Arthritic Big Toe

The Sklar Bunionectomy | www.footfirst.com

A common condition that we treat here at Foot First is arthritis of the big toe, also called hallux limitus or rigidus.  In our practice we lovingly call this deformity an arthritic bunion.  It is commonly caused by genetics, however it can sometimes be precipitated by an injury to the joint.  These types of patients often have a large lump at the top of their big toe, as opposed to the side like in a traditional bunion.  Depending on how severe the arthritis is, the joint may be stiff or not move at all.  The pain most people experience is over the lump, within the joint, or on other parts of the foot because the joint does not move like it should.  The purpose of this post is to give you a basic understanding of what doctors have to offer in the way of helping a patient.

There are two types of procedures that can be performed for an arthritic big toe joint.  The first is joint salvage.  Joint salvage procedures have the goal of surgically improving the joint without removing it.  These procedures include removing the bone spurs (Cheilectomy), joint decompression, and/or joint realignment.  Removing the bone spurs can offer comfort if a patient is only having pain around the bump over their big toe, however if they are having joint pain then joint decompression and realignment are also necessary to improve the pain.  The advantage to these procedures is that they allow for mobility of the joint so it can keep functioning normally and it is less invasive.  The disadvantage to these procedures is that the joint still remains so it is possible to produce more arthritis in the patient’s lifetime.  The doctor or the patient will know how fast this will happen, if it does, but generally these are successful long lasting procedures for most people.

The second type of procedures are called joint destructive procedures.  These most commonly include joint fusion or joint replacement.  Joint fusion is when the cartilage is removed from the joint so it can heal together where the joint will never move again.  It is hard for most patients to believe, but most people can live very normally without that joint.  Joint replacement procedures remove the cartilage, like in a fusion, but a prosthetic joint is inserted.  The disadvantages to these procedures are that they are more invasive and more permanent.  For instance, if the patient is unhappy with these surgeries, there are much more limited options when it comes to revision as there is no more joint to work with.  The advantage to these surgeries is that since they remove the joint there is no more chance for arthritis to reoccur.  

A patient can also attempt conservative therapy if they aren’t ready for surgery.  Some different types of treatments include ice, NSAIDS, orthotics, physical therapy, change in shoes, PRP injections, and cortisone injections.  At our practice we have a lot of success with change into Hoka brand shoes, and cortisone injections.  Cortisone works to decrease the inflammation around the joint greatly reducing pain and swelling.  This combo can buy some patients months to years before they elect to have surgery.

If a patient elects to have surgery in our practice we almost always turn to our joint salvage Sklar Bunionectomy.  Our procedure is revolutionary in the fact that it both decompresses and realigns the joint without shortening the big toe.  When the big toe is shortened it can be cosmetically displeasing, but also put more pressure on the ball of your foot causing further pain.  With our procedure there are also no visible scars.  Our incision is hidden on the side of the foot which again, provides a functional and cosmetic advantage.  When the scar is on top of the foot it creates scar tissue across the joint.  This can undo the motion that the surgeon is trying to give the stiff big toe joint in the first place.  This works against the goal of surgery.  Lastly, our procedure allows you to step on your foot right away, and return to a gym shoe in 2-3 weeks.  No cast or crutches are necessary.  There is no exercise on the surgical foot for 8 weeks from surgery.  

No matter how bad your arthritic bunion pain is, we are ready to help!  If you would like a consultation regarding this issue please use the contact us form on our website or give the office a call at 847-352-9221.  

Can you Shorten the Big Toe?

When we talk about toe shortening in our practice, we almost always are referring to the smaller toes.  Patients more often develop corns, pain, and hammertoes on the lesser toes from them being too long in their shoes.  Occasionally, however, sometimes patients ask if they can shorten the big toe.

Of course we can!  

The big toe is too long usually due to genetics.  Patients can get the same symptoms to the big toe as they do the smaller toes when they are too long.  By shortening the big toe we can reduce pain in shoes, corns, or keep them from hammering.  

Toe shortening recovery for the big toe is similar to when we do toe shortening to the smaller toes.  Surgery is done under twilight anesthesia, where we remove a section of bone through an incision of the side of the foot.  If you have a bunion, we also can correct this at the same time.  After we remove the section of bone we use pins to hold it in place.  These pins are buried underneath the skin, and do not stick out of your foot.  After your toe is done healing, we remove the pins under local anesthesia usually in between 8 and 12 weeks after surgery.  During that time you may not run, jump, or walk for exercise.  You are able to stand and walk for limited amounts of time, and you do not necessarily need crutches.  Patients are usually able to get into a gym shoe after three weeks.  

