Two common complications with the feet are bunions and hammertoes.
Have you had discomfort when wearing your shoes? Have you seen a bump on your toes? Or has one of your toes started to overlap another?
You could be experiencing the side effect of a bunion or hammertoe.
With this kind of discomfort, it makes you wonder when should you be consulting with your doctor and is surgery the right option for you?
Eric Tan, MD, an orthopaedic surgeon at Keck Medicine of USC and associate professor of orthopaedic surgery at the Keck School of Medicine of USC, says people come to see him if they start to see their toe is either drifting or clawing up.
This is what he does when you come to see him for a consultation:
1. History and Physical Examination.
Dr. Tan does a thorough history and physical examination to get a background of your current state of health. He evaluates both of your feet. This will help him determine the appropriate type of treatment for you.
2. Assess the bunion or hammertoe.
3. Observe how your foot fits into your shoe.
4. Examine how the joint moves to see if there are any indications of arthritis.
5. Obtain x-rays to see the deformity and the quality of the bone.
6. Thorough discussion of all the findings.
Once Dr. Tan goes through the thorough set of diagnostics he will sit down with you and discuss what bunions and hammertoes are, the history behind them, what complications you may encounter and what it means for you.
7. Start a treatment plan.
In the majority of instances, treatment is initiated with conservative measures. This could involve taping down the toes or stretching them. Then the toes are monitored. Sometimes maintenance is all that is necessary and that lasts for many years. In other situations your condition may not respond to conservative therapy and may progress.
What can be done besides surgery to treat these problems:
Dr. Tan says that there are a lot of splints and spacers out there, (i.e. the bunion stretcher) that may be used. The problem is that once a bunion starts, you cannot stretch it back. The reason you cannot stretch it back is because it ends up affecting the bone, ligaments and tendons. The splints and stretches may provide symptomatic relief but do not lead to a lasting correction.
You have two main treatment options.
- You can live with the problem and utilize the taping and splinting
- If you start to have significant pain and deformity, you cannot fix the bone with anything short of surgery.
There are over 60 described surgeries for how to fix a bunion, so each case is patient specific.
What you need to know:
Not all bunions are created equal. That means the process of recovery is very individualistic.
What matters most is your level of comfort. If you work behind a desk and are not as active, it may be better to watch and wait to see how the bunion and hammertoe progress before considering surgery. However, if you are on your feet a lot, then surgery may be the right thing to do in the long run. The only time surgery would be absolutely necessary is if your bunion or hammertoe becomes infected, or involves a more worrisome complication.
If you choose surgery as an option, you need to select a foot surgeon who has experience in correcting these complications to get the best results. Some surgeons just cut off the bump, but it does not actually change the forces that would prevent a recurrence of the deformity.
In order to correct the problem, you need someone who understands that they not only need to correct the boney deformity, but also the forces that cause the deformation. This is a complicated process that very few surgeons understand.
After surgery, you are placed in a dressing and given a post-operative shoe, which is a hard-soled shoe.
The next day, you are able to walk on the heel and the outside of the foot, but it is recommended that you avoid putting weight on the part that was operated on for about three to four weeks. You may also have pins sticking out of the end of your toes that will need to be cleaned. To help avoid putting weight on the part that is operated upon, crutches are provided for additional support.
After four weeks, you can start walking more flat-footed and independently off of the crutches. The pins, if present, will be removed at this time. Then at about six to eight weeks, you can wear shoes.
Will my bunion or hammertoe come back?
There is a very low risk for a bunion or hammertoe coming back. If any sort of bunion correction is done, there is a chance later in life, fifteen, twenty years out, where it could potentially come back, but it is not common.
If you have a severe bunion, it may involve fusion of a few joints. If you get a fusion, there is almost no chance of recurrence, but you also lose motion of the joint. If realignment of the bone is done instead, you are able to preserve the motion of the joint. This usually lasts for a minimum of tens of years, but there is a small risk that over time, the problem could slowly reoccur.
The more common problem is arthritis. That may be another complication to address in the future.