Long, short, curled or even just plain ugly toes? At Foot First we can fix that!

Before & After results with the Sklar Bunionectomy & Toe Shortening Procedure

Long toes can be troublesome for a patient for many reasons.  Toe shortening is a unique procedure that we perform alone, or along with our bunion surgery, the Sklar Bunionectomy™.   

Toe shortening has a similar recovery to our bunion surgery where you are able to weight bear immediately, and get back into a gym shoe in a short amount of time.

You may wonder why some people request to have their toes shortened.  Long toes can be problematic not only cosmetically, but also functionally.  A long toe extends past the other shorter toes so it may hit the end of the shoe first, causing the toe to curl and jam.  This can cause a hammertoe over time, or a painful corn on top of the toe as it rubs on the shoe. The constant jamming at the end of the shoe can also cause the toe to dislocate over the metatarsal bone.  This causes a painful callus on the ball of the foot. This also occurs when the metatarsal bone behind the toe is too long as well, and would require an additional procedure to the toe shortening to fix.

If you have a bunion along with long toes, we always correct the bunion with the toe shortening procedure.  This is because if we do not correct the bunion deformity, the big toe pushes against the smaller toes as they heal.  This eventually causes them to heal crooked, or become crooked over time. This is why we always address the bunion deformity as well.  The image to the right is a patient who had her toes shortened by another doctor without fixing her bunion. We then had to correct her bunion along with her crooked toes.

During our initial consultation we determine which toe shortening procedures you need by where you are feeling pain, and with X-rays of your feet.  We also determine how much you want your toe shortened. You tell us approximately where you envision your shortened toe to be in comparison to the other toes.  For instance, some patients still want their second toe to be in line with the big toe, or some patients want their second toe to be shorter than the big toe. This is where the surgery becomes more of an art than a science, because everyone has a different opinion of what they consider beautiful.

Surgery for toe shortening is done under local anesthesia (awake with numbing of the toes) or twilight anesthesia (asleep) through a small incision on the side of the toe.  We remove a section of bone that we determine before surgery. How much bone we remove will depend on how much your toe needs to be shortened. We then insert a wire to hold the toe while it heals.  The wire will be underneath the skin and will NOT stick out the ends of your toe. The wire is not meant to be permanent and will need to be removed at a later date. We then close the incision usually with only one stitch, and allow you to recover.

After toe shortening surgery patients usually experience pain for three days.  They are able to weight bear immediately and are wearing a surgical shoe. Patients wear the surgical shoe for three weeks, and also have to keep the foot clean and dry during that time.  At three weeks the sutures will be removed and patients will be allowed to wear a gym shoe. At 8-12 weeks, depending on how the bones are healing, we will numb the toes to remove the pin inside of the toe.  Then patients are allowed to return to exercise like running, jumping, and wear different shoes.

Toe shortening surgery is very successful, although it will never be perfect.  Healing is determined by the success of the surgery, genetics, and compliance with instructions all combined.  With all the surgeries we tell our patients that toes will cosmetically look ugly for 4-6 months before they start to see their true result.  This is how long it takes for most patients’ swelling to come down. Some more serious complications of toe surgery are, but not limited to, floating toe, crooked healing, creases/scarring to the skin, a swollen toe, numbness, or a toe that is painful.  Usually if we work together by us performing good surgery, and the patient follows instructions and genetically heals well, we all end up with a beautiful result.

Our unique toe shortening procedure offers patients the chance to lessen their pain, and have a beautiful looking foot.  Our before and after pictures showcase our most beautiful results. As stated before, toes take 4-6 months on average to become beautiful.  All after photos posted are usually taken at 6 months to 1 year after having toe shortening surgery.

For more information about our unique Toe Shortening procedure or to view additional before and after results, visit www.footfirst.com.

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.

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.

View fullsize

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.