Cosmetically, when we shorten any toe, a full cosmetic result takes 6 months to 1 year.  Our best photos in our gallery are all taken at about that time after surgery.  

If toe shortening or bunion surgery is something you are interested in, please reach out for a consultation by visiting the “contact us” link on our website at footfirst.com.

What are Corns?

What are corns, and how do those ugly things get on our toes?  Can’t you just cut them out?

Corns are small calluses that form on top of toes or in between toes.  They are hard, and can be painful when they rub against each other or in shoes.  The calluses can be trimmed down or padded so they don’t hurt as much, but why do they keep coming back?  The cause of these little nuisances is usually deeper than the corn itself.  Corns occur and keep coming back, because there is an underlying deformity to the toe that it is on.  

A hammertoe is the number one cause of how a corn can form.  A hammertoe is when the toe becomes permanently bent over time.  This can happen with genetics, aging, or because a bunion is pushing the toe.  Where the toe bends down, it rubs on the tops of shoes.  This constant rubbing produces a callus, and eventually a deep corn.  

Another very common cause for corns is the toe is too long.  Similar to hammertoes, when a toe is too long it buckles when it goes into a shoe.  Where it buckles, or bends, the shoe rubs and creates the corn.  

Sometimes a corn is caused, because a person has a lump on the bone.  When a patient has a lump on the side of their toe, that causes corns in between the toes.  

To fix a corn, the underlying problem with the toe must be corrected, or it will just keep coming back.  

If a patient has a hammertoe we correct the underlying issue by straightening the toe.  If the toe is too long, we shorten the toe.  This prevents the toe from rubbing on the top of the patient’s shoe and the corn can eventually heal on its own.  If the patient has a bony prominence, we will file the bone down so it stops rubbing.  

We try never to cut a corn off of the toe, because it can leave a scar.  We want the corns to subside on their own so when the patient is done healing there are no visible scars, and no one can tell that surgery was even done!

Some corns are difficult to cure.  Corns are more stubborn if a patient smokes cigarettes.  Smoking cigarettes has a negative effect on the tiny vessels that keep skin soft and healthy.  We often see that cigarette smokers have a harder time healing corns even if surgery is done.  Another cause of stubborn corns is genetics.  Some patients are genetically predisposed to making calluses, and that will also make it harder for them to heal.  Lastly, if the corn has been present for many many years, then it will make it harder for the surgery to be as successful. 

If you would like to schedule a consultation because you have ugly corns, please reach out through our website at www.footfirst.com, on Instagram at footfirstpod or call 847-352-9221.

The Sklar Bunionectomy® vs. Minimal Incision Bunionectomy

We frequently get asked in our practice, “What is the difference between minimally invasive surgery, and minimal incision surgery?”  Though the two names sound very similar, they are two very different ways to perform bunion surgery.   

Procedure Descriptions

Minimally invasive bunion surgery refers to our procedure, The Sklar Bunionectomy® that is performed at the first metatarsal-phalangeal joint where the bunion deformity takes place. A small hidden incision that measures approximately 3-4cm on the side of the bunion and close to the bottom of the foot is made.  We cut the bone at the head of the first metatarsal, in an area that heals consistently and predictably.  Another cut is made in the proximal phalanx.  The cuts are made using a thin blade with an oscillating saw.  We use two to three screws to fixate this procedure. This is called minimally invasive, because it is much different than traditional bunion surgery that creates long visible scars on top of the foot and potentially excessive hardware.  These long dorsal scars are not only ugly, but can also cause problematic adhesions and scar tissue.

Minimally Incision surgery (MIS) refers to a completely different procedure, in itself.  Small punctures are made around the bunion area so a small burr can be inserted.  The burr is used to break the bone just behind the first metatarsal head.  The number of incisions made and the number of screws used depends on the surgeon and their preference.  The amount of bone that is removed or shifted is determined by intraoperative X-Rays.  

What does this mean to me?

Because we make a small incision instead of punctures, we are able to visualize how we can correct the bunion.  We can accurately see how much bone we are removing, and how much we are shifting the bone into position.  We can see exactly where we are placing the screws, and where exactly all the important soft tissues are so we can avoid and protect them.  Because we can protect the tissues from the saw, our patients have a lot less swelling than the typical minimal incision patient.  Also, because we use a bone saw instead of a burr, we typically have significantly less shortening of the first metatarsal.  With less shortening you get less instances of an elevated big toe that doesn’t touch the ground.

