Monday, February 6, 2017

So you have a Bunion! What do you do?

Bunions are very misunderstood by patients in many cases.  Patients want to believe that the big bump on the inside of their foot is just skin.  I mean, they push on it and feel it's hard but want to deny the facts that are really going on here. A bunion at its core is a bone deformity, yes there is some imbalance at the joint from the capsule being overstretched on one side and over contracted on the other.  But the bone is ultimately the biggest problem that causes a patient to stroll into our office.

Some patients just want to know what's going on with their foot and some are convinced they need surgery immediately! If you have a bunion it might be worth reading this before seeing the doctor, we have broken down the most common type of patients that come in with a bunion. Knowing which one you are could save you from unnecessary foot surgery!

Not All Bunions Are Created Equal

1. The no pain bunion but someone has convinced them they need to do something before it gets worse. These patients usually are just curious what is wrong with their foot and want to make sure they are not going to be disabled if they do nothing.  These patients are educated on shoe gear and we explain that if you stay away from bad shoes, this may be what their foot is like for the rest of their life.  This visit usually ends with a relieved patient who is happy to not have to have surgery.

2. The no pain bunion but the patient hates the way their foot looks! These are sometimes the most frustrating patient to really help.  They have no pain yet they are contemplating surgery because they think their foot will be prettier.  There is a 50/50 chance this patient walks out of our office angry because we refuse to perform unnecessary surgery on a foot that does not hurt at all. We explain to the patient that even if we were to perform surgery, there is no guarantee that they are going to fit into a narrower, "cuter" pair of shoes after surgery. Some patients appreciate our open and honest opinion and others are just pissed they paid a $40 copay for me to tell them "wear wider shoes"!

3. The painful bunion that only hurts in certain shoes.  This patient demographic is identical to the #2 above, but these patients often present in a high heel stiletto with a foot that is identical to Fred Flintstone! They literally do not want to accept that their foot is just not meant for the shoes they are wearing.  Many of these patients, if they just switch to a mesh athletic shoe or wider shoe have no problems.  But getting this patient on board with this simple solution is sometimes difficult.  I explain that in order to fix their problem I have to cut their bone with a saw, move the bone over to correct the deformity and then put a screw in it.  I explain that they can not get it wet for 2 weeks and they have to wear a post-op shoe for 6-8 weeks.  Almost everyone of these irrational patients say, "can't you just shave the bump?" Because they are now the expert!  I have to almost always explain that we have to correct this problem at the level of the deformity so that the problem does not recur because I like to do my job right. These patients usually leave frustrated and seek the care of another podiatrist who decides that this a great patient selection for surgery. The patient that go to have surgery by another doctor are usually the horror stories you read when you google bunion surgery.  See if you do not have pain before, performing surgery is just cruel and unusually punishment that could lead on to lifelong disability. Pain in and out of all shoe gear is the requirement to have surgery and be happy.

4. The last bunion patient is the painful bunion in and out of almost all shoe gear.  These patients have pain that does not completely resolve with the absence of shoe gear.  This is ultimately the type of patient that does great with bunion surgery.  These people are so happy to have a realigned pain free joint and are accepting of some tingling or numbness that can occur with surgery in this area. But even these patients can decide to keep looking for the shoe that offers them comfort.  

Treatments for Bunions

Again there really are only two treatment options for bunions:

1. Modify shoe gear(go into wider shoes)
2. Surgery

There really are no great in between options for fixing a bunion.  If you have a bunion and you take away pressure to the big toe joint you get rid of what is causing the deformity to get worse and for some take away the pain. If the bunion is mild you can try something like the Yoga toes, but there is no guarantee this product will yield a great result but it may help stretch that over contracted part of the joint. Also, using a gel toe spacer may also yield some minimal improvement but both of these options are much better than surgery that may not be necessary.  If the foot is killing you and you are unable to be comfortable in and out of shoe gear, then bunion surgery may be a good options for you.  If you are looking to learn more about foot and ankle problems feel free to follow the link to our website at

Michele McGowan, DPM

If you live in the Central Florida area, it may be worth your time to take the drive to our office in Clermont to evaluate your bunion to see if surgery is really necessary or not. We are located at:

3190 Citrus Tower Blvd Ste A
Clermont, Fl 34711

Our number is 352-242-2502 if you would like to call to schedule your evaluation.