Bunion Surgery the Foot First Way

A few patients new to my office came in to discuss their bunion deformity and how to help treat it. They were worried about having their bunions removed after they saw a Podiatrist and a surgical patient on the Dr. Oz show. What they learned from that episode was:

1. Bunion surgery should be a last resort treatment
2. Bunion surgery is very painful
3. Cast and crutches are needed
4. Must be off work for up to 8 weeks
5. Performed in a hospital
6. Performed under general anesthesia
7. Long ugly scar "

That is bunion surgery done THEIR way.

- BUNION SURGERY DONE MY WAY IS WAY DIFFERENT -

A typical bunion surgery done in MY office does not require casting or crutches. My incisions are hidden on the side of the foot and can barely be seen. Depending on what type of work you do, most patients have the surgery in my certified surgical suite on a Thursday, are driving a car by Saturday and return to work on Monday.

Cortisone Injections

At Foot First Podiatry, cortisone injections are recommended for treating many causes of foot pain and injuries. These cortisone injections are commonly used as a first line treatment option because of its quick onset of the medication's action, high dependability, and minimal side effects. They can also provide relief of localized inflammation that is much more rapid and powerful than traditional anti-inflammatory medications given by mouth such as Aspirin, Tylenol, or Motrin. Cortisone injections can avoid certain side effects, notably irritation of the stomach that can accompany many oral anti-inflammatory medications.

For over 26 years, the doctors at Foot First Podiatry have successfully been using cortisone as a part of their treatment plan. Cortisone injections can be administered easily in the office. The Doctors at Foot First Podiatry inject this medication to treat many foot problems including pain, swelling, arthritic conditions and scar tissue.

While cortisone injections have proven to be an excellent treatment option for our patients, some patients were hesitant about being treated with cortisone. This is a normal feeling due to the many myths associated with "cortisone injections". It is always easier to find possible negative effects about the injections rather than the benefits and success stories of people. Let the doctors at Foot First Podiatry help educate you and straighten out some of your concerns pertaining to cortisone injections.

Cortisone belongs to the group of steroids called corticosteroids and is a NATURAL steroid produced by the adrenal gland inside your body.

Researchers have learned to make the same corticosteroid synthetically that your body produces normally. This "synthetic" cortisone can then be used as an anti-inflammatory medication.

Please note it is NOT an anabolic steroid (drugs used by athletes to boost strength and enhance physical performance). The medication we inject is NOT illegal and is NOT a "banned drug" in any sport played.

Some of the myths associated with cortisone injections do have some truth, but when given correctly this treatment option could prove to be an excellent way to experience relief from your pain.

Myth: Steroid injections are not safe.
Truth: Steroid injections are safe when administered properly. At Foot First Podiatry, cortisone injections are administered at a very low dose that poses side effects in less than 1% of patients. Steroid injections do not enter the bloodstream; they only affect the area of inflammation.

Myth: Cortisone injections are extremely painful.
Truth: At Foot First Podiatry we use small needles to administer the injection, reducing the pain to very little. Also, due to our small doses, the shots are very quick.

Myth: I've heard that you can only have 3 cortisone injections.
Truth: First there is no limit as to the number of cortisone injections a person can have. However, if a person has not responded favorably to a series of 3 to 4 cortisone injections, we will discuss a different type of treatment plan.

Myth: Cortisone can cause my bones to become brittle.
Truth: Due to the small dose of cortisone injected, there is not enough medicine to cause damage to bones.

While the inflammation for which corticosteroids are given can recur, corticosteroid injections can provide months to years of relief when used properly. These injections also can cure diseases (permanently resolve them) when the problem is tissue inflammation localized to a small area, such as bursitis and tendonitis. Cortisone is not a pain reliever, but an anti-inflammatory medication. Relief felt is due to the reduction of inflammation in the area affected; the pain is not being masked but eliminated.

Cortisone injections should be considered as a viable treatment option for your foot pain. Please call for an appointment so we can help take care of your feet today.

What is a Bunion

What is a bunion?

A bunion (Hallux Abducto Valgus) is a bony bump at the joint that connects the big toe to the main part of the foot. The prominence or "bump" is more commonly seen to the side of the base of the big toe joint (1st metatarsophalangeal joint) but can also be seen on top of the joint.

