Not All Bunions Need Surgery!!!

 Doctor McGowan explains in this video what a bunion is and why not all bunions need surgery. Feel free to leave a comment and let us know what you think!

Want to learn more about bunions? Check out our website at: https://centeranklefootcare.com/cafcblog/bunions-what-you-need-to-know

Telehealth and Bunions: When to go to see your Podiatrist during the Coronavirus Pandemic

So we are knee deep into day 2 of seeing patients after getting back after our kids spring break.  It has been day two and it feels like, I don't know, maybe a month!!

 Goal #1:  Stay Out of the Hospital -  Day 2    I had to go to the Villages Hospital for emergent surgery. So we love what we do and love limb salvage and helping patients keep their toes, feet and legs.  It really is very gratifying to offer options for patients when others just offer below the knee amputation.  It was incredible to just call the hospital and be able to add a case whenever I wanted or was able to do so.   But it also was ominous,  the effect of the coronavirus on the medical community.

Goal #2: Keep non-emergent non-medically necessary patients out of the office- Day 2  We had at least 5 patients show up with non-emergent problems like bunions and hammertoes. 
So if you have a bunion or hammertoe, don't go see your podiatrist right now in the light of a pandemic aka the coronavirus.  Maybe do a Telehealth visit with your podiatrist if you are not sure after watching this. Yes it will suck for a doctor to tell you, buy bigger/wider shoes, but it could save someone else from getting sick!

Goal #3: Keep kids well stocked with supplies during the time of virtual learning- Day 2 The oldest child complains about not having "fancy mechanical pencils"  We have a box of a 150
pre-sharpened pencils available to the children.  Back in my day pre-sharpened pencils was a luxury!!

Goal #4 Forced Family Yard Time ( Like prison getting a little exercise) - Day 2 ended short when 8 year old fell off scooter and blamed Mother Nature for her pants getting wet.  Sprinkler was broken and she landed in the only puddle of water on the driveway.  

So we are all in this together! Stay safe, wash your hands, try to laugh when you can:)  

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 http://centeranklefootcare.com/services.html

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.

To Fix or Not To Fix My Bunion!!!! The Real Deal On Bunion Surgery!!!!

If you have just left your doctors office and they have told you that surgery is your best option for your foot deformity, you may want to read this and listen to our podcast above first before going through with the surgery.  Now full disclosure Dr. Henne and myself are Board Certified in foot surgery and perform surgery weekly.  That being said we will be the first people to try and talk you out of having unnecessary surgery.  More importantly we make sure you fully understand the post operative course (how bad it really is).  We never SUGAR COAT anything.

Many people come into the office with a bunion or a hammer toe and want it fixed.  But unless they pass a very strict set of criteria to be a candidate for surgery, we turn them away.  I will jump right into the nitty gritty here folks.  Number one reason to not have surgery is NO PAIN!  Yes the old adage if it ain't broke don't fix it still stands. If you do not like the way your feet look, surgery is never the answer! Feet are for function not for entering beauty pageants.  If you want pretty feet, foot surgery will give you pain and may never guarantee a beautiful foot.

When do I operate on someone? The answer is simple: if they have pain that has not improved with a normal course of conservative care and I know that there is a great chance their foot will feel better after surgery.  I never tell someone that their foot will look so much better only that their foot will feel better. I believe the unrealistic expectation that your foot will look better after surgery plays a huge role in why some people are very unhappy after foot surgery.

Bunions are a great example of the type of deformity a lot of people have but do not have a lot of pain with it.  They present with the big bump on the side and want their foot to look thinner but have no pain.

A bunion is a enlarged bump on the inside of the foot at the base of the big toe.  A bunion, in its simplest definition, is a imbalance at the 1st metatarsal phalangeal joint(the big toe joint). A contracture of the lateral side of the joint and stretching of the  medial side of the joint further contributes to the bone getting more deformed.

Over time a bunion can become a progressive deformity that can lead to other deformities like hammertoes, blisters and more. But if you have no pain other than the bump being irritated in some shoe gear, then do not have surgery. The fix for the non-painful bunion is really an adjustment in shoe gear.  Go for a wider toe box and get a mesh sneaker, stay away from constricting leather.  The mesh will give unlike a leather or pleather material. The less pushing you have on the big toe the better to prevent any further progression of the deformity. Also if you just have to wear those fabulous shoes for the day then just do it. Yes your foot is going to hurt after, but just wear good shoes after that! 

 Hammer toes are a very similar situation to bunions as far as a guide to when to fix and when to just wear a more suitable shoe for your foot type. The hammer toe that is most common is the 2nd metatarsal joint(joint at the base of the 2nd toe) hammer toe.  People often come in and complain of a contracted toe that rubs on shoe gear on the top of the toe.  After a thorough examination, if they have no pain but just the nuisance of shoes that they want to wear not fitting right, I tell them to get new shoes.  I explain that the pain they will have after surgery and the aesthetic result they want to have may not line up to what they expect in their mind.

 There are many instances where people have hammer toe surgery and their toe is still kind of deformed looking and much stiffer than they would have expected.  My criteria, which if you are contemplating foot surgery please read closely, no pain in the toe means shoe gear adjustment and using gel sleeves to protect the toe with activity in enclosed shoes.  If there is real pain in the toe and the joint that is unable to be treated with conservative care, then we consider surgical intervention.  I tell all of my surgical hammer toe patients, "You may never be able to wear heels again, and all shoes will not be able to fit just because your toe was fixed."  I always explain the end result is functionality when you have foot surgery not beauty.  

Again, for hammer toes and bunions they make extra-depth and extra-width shoes, that don't look like ugly orthopedic shoes.  They just cheat the extra room where you need it in the shoe with out making the shoe look like it should be on Frankenstein! 

Now, I will tell you that I perform foot surgery weekly on people but only on those who truly need it. If you go see a foot an ankle surgeon and the first thing they offer you for your bunion or hammer toe deformity is surgery, you should run out on your non painful deformed feet and go get some new shoes.  I leave you with this last thought, feet are not pretty.  Feet are for transportation not to be entered in a beauty contest.  I have never seen the foot competition in Miss America for a reason, most people have ugly feet!

If you would like to learn more about other foot and ankle deformities visit our website at http://centeranklefootcare.com/services.html
Michele McGowan DPM
Center for Ankle and Foot Surgery @2014

Should I have foot surgery? To fix or not to fix my bunion or hammertoe?

If you have just left your doctors office and they have told you that surgery is your best option for your foot deformity, you may want to read this and listen to our latest podcast above first before going through with the surgery.  Now full disclosure Dr. Henne and myself are Board Certified in foot surgery and perform surgery weekly.  That being said we will be the first people to try and talk you out of having unnecessary surgery.  More importantly we make sure you fully understand the post operative course (how bad it really is).  We never SUGAR COAT anything.

Many people come into the office with a bunion or a hammer toe and want it fixed.  But unless they pass a very strict set of