Wednesday, January 14, 2009

Bunions: Should I have Surgery?

A bunion or hallux valgus is a foot deformity that causes your big toe to tilt inward. This causes an enlargement of the metatarso-phalangeal joint, the joint where the big toe meets the foot. This deformity can be seen as a bump on the outside edge of your foot at the base of the big toe. The subluxation of the joint, compromises the joint’s normal function. Since the joint is important in ambulation and takes on a considerable amount of weight and stress, the deformation can cause pain. There is much debate about whether shoes alone can lead to bunions or if there is a genetic predisposition. Bunions are much more common in societies that wear shoes, but since bunions do show up in societies that remain barefoot, we can conclude that shoes are not the principle or only factor that causes the deformity.

Surgery has been shown to be the best treatment for bunions. It has the highest rate of patient satisfaction and over long periods of time, it has the lowest rate of pain, cosmetic disturbances and footwear issues. Like all surgeries, there is risk of complications during or after the procedure. This risk is very low. So why don’t we rush everyone to the operating room? Not everyone is a surgical candidate. Elder patients and patients with some other medical conditions have an increased risk of surgical complications, and therefore are not advised to go under the knife. Podiatric surgeons do not find cosmetic appearances justifiable for surgery. Though the risk is small for complications, it is best to avoid surgery if it is not necessary. A podiatric physician may consider surgery for you if the deformity is causing you pain and interfering with your life, shoe gear can no longer accommodate your deformity, or conservative treatments have failed to relieve you of your pain.

It is best to always start with conservative treatments. If these treatments do not work then the podiatric physician will explore more invasive modalities such as surgery. Since a bunion is a problem in joint subluxation (moving out of place), it is impossible to completely correct the deformity without surgery , but the progression of the deformity and pain caused by the deformity can be greatly reduced by other means.

Orthotics are the wonder treatment in podiatric medicine. Since so many foot problems are due to biomechanical mishaps in the foot, orthotics are necessary to regain proper function of the foot and ankle. Podiatric physicians are also trained to accommodate orthotics to the patient’s specific deformity or functional problem.

Padding is a very easy and cheap way to address bunion pain. Podiatrists are trained in padding techniques that may be applied directly to your foot or placed in your shoe to help relieve the pressure on your bunion.

Proper shoe gear is always very important. Getting out of heals and wearing shoes with a wider toe box can greatly relieve pain and slow the progression of the deformity. Weather you have surgery or not, you have to say goodbye to pointy toes and high heels.

Night splints have also shown to reduce pain and progression. Few studies have measured the success of the devices in adults, but they have shown to be very beneficial in adolescents. There are many generic devices that can be bought over the counter, but it is best to speak to your podiatric physician before using such device. They may cause irritation and people with diabetes should be especially cautious when using any over-the-counter product.

Though surgery has many successful outcomes, it is still a serious commitment and needs to be well thought through. It is important to have good communication with your doctor about your worries and concerns. Surgery should be a last resort treatment for you and your doctor. Conservative treatment is less expensive, less invasive, and less risky. Since conservative treatment is not correcting the underlying problem, it does not work for everyone. Thus, if non-invasive treatment has not relieved your pain, you and your doctor may need to consider surgery.

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