Bunions-Part 3 Treatment
Posted by editor 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.
If you have any foot problems or pain, contact The Center for Podiatric Care and Sports Medicine. Dr. Josef J. Geldwert, Dr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.