  They have it backwards.  Bunions are a cause of tight shoes.  These deformities happen because of instability of the feet when standing or walking.  Not quite flat feet, but excessive flattening of the feet when you stand.  The metatarsal bone behind the big toe and often the 5th toe can’t hold their position and spread outward. The joint buckles sideways, resulting in a bunion deformity.  If the shoes were too tight, the deformities couldn’t happen, but once the deformities develop, that part of the foot takes up more room in the shoe. Remember, tight shoes don't cause bunions, bunions cause tight shoes!

The same applies in the case of hammertoe deformities.

Biomechanical issues are also responsible for arch pain, plantar fasciitis, heel spurs and much of Achilles tendonitis.  Why?  Because the feet don’t function efficiently when not built properly in the first place, the result is excessive strain placed on the muscles, ligaments and tendons in the foot and ankle.  These structures are just waiting for the trigger, the proverbial straw that breaks the camel’s back (or foot, in this case). This faulty engineering can also be at the root of a great deal of knee, hip and back pain.

There are many more foot problems which can be traced back to these biomechanical issues such as Calcaneal apophysitis (Sever’s Disease) in pre-teens, chronic ankle sprains, chondromalacia in the knees, corns and calluses are examples.

Once we can determine the underlying causes for these problems, successful treatment becomes much more likely.  Correcting a bunion surgically without addressing the faulty foot function reduces the deformity and relieves pain, but does nothing about why the bunion developed in the first place.  The same for a cortisone injection given for plantar fasciitis, or paring down corns and calluses.  More often than not, the use of prescription orthotics is what is needed to deal with the root cause of these problems.  Sometimes orthotics are the primary treatment, other times there’s treatment of the immediate problem and the orthotics work to deal with long-term treatment and prevention of recurrences.

In the coming weeks, we’re going to publish a series of short articles about a number of foot conditions:  “Where Did My _______  Come From?”  In each, we’ll get specific about the cause of the problem and then it will be easier to understand the treatment plan that provides the best results.

As always, if you have questions regarding a foot problem, check out our website www.clarkpodiatry.com for information.  You can ask a question or request and appointment there or by calling our Clark Podiatry Center office at 732-382-3470

Brandon Macy, D.P.M.

Clark Podiatry Center


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1114 Raritan Road
Clark, NJ 07066

Podiatrist - Clark, Dr. Brandon Macy, 1114 Raritan Road, Clark NJ, 07066 732-382-3470