Ask the Doctors May 2018 Issue

Ask The Doctors: May 2018

Dr. Steven Maschke

Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

Q: What should I do about my bunions? Should I have surgery?

A: Bunions, which are very common, can be annoying, painful and affect your ability to do activities. Just because you have a bunion doesn’t mean you should rush to get surgery. Don’t ignore it either. Left untreated, a bunion can lead to other foot deformities.

With a bunion, the big toe bends toward the second toe, creating a bump at the base of the toe. The bump can turn red and swollen. Certain medical conditions, such as rheumatoid arthritis, can raise your risk for developing bunions. The most common culprit is osteoarthritis in the joint at the base of the toe. There often is a genetic component to getting bunions. You may have inherited a foot shape and biomechanics that put excess pressure on the big toe.

We recommend seeing a podiatrist who can make an evaluation and help with nonsurgical measures. Properly fitted shoes and shoe inserts with arch support are the place to start. Shoe size and width can change with age, so make sure your shoes are the right size. Choose shoes that have a good heel counter and room for a shoe insert.

Every time you take a step, you put about one-third of your body weight on the long bones in the middle of the foot that connect to the bones in the toes. Using a shoe insert with arch support can more evenly distribute your weight off the bunion area. You can get shoe inserts in a drugstore or have them custom made. A shoe insert can be modified with a soft pad or bar under the ball of the foot to take more weight off the toe, which helps some people.

You can also get pads that fit between the toes to separate them or a sleeve that goes over the bunion to decrease friction.

Q: I have osteopenia and I know I should be getting more calcium. I’ve had a kidney stone. Will calcium make me more likely to have another one?

A: There are different types of kidney stones. Most are made of calcium, so it might seem like consuming a lot of calcium would lead to kidney stones. It’s not that simple.

The kidneys filter waste products and eliminate them in urine. One of those waste products is oxalate, a naturally-occurring substance found in many foods. If there’s not enough liquid in the kidneys, oxalate can bind to calcium and form a hard crystal (kidney stone). One of the most important ways to prevent kidney stones is to drink plenty of water. If the kidneys have enough liquid, oxalate and other waste material is flushed out before crystals can form.

Surprisingly, consuming dairy products may actually help prevent kidney stones. This is because the calcium in these foods will bind to oxalate while still in the stomach and intestines, before reaching the kidneys. They are then excreted and less likely to form stones. This works best when you eat calcium-containing foods along with those with oxalates.

Some evidence suggests that calcium supplements may slightly increase risk for kidney stones, although this is controversial. If you do use a calcium supplement, take it with a meal, and choose calcium citrate over calcium carbonate. Citrate (also found in citrus fruits) inhibits crystal formation.

Other advice for preventing kidney stones includes limiting intake of salt and animal protein. If you’ve had a kidney stone, shy away from foods high in oxalates (such as beets, spinach, Swiss chard and buckwheat flour). Don’t eliminate all oxalate-containing foods because most of them are part of a healthy diet.

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