Myths about bunions

There are many myths about bunions. We want to clarify some common misconceptions about bunions.

The first myth about bunions is that you can reverse a bunion without surgery. It is common for patients come in to the office inquiring about ways to reverse their bunion. There are many over the counter devices that claim to realign the bunion bringing the big toe to a straight position. This is a myth about bunions because a bunion is a deviation of the big toe joint. There is no way to reverse it without performing surgery. The joint must be realigned through surgical correction.

A second myth about bunions is that high heels cause bunions. A bunion is caused by your foot type. The shoes you wear and the activities you perform will make it worse but it is caused by heredity. Heredity and genetics play the biggest role. In your family history if somebody has a bunion you are more prone to developing that bunion regardless of the shoes you wear. High heel shoes and pointy-toed shoes do you aggravate the condition and make it worse however it is not the underlying cause.  A lot of men develop bunions and yet a lot of men do not wear high heels.

The third myth about bunions is that surgery is extremely painful. A lot of patients are afraid to undergo bunion surgery. They have heard horror stories and read many online reviews stating that bunion surgery is extremely painful. What I will say about bunion surgery is that you do require the appropriate post-op care to minimize any discomfort. Most surgeries come with a level of discomfort however the key to reducing pain after a bunion correction is to take anti-inflammatory medication and keep your foot elevated for at least two weeks. It is typically the inflammation that causes the most amount of pain. When you put your foot down after surgery blood will rush to the area, the foot swells, and pain starts. Once the swelling is in the foot it is extremely difficult to get it out.  You must be able to commit to the healing after bunion surgery and do not plan on performing activities for two weeks. Do not let this myth about bunions stop you from seeking treatment.

BUNIONS

What is a bunion? A bunion is a deviation of the big toe joint where the great toe otherwise known as the first toe or big toe moves towards the second toe. Where two bones that interface is called a joint. Typically the 2 bones are straight and move on each other like a hinge on the door. When the two bones at the joint bend you have a deviation of the joint.  If you look at your elbow and straighten it you have the big toe joint. Now bend your elbow, and this is what happens in the big toe. As the big toe is meant to move up and down it becomes painful when moves to the side and then have to move up and down for you to walk. The bump that is noted can in large overtime but it is a bone that has become more prominent that you feel.

What causes a bunion?
A bunion is hereditary caused by genetics and what your ancestors have. It is your basic foot type that you inherit. The foot type and the position will lead to poor function when you rock leading to deviation of the joints in the front and thus the bunion. The more active you are and the more stress and strain placed on the joint will cause the bunion to form faster. Pointy shoes can also make the bunion form faster over time as the shape of the shoe causes the toe to turn in even more than it would naturally.

What are the treatment options for a bunion?
There are two main options. Conservative or nonsurgical care or surgery correction. Conservative care will not correct a bunion.

Conservative care includes

1. Change your shoes to wear a supportive sneaker or supportive sandals.
2. Use orthotic inserts. Orthotics which are inserts that go into a shoe and control the mechanics of the foot and joint alignment will help slow the progression of a bunion and help to decrease any pain in the big toe joint.
3. If you develop an arthritic flare with inflammation including a red hot and swollen big toe joint one can use cortisone or steroid injections or oral anti-inflammatories. It is generally not recommended to inject cortisone into the deviated bunion. The reason for this is that steroid injections work very well in the short term to decrease pain and inflammation however the cortisone crystals stay in the joint and can break down the soft tissue making the bunion condition worse over time.
4. Protein Rich Plasma (PRP) or amnion stem cells can also decrease inflammation but will not reverse the bunion.
5. Over-the-counter splints will not correct the position either but may decrease any muscle spasm that one can have.

Surgery without the myths about bunions

Surgical correction includes realigning the first metatarsal bone and the big toe. The doctor will perform x-ray or scanning modalities to evaluate the structures and position of the foot and perform a procedure that is most appropriate to realign the position of the big toe joint. Most often a bone cut is made in the first metatarsal and a screw is used to fix the position. Healing for this can take anywhere from 6 to 12 weeks depending on how severe the condition is.

Some people who have bunions never have pain. In this group no surgery is required to realign the joint if the bunion is not bothersome to you. If it starts to interfere with the activities you like to perform and the shoes you like to wear surgery can be performed.

Orthotic Inner Soles

Orthotics are inserts that are placed into the soul of the shoe that control your foot when you walk. There are various foot types with no two people having the same foot type. When you walk, 26 foot bones have to remain aligned and work together efficiently to provide pain-free walking without developing problems as we age. Unfortunately, genetics, injuries, trauma, shoes and activities can cause various problems in the foot. The purpose of the orthotic is to take an altered position of the bone structures of the foot and realign them so that you can walk easier. By walking more efficiently your pain is greatly decreased or completely eradicated.

Orthotics fit into most sneakers, slip on shoes, closed back shoes and some open sandals that have a removable footbed. There are various ways to measure the foot for an orthotic. At the Foot, Ankle & Leg Vein Center we perform a walking gait analysis, a biomechanical foot examination, and re-position the foot for casting. We perform a cast mold of the foot so that a specific insert device is made for you.

There are many ways people can develop and analyze the foot for an orthotic. Some include a foam box, walking across the mat or plaster casting. The plaster cast method is the original method design a hundred years ago and has been shown and proven to still be the best way to analyze the foot and get it in the corrected position. This is performed by the doctors themselves.

Modifications can be built into a custom device to accommodate for various conditions such as metatarsal ball of the foot pain, neuromas, and heel pain or plantar fasciitis.

What is the difference between a custom molded orthotics and an over the counter device?

1, A custom molded device it’s made specifically for cure for type. No two feet are alike. An over the counter insert is typically designed for the general public with a one size fits all concept.

2. A custom molded orthotics will last you many years while an over the counter device is designed to last an average of three months.
3. Modifications can be made into a custom device for a foot problem, but not in an over the counter insert.

Here are some analogies to help you understand what an orthotic does and how it can help.

Orthotics are like eyeglasses. You have poor vision so you go to an eye doctor and they make a prescription lens that you can put on glasses and you can see better.  You have an altered for type an orthotic is made for your foot so that you can walk more efficiently when you wear it. Similar to eyeglasses that will not correct your vision, orthotics will not correct your foot so that when you don’t wear the device (glasses or the foot insert) they will not help you. Orthotics will not correct the foot so that when you wear them don’t wear them they will not work.

Orthotics are like a retainer after braces. After corrective foot surgery, it is recommended that the alignment be maintained with an orthotic.

The difference between getting an over-the-counter orthotic versus custom device is like getting magnifiers instead of a prescription lens.