April 10, 2013 Posted by Dr.ChangWHAT ARE BUNIONS? Bunions are enlargements of the joints at the big toe (hallux valgus) or little toe (Tailor’s Bunionette). However, bunions are more than just bony protrusions: they are structural abnormalities in the foot, misalignments caused by hereditary factors or lifestyle habits such as wearing narrow shoes, high heels, and tight sporting or dance shoes. The structural change causes the “V” shape, or “valgus” of the big toe, that is marked by an enlarged joint. Especially because your feet support the weight and movement of your entire body each day, it makes sense that any sort of disturbance to the structure of your feet can cause considerable pain. However, the “V”ing of your first toe joint places considerably more stress on the joint than when the bones in the joint connect in a straight line. Bunions can therefore be excruciatingly painful. Luckily, treatment and surgery for bunions are highly effective means to limiting your pain and allowing you to return to your daily activities! TREATMENT FOR BUNIONS Initial, non-invasive treatments for bunions include side lining your tight-fitting shoes in favor of comfortable, well-fitted footwear (shoes that do not bunch your toes together or cause pressure on your toe joints). Splints and orthotics can also do wonders for repositioning your toes. Bunions caused by arthritis in the joint are treated well by medications that can reduce pain and swelling. If these methods do not improve your foot pain, your podiatrist may suggest surgery, which is a highly effective form of addressing the structural misalignment in your foot. WHAT IS BUNION SURGERY? The main goal of bunion surgery is to improve your ability to walk and do other activities on your feet. Bunion surgery straightens the structural misalignment of the bones in your foot, decreasing the pressure on the joints. As a result of your surgery, your pain will be drastically improved, if not eliminated. Bunion surgery involves work on the soft tissue and/or bone of the big toe joint in order to relieve the pain in the joint, and to restore normal alignment to the joint. Not all bunions are created equally, and, as follows, not all patients with bunions will receive the same sugery. In fact, there are over one hundred kinds of bunion surgery! Common types of bunion surgery include: *Removal of the metatarsal head (the part of the foot that is bulging out toward the center of your body). This is called an “exostectomy” or “bunionectomy.” *Realignment of the soft tissues (ligaments) around the big toe joint. *Removal of a small wedge of bone from the foot (metatarsal osteotomy), or from the toe (phalangeal osteotomy). *Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe (metatarsophalangeal joint). At this joint, both the big toe and the metatarsal bones are reshaped (resection arthroplasty). *Fusion (arthrodesis) of the big toe joint *Fusion of the joint where the metatarsal bone joins the mid-foot (Lapidus procedure) *Implant insertion of all or part of an artificial joint The more involved the bunion is, the more complex the surgery. In the case that the joint is severely deformed, a surgeon may stabilize the re-alignment with wires, stitches, screws, or plates. Depending on your foot misalignment, your surgeon will suggest the optimal procedure for you. Bunion surgeries are most frequently conducted as an outpatient operation, and take about one hour. Most often, patients receive local anesthetics with IV sedation (twilight anesthisa). You will be required to have a follow up visit to take your stitches out in two weeks. In most cases the healing process takes about 6 weeks. DEBUNKING THE MYTHS: Unfortunately, there are many distressing myths about bunion surgery that you may find while browsing the internet. Let us help to quell your fears by assuring you that an overwhelming number of bunion surgeries (over 90%!) are successful in relieving pain and properly realigning the joint. While surgery can be painful, bunion surgery is no more painful than any other invasive procedure. The greatest cause of pain, in fact, is the swelling after surgery. Remember that, because your foot is below your heart, it is more difficult for your veins to fight gravity in order to return blood from your foot to your heart. Therefore, the swelling can often throb, and you will have to consistently elevate your foot. Furthermore, your feet have an incredible amount of nerves without much soft-tissue padding around them. The swelling can aggravate the nerves and cause pain. However, in the long run, bunion surgery vastly reduces pain that bunions cause with walking and standing for long periods of time. Another myth is that bunions can reemerge after surgery. While reoccurrence is possible, it is not likely. Furthermore, a bunion would come back over time and due to a lack of change in lifestyle and habits that caused your bunion in the first place. Go into the surgery aware of the fact that you will have to stay committed to the health of your feet! Side-lining your high heels and prioritizing comfortable shoes and time for foot exercises will be necessary for the longevity of the surgery. Finally, depending on your specific surgery, you won’t necessarily have to take a lot of time off of work. Most patients can return to a desk job after two weeks, and to an active job after two months. Additionally, over 90% of our patients report an amazing decrease in pain and increase in function after their surgeries! AFTER SURGERY: Depending on the surgery, you may be placed in a surgical boot and able to walk within two weeks of the surgery. With more complex surgical procedures, you may be required to wear a cast or splint, and walk on crutches. In order to best maintain the results of your surgery, it will be important for you to continue to be dedicated to the health and wellbeing of your feet. Committing to lifestyle changes, such as not wearing tight shoes and doing prescribed exercises and stretches for your toes and feet, will drastically increase the benefits of surgery, and reduce the likelihood of any future pain. Dr. Chang and Dr. Murray to have decades of experience successfully treating and operating on bunions. Remember that treatment and surgeries are most successful when you address and treat your bunion early. So contact us at Blue Ridge Foot and Ankle – we can help you solve your foot pain! Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you! Blue Ridge Foot and Ankle Clinic Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116 Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 (540) 949-5150 Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.