Pedram A. Hendizadeh, DPM, FACFAS
Cinderella, your shoes are waiting.
Do you have shoe envy? Are your friends able to get into 5-inch Manolos or Jimmy Choos and you can't even think about it? Do your feet hurt at the thought of an upcoming wedding or elegant evening event because you do not know which shoes will be less irritating? For years now, women have been subjected to wearing shoes that aren't necessarily the best for their feet. History has shown this with customs like chinese foot binding, that the well being of a woman's foot has taken a backseat to social norms and beauty.
You may be dealing with a wide foot caused by a bunion, bunionette, or both called a splayfoot. Bunions are one of the most common orthopedic foot conditions that have created a great deal of frustration for many patients. Those who suffer from bunions are afraid to undergo the procedure to correct this unsightly, painful condition because they may have heard horror stories of the recovery. With today's advancements in surgical skills, screw technology, and post-op shoes, the recovery period is shorter, less painful, and patients can generally walk right after the surgery.
The medical term for a bunion deformity is Hallux Abducto Valgus. The problem starts with a mal-alignment between the big toe and the metatarsal. This area behind the great toe can become red, swollen and painful with and without shoes. Generally, genetics have a big part in this but tight shoes and high heels many times contribute and exacerbate the problem as well. Certainly, surgery, called bunionectomy, is the most definitive option, but before surgery in most cases conservative treatment options should be considered. Wider shoes, anti-inflammatory medications, cortisone injections, shoe inserts or orthotics, and bunion splints/pads may be utilized. Although they will not change the architecture of your foot, they can make you more comfortable. Overall, conservative treatment options have little long-term benefits, but they can many times delay the need for surgery.
Over the years, it has become evident that asking women to not wear high heeled shoes is simply unrealistic. That is why the bunionectomy procedure has become more popular. Here is a list of suggestions when considering surgery.
1. Be sure to seek out a board certified foot surgeon who specializes in foot surgery. There are many doctors who do these procedures, but the ones that do at least 5 or 6 per month or greater cases in their career should be consulted with.
2. Ask the doctor what type of fixation he uses to hold the bone together. There are several options. Years ago, there was no fixation; the doctors just relied on a cast and waited until mother nature allowed the bone to heal. The problem with this is that the bones may shift and it can take months before the bones heal. Later, wire fixation was utilized. This was an improvement in holding the bone, but bones could still shift as the wires do not allow for compression. In addition, the wires were many times placed through the skin and then removed in the office once the bones are healed. This increases the chances of infection. The best fixation that is utilized today is a compressive screw. Screws allow for a tighter fixation and the ability for you to walk sooner, usually right after the procedure in a boot. There is also less pain associated with screw fixation as the screw(s) are buried in the bone and they do no irritate the surrounding soft tissue. There is generally no need to have the screw removed. Recently, Absorbale screws were made available. In theory, they sound great but they can cause some complications of their own.
3. Ask your doctor what he utilizes for post-op pain. Most patients should not need more than 5 to 10 Tylenol with codeine pills. Most doctors today give a small amount of injectible post-op anesthesia and steroids to give the patient long pain relief. Heavy narcotics such as Vicodin or percocet are generally not necessary. Most patients can transition to Ibuprofen in just a few days.
4. Aggresively icing and elevating your foot for the first 3 to 4 days after the procedure really helps reduce your pain level, reduce your swelling, allows for increased flexibility in the joint, and enables you to return to normal activities much sooner.
5. You may ask the doctor if you can contact a few patients who have had it done to get a better idea of what to expect. Most doctors would be more than happy to give you a few references.
6. Be sure that it is done under local anesthesia and sedation. There is absolutely no need for general anesthesia unless you want it.
What happens is you wait too long to have surgery? The good news is that the procedure is an elective procedure that you schedule at a convenient time. Unlike a ruptured appendix, or gall bladder, it is not an emergency that you need to attend to right away. However, delaying the surgery can cause other problems such as arthritis, cartilage destruction, or a hammer toe of the second toe, rupturing of the ligament under the second toe if the big toe pushes the second toe up and out of the way.
You can reduce your foot's width by 1 to 2 centimeters and overall the bunionectomy has come a long way and it is a relatively simple procedure. It is done as an outpatient in the hospital or local surgery center and only takes 45 to 75 minutes. These are less complications today, there is less pain and quicker recovery. More and more patients are electing to have it performed so that they can wear the shoes that they want. It is covered by almost all insurance plans and is considered medically necessary as long as your condition is painful. The bottom line is that there is no need to be in pain with the shoes you want to wear.
Don't hesitate to inquire about a bunion problem or educate yourself further on correcting bunions by contacting one of our offices. You may also contact us 24/7 through our Appointment Request Form .