Recovery

With our Sklar Bunionectomy® the recovery is much more manageable.  Our patients are able to step on their feet immediately after surgery.  In fact, our patients walk out of surgery safely to their respective rides to take them home.  They are to be bandaged in a surgical shoe for approximately two weeks, then they are able to wear a tennis shoe comfortably.  We do limit our patient’s walking, however most are able to return to a desk job within about three days.  We also do not restrict driving even if surgery is performed on the right foot.   Return to full activity can be as soon as 8 weeks. 

Although MIS surgery sounds like it would be an easy recovery because of the small incisions, the reality is that MIS relies greatly on bandaging and reduced activity to provide its result.  Depending on the surgeon crutches may be required, however most patients are also able to walk in a surgical shoe.  However, generally patients with MIS are required to have bandaging, or wear a surgical shoe for 6 weeks, and a return to full activity may not be until at least 3-4 months. 

Cosmetic Result

Fixing Feet Beautifully™ is our motto at Foot First because we pride ourselves with not only how our Sklar Bunionectomy® functions, but also how beautiful it leaves a foot.  There is a remarkable difference with how a foot that has healed from an MIS bunionectomy versus with the Sklar Bunionectomy®.  

With the Sklar Bunionectomy® our small scars are hidden to the side of the foot where they cannot be seen.  There is also minimal to no shortening of the big toe to make it look disproportionate to the other digits.  This means that after a patient has recovered from surgery their foot appears as if it had never needed surgery in the first place: naturally beautiful. 

MIS surgery has a less consistent result because the surgeon has less control over what is happening internally by not making an incision.  This can leave the cosmesis to be somewhat abnormal looking, and not the naturally beautiful result a patient can hope for.  This can mean the toe sits elevated, it can be too straight or not straight enough.  Sometimes it can even appear twisted.  

Both the Sklar Bunionectomy® and MIS procedures can undoubtedly offer good results when correcting a bunion, however the journey to the end result is drastically different, as well as the consistency in appearance and functionality.  We at Foot First always recommend patients to read reviews, and ask for before and after pictures when choosing their surgeon and procedure.  To us the obvious choice is always the Sklar Bunionectomy® .

The Sklar Bunionectomy® vs Lapidus Type Procedures

A common question we get here at Foot First Podiatry is what is the difference between the Sklar Bunionectomy® and Lapidus type bunion procedures? 

There are three major differences between these two procedures: the cut in the bone, the cosmetic appearance, and the recovery.

Bone Cut

Lapidus type bunion surgeries typically are performed at the first metatarsal-cuneiform joint, and involves fusing this joint so it no longer moves ever again.  This is done at the base of the first metatarsal closer to the top of the arch of your foot, not near the area of the bunion.  The cut in the bone is usually fixated with screws and plates.  The screws and plates used can be very expensive depending on the system the doctor chooses.  Because this type of procedure fuses a joint it typically requires removal of bone, which in turn shortens the big toe in comparison to the lesser toes.  There are also certain risks that a Lapidus type procedure exposes a patient to, such as higher risk of delayed or nonunion (the bones may not heal together), or elevated positioning of the 1st metatarsal.

The Sklar Bunionectomy®  is a minimally invasive surgery performed at the first metatarsal-phalangeal joint where the bunion deformity takes place.  We use two to three screws to fixate this procedure.  Typically there is much less metal placed in a patients’ body than that is used with Lapidus type procedure.  The cuts in the bone are placed in areas that heal consistently and predictably.

Recovery

The biggest difference between the two procedures is recovery time.  With a Lapidus type bunion surgery most patients are required to be bandaged and in a boot for 4-8 weeks after surgery.  In addition to that, there is a high possibility of not walking and using crutches during this time.  If surgery is performed on the right foot driving is prohibited.  

With our Sklar Bunionectomy® the recovery is much more manageable.  Our patients are able to step on their feet immediately after surgery.  In fact, our patients walk out of surgery safely to their respective rides to take them home.  They are to be bandaged in a surgical shoe for approximately two weeks, then they are able to get into a tennis shoe.  We do limit our patient’s walking, however most are able to return to a desk job within about three days.  We also do not restrict driving even if surgery is performed on the right foot.   

Cosmetic Appearance

Fixing Feet Beautifully™ is our motto at Foot First Podiatry because we pride ourselves with not only how our Sklar Bunionectomy® functions, but also how beautiful it leaves a foot.  There is a remarkable difference with how a foot that has healed from a Lapidus type bunionectomy has healed than with the Sklar Bunionectomy®.  This is mostly due to the scarring that is left after surgery.

With the Sklar Bunionectomy® our small scars are hidden to the side of the foot where they cannot be seen.  There is also minimal to no shortening of the big toe to make it look disproportionate to the other digits.  This means that after a patient has recovered from surgery their foot appears as if it had never needed surgery in the first place: naturally beautiful.  

With Lapidus type procedures there are typically one very long scar or multiple scars on top of the foot.  Scars on top of the foot are not only unsightly, but can also create problematic scar tissue that can affect the end functional result of surgery as well.  And also as stated above, there can be remarkable shortening of the big toe, causing an awkward looking appearance after surgery.

Below are two examples of Lapidus type surgical results: 

Lapidus Type Scarring

Following that image of the two examples of Lapidus Type surgical results are comparisons of patients who have had the Sklar Bunionectomy® on one foot, and a Lapidus type procedure on the other:

The Sklar Bunionectomy vs Lapidus Type Surgical Results

The Sklar Bunionectomy vs Lapidus Type Surgical Results

Both the Sklar Bunionectomy® and Lapidus type procedures can offer good results when correcting a bunion, however the journey to the end result is drastically different, as well as the appearance.  We at Foot First always recommend patients to read reviews, and ask for before and after pictures when choosing their surgeon and procedure.  To us the obvious choice is always the Sklar Bunionectomy®.

Both procedures:

• Involve cutting the bone and using hardware

• Can offer correction of bunions of many shapes and sizes

• May need removal of hardware 

Lapidus type procedures:

• More scarring/visible scarring 

• Shortening of the big toe

• More internal hardware used

• Longer and more involved recovery

• Fuses a joint

Sklar Bunionectomy®:

• No visible scars 

• Minimal shortening of the big toe

• Manageable recovery
  

If you are thinking about having foot surgery, please explore our website at www.footfirst.com or connect with us on our Instagram handle @footfirstpod. You have choices when it comes to the type of surgical procedures you can have, so why not choose the one that makes recovery easy and your foot looking beautiful.

Do your Painful Bunions Prevent you from Wearing the Shoes you Love?

Have you ever wanted to wear beautiful shoes but couldn’t because of bunions or long hammertoes?

So many women suffer with ugly and painful foot deformities because they are afraid of surgery, time off of work and noticeable scars. The Sklar Bunionectomy™️ allows women to remain on their feet after surgery and leaves no visible scars. The Sklar Bunionectomy™️ leaves your foot looking beautiful and functional.

These two women had the Sklar Bunionectomy™ to both sides of their feet, and one had toe shortening to as well.  Both of these women were able to walk out of surgery. Both of these women were back into a gym shoe in 2-3 weeks.  Both of these women now have beautiful, scar free feet shown here and in their high heels.  

If you are thinking about having foot surgery or have feet similar to this, please explore our website at www.footfirst.com.  We have testimonials, a before/after gallery, and information about out of state surgery. Please contact our office for consultations, questions, and pricing.

Travel to Foot First for Bunion Surgery

A lot of people lament about how we should have more offices across the country.  Although it would be nice to have the time to jetset across the country slaying bunions of all shapes and sizes, this is not a realistic lifestyle for the doctors at Foot First.  

Before & After results with the Sklar Bunionectomy

I always try to explain that our bunion surgery recovery is so manageable that you can fly in to have this procedure and safely travel home to recover in just a few days.  This patient shown here flew in from Philadelphia on a Thursday to have her bunion removed. She came to our office and had a preoperative consultation where we took her X-Rays, gave her her post-operative prescriptions and instructions, and met with my Dad and I.  Following her consultation she was able to have bunion surgery that day under twilight anesthesia. After her surgery she recovered at the office, and then was able to weight bear immediately and return to where she was staying.

If you are recovering in a hotel, our patients are able to get out of bed and take care of themselves.  We ask our patients to stay a few days so we can perform the first bandage change. The initial bandage we put on is bulky and can become uncomfortable as the foot swells from surgery.  After a few days we apply a more minimal and comfortable bandage. This way you can fly back home comfortably.

Again, we wish we could travel all around to make all the feet of the world beautiful, but we can’t.  If we can’t come to you, then come to us! We will keep you on your feet with immediate weight bearing, no cast or crutches.  Not to mention a beautiful bunion free foot with hidden scars. In our opinion an easy recovery with a beautiful result is something worth traveling for.  If you have any questions about traveling to have surgery please do not hesitate to contact us.