Foot and Ankle Care

with Eric Malicky, Orthopaedic Surgery, Advanced Healthcare

Posted: April 1, 2004

As a surgeon who has done a fellowship concentrating exclusively on problems of the foot and ankle, Dr. Malicky has seen a wide variety of unusually built feet.

“What is amazing to me is there are some folks who will have huge bunions, curled toes or other conditions that appear to be extremely painful, but they don’t have any pain,” he said. “So what it comes down to is that you have to treat the patient for the symptoms he or she has; you don’t treat the X-ray, and you certainly don’t treat a condition that doesn’t hurt.”

Eric Malicky, M.D., Orthopaedic Surgery, Advanced Healthcare "People have no trouble adjusting their beltlines as they go through life, but they have a real problem adjusting their shoe size, even as their feet get bigger and wider."

In other words, if you’ve got lumps, bumps, corns, bunions or other irregularities on your feet and they aren’t bothering you, don’t worry. The exception to that rule is a diabetic patient.

“If someone is diabetic, has poor blood flow or an ulcer, he or she should be seen,” he said.

Foot and ankle surgery
Patients whose foot problems or ankle problems, whether caused by injury, rheumatoid arthritis, osteoarthritis, chronic painful bunions, toe deformities or neuromas, have not been eased by wearing more comfortable shoes, are good candidates for surgery.

While some ankle surgery can be performed arthroscopically, many foot surgeries are still performed using the traditional “open” method.

Dr. Malicky also warned that procedures billed as “minimally invasive” can still involve cutting through bone. He also emphasized that there are no long-term studies on whether the outcomes from the new procedures are better than existing surgical practices.

“People have the perception that minimally invasive means the recovery period will be quicker or the surgery will be less risky, however, that’s not necessarily true,” he said. “The size of the incision should not pre-operatively dictate how a procedure is done.”

Dr. Eric Malicky doesn’t mince words when the topic turns to cosmetic surgery of the feet.

“Surgery should be for pain relief, to improve function or to enhance quality of life,” he said.

In other words, don’t expect to find Dr. Malicky shortening toes or offering laser treatments to stimulate collagen production on the balls of the feet for women desperate to fit into pointy-toed stilettos.

The popularity of TV shows featuring women sashaying effortlessly through their way-more-exciting-than-the-rest-of-us lives (“Sex in the City” comes to mind) in five-inch Manolo Blahniks and Jimmy Choos has created yet another impossible standard of female beauty.

The reality is that constant wearing of high heeled, narrow-toed shoes can lead to a variety of foot problems, including bunions, hammer toes, claw toes, corns, bunionettes and neuromas.

While fewer than 5 percent of Dr. Malicky’s patients ask about cosmetic foot surgery, he takes those requests no less seriously than he does any other patient concern.

“Where there’s some kind of unusual appearance but no pain, I discourage surgery and try to teach them about sensible shoe wear and provide advice as far as foot pads or ways to buy shoes,” he said.

He also lets them know that the American Orthopaedic Foot and Ankle Society, of which he is a member, has issued a position statement regarding cosmetic foot surgery.

The risks, according to that statement, far outweigh the benefits.

“Cosmetic surgery fails to provide pain relief, improve function or enhance the quality of life during normal activities of daily living,” it states, in part. The entire statement can be found at www.footcaremd.com, a patient-advocacy Web site Dr. Malicky recommended to anyone wanting to know more about foot and ankle care.

Shoe tips
For people whose feet are otherwise pain-free and healthy, he said, the best way to keep them that way is by making sure their shoes are well fitted and comfortable.

“Women don’t just have to wear big, bulky shoes,” he said. “They can wear heels, but they should really keep them underneath an inch or two at most.”

Of greater importance, said Dr. Malicky, is the toe box, or front of the shoe. Make sure it’s wide enough to accommodate your toes comfortably. Softer shoes, with more pliable leather or other soft fabric, are also better for your feet.

But he’s not unsympathetic to those in need of the occasional fashion-over-comfort fix.

“I tell them to wear their sensible shoes during the day and the others at night,” he said.

The most important thing, however, is making sure that the shoe fits. That, he said, is an issue for both men and women, particularly as they get older.

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