Bunions-Part 3 Treatment

Posted by on Monday, September 19th, 2011

Drs Geldwert,  Lai and Minara have over 60 years of combined experience successfully repairing bunion deformities.

There are 3 basic approaches to caring for bunion deformities.First is benign neglect. This involves wearing the most comfortable shoe that can possibly be tolerated with any degree of comfort. It also involves limiting one’s activity to those which are reasonably tolerated without pain.This is a perfectly acceptable way  of dealing with a bunion deformity as long as the individual is willing to live within the constraints that are applied.The second step involves active participation of the individual in caring for the sequelae of the bunion deformity.The most important thing is to get properly fitting shoes that accommodate the foot of the foot adequately. Invariably the heel will be loose and this needs to be adjusted or fixed by a shoemaker. Secondly, a pumice stone should be used on the calluses every day or every other day before getting out of the bath or shower to keep them under control so that the normal skin around them does not become painful when it is squeezed against the calluses. An over the counter insole or custom made orthotic may be appropriate at this stage. The orthotic would be used to help substitute ,in part,for the function of the plantar fascia.The third alternative is surgical correction of the deformity. Although there are well over one hundred procedures described to treat bunion deformities, there are certain basic guidelines that must be followed no matter which procedure is used. In treating any joint and bone deformity, the joint surfaces must be re-aligned. The bones must be re-aligned to do this.This means that the bones will need to be cut and re-aligned.The normal capsular balance must be fixed which means that the loose ligaments on the inside of the toe  joint will need to be tightened and the tight ligaments on the outside loosened. Also, the tendons must be re-aligned. If any one of these steps is not done, an incomplete repair may very well result. This can lead to a quick recurrence of the deformity.The decision as to whether to have surgery or not is a difficult one for any individual to make. There are several guidelines that are important. First,one should have tried conservative means for relieving the pain associated with the deformity.The decision to have surgery should be made only after the individual feels that his or her daily activities are being limited. This means that the individual can no longer wear the shoes that he or she wants to wear without pain and is not able to participate in activities that he or she wants to because of the discomfort associated with the deformity. It is important to remember that the deformity gets progressively worse with age. There is no advantage to delaying surgery once the deformity has progressed to the point where it interferes with the activities of daily living. As the deformity progresses, the surgery becomes more and more difficult. The potential complications increasesas the deformities get worse. The decision as to whether to have surgery is a personal decision that should be made by the individual and not by a doctor,family member, or friend.Unfortunately many non-medical people who know nothing about this type of surgery become authorities and give the perspective surgical candidate very poor and inaccurate advice.Remember the best advice one can get is from a qualified podiatric( foot) surgeon. If you have doubts about the procedure being done, get a second opinion.The operation should correct all of the components of the deformity. A procedure that is done to shave the bump only, is doomed to failure because it does not re-align the deformity. If you are going to have an operation, the proper procedure should be done and not a lesser procedure which may have an easier recovery but will  not give the same quality result. You should be sure to ask the surgeon about the risks of the procedure and how they can be handled if they occur. It is important to ask about the approximate time of recovery and about what will be expected of you in terms of range of motion exercises of the toe and how to use the toe in walking to get your foot back in shape.Also remember, bunion surgery is almost never an emergency or urgent.  Since bunion surgery is usually not done on an emergency basis, do your due diligence to feel comfortable about your decision.

We have performed approximately 10,ooo bunion procedures in our careers. Call us for an evaluation or second opinion at 212-996-1900 or 914-328-3400.

Bunions-Part 2 What Happens

Posted by on Thursday, September 15th, 2011

Drs Geldwert,Lai and Minara have 60 years of combined experience of successfully  repairing bunion deformities.

We don’t know exactly what the first step is in bunion formation,but we do know that there is medial or inward rolling or pronation of the first metatarsal along with its associated joint-the first metatarsophalangeal joint and the great toe. The skin, nerves,fat and the arteries are squeezed over the bony prominence. When a shoe squeezes the skin and associated soft tissue under the skin over the medial bump,pain will result. There is no dire correlation between the size of the bunion deformity and the amount of discomfor noted. Some people have tremendous deformity and no pain and some people have small deformities and significant pain. In individuals who have significant deformities and minimal pain, there is usually a smooth rounding to the bump which forms the bunion. In those people who have significant pain,there is usually a more angular deformity to the metatarsal head which may account for the increase in pain. As the 1st metatarsal moves toward the other foot,a small muscle on the inside of the foot pulls the end of the toe over so that it leans toward the middle of the foot.This is referred to as hallux ( great toe) valgus( an orthopedic term which means moving toward the midline of the foot).As the first metatarsal moves toward the midline of the body,(that is ,towards the other foot), it is referred to as metatarsus(metatarsal) primus(first) varus(which means it moves away from the midline of the foot). As a result of the bony migration, the outside portion of the capsule which holds the joints together becomes very contracted and the inside portion becomes very stretched out or attenuated. The tendons which connect the muscle with the bone run through tunnels in the capsule.As the joint capsule contracts laterally and expands medially,the tendons change position so that they no longer have their normal functions and positions.As the big toe moved away from the midline of the body,it can lift up the second and eventually third and fourth toes, causing them to hammer and to even dislocate where they conect to the metatarsals.As the deformity progresses, the individual has increasing problems using the great toe for roll-off. We start to roll off of the metatarsal head and therefore callouses begin to develop in the skin over the bottom aspect of the metatarsal head.These can become very painful.With the increase in size of the medial prominence(bump),shoe fittings becomes more and more difficult.

The next blog will cover what can be done to help treat your bunions. I f you would like one of the doctors to evaluate your bunions call either 212-996-1900 or 914-328-3400 for an appointment.

Bunions-Part 1

Posted by on Friday, September 9th, 2011

Drs. Geldwert,Lai and Minara have over 60 years combined experience in successfully correcting bunions. The following is an explanation of what bunions are. Future blogs will explain what happens to you when you have a bunion and the different approaches to caring for bunion deformities.

The term bunion comes from the word turnip. In this case,it refers to the large bump that forms on the head of the 1st metatarsal.The term bunion is a simple term that denotes a complex of deformities. One can see a bunion forming in a newborn baby’s foot,or it can develop in someone who is in their eighties or nineties. Bunions are genetically determined and are not caused by shoe-wear or abnormal mechanics. They may be severely aggravated by improperly fitting shoes and poor mechanics,but they are caused by one’s genetic background. Commonly associated with bunion deformities is ligamentous laxity. Ligaments hold joints together. Some people have loose or hyper-elastic ligaments. We often say these individuals are ” double jointed” because they have the ability to hyper- extend their fingers,elbows or knees. Many people with scoliosis,which is a lateral “s” curve in the spine,also have bunion deformities.There have been studies which document that barefoot tribes get bunions as well as people who wear shoes.

If you would like to have your bunions evaluated by the doctors call 212-996-1900 or 914-328-3400 for an appointment.