A bunion is a progressive deformity in which the bump on the side of the foot becomes enlarged as the big toe continues to shift or bend in the opposite direction towards the smaller toes. In extreme cases, the big toe will continue to shift until it is sitting on top of the 2nd toe, or more commonly, until it is sitting underneath the 2nd toe. This, in turn, creates another problem as the big toe sitting underneath the 2nd toe can cause a "hammertoe" in which the elevated 2nd toe becomes painful due to pressure and rubbing against the top of a shoe.

A bunion typically becomes painful due to pressure when the bony bump rubs against the side of a shoe. This pressure from the shoe against the skin, nerve, bone, and joint causes redness, swelling, and pain to the bunion area.

Bunions can be seen in both males and females. In our practice, we typically see more females presenting with bunion pain than males because of the type of shoe gear that women wear (i.e. high heels and shoes with narrow toe-boxes). Males also come to the office with bunion pain that is usually caused by ill-fitting shoe gear (i.e. steel-toed work boots or dress shoes with a narrow toe-box). A bunion can be seen in both children and adults. In our office, we have seen child with a bunion that was so severe and painful that surgery was required at 9 years old. It is rare to see a child that young with a bunion so progressed that it becomes symptomatic, but it is much more common than people think to see bunions in the younger population, especially teenagers.

What causes a bunion?

It is more myth than fact that bunions are caused by shoes. Shoes can definitely aggravate and irritate a bunion that has already formed, but the shoes are usually not the cause of the bunion.

A bunion is typically caused by improper foot structure and function. A person is often born with this poor type of foot structure in which the bones are not aligned properly. This improper bone alignment causes faulty biomechanics (the way in which the tendons, ligaments, bones, and joints work together when walking). There is an imbalance in the forces exerted across the big toe joint (1st metatarsophalangeal joint) during walking. The abnormal motion and pressure to the joint leads to joint instability and the tendons begin to the pull the bones (1st metatarsal and big toe) in opposite directions.

We often see many people in one family with bunions (grandmother, mother, aunt, daughter, etc.). This is due to the fact that one can inherit this improper foot structure that is prone to bunion formation.

Other causes of bunions include injury/trauma to the foot or big toe joint area, neuromuscular conditions, osteoarthritis, and inflammatory joint disease such as psoriatic arthritis, rheumatoid arthritis, and gout.

What are possible treatment options for a bunion?

A bunion can be treated both conservatively and surgically. Conservative treatment is always considered the first line of treatment, but it may not be sufficient in certain cases where the bunion deformity and symptoms are so progressed that surgery is the only way to alleviate the pain.

First suggestions to reduce or eliminate bunion pain include wearing shoes that are wider in the toe-box area to accommodate the bunion and reduce pressure and rubbing on the bone. Padding can also be added to the bunion area of a shoe. Cortisone injections to the bunion area can be very helpful because they can greatly reduce the pain, swelling, and inflammation associated with a bunion. Physical therapy and anti-inflammatory medications may be helpful as well.

Another very helpful conservative treatment for a bunion is the use of custom molded arch supports, also known as orthotics. The main reason that a bunion forms is due to faulty or improper foot structure and function. Orthotics can improve the foot function and structure by supporting the foot and holding it in a more proper position. This will reduce the stress on the joints of the foot, especially the big toe joint (1st MPJ), which in turn will reduce the pain. Also with the orthotics properly supporting the foot structure when we walk, they can possibly prevent the bones from further abnormal shifting and keep the bunion deformity from getting larger.

In many cases though, surgery is inevitable. It is the only true way of permanently correcting the root cause for the bunion pain and bunion formation. Surgery is utilized to remove the bunion "bump" and to realign the bones (big toe and 1st metatarsal) that are abnormally shifting and causing the bunion to form. Screw fixation is often used to hold the correction in place after the bones have been "realigned".

Patients are often worried that they will be incapacitated and unable to do anything for months after surgery. In our practice, there are no casts or crutches used and the patient is able to walk immediately after the surgery (with the use of a special surgical shoe). The patient can wear a normal shoe as soon as 2 to 3 weeks after surgery.

Please feel free to call our office at Foot First for a consult regarding your bunion or any other foot and ankle problems you may have. We will gladly evaluate your feet and personally discuss with you all of the possible treatment options that we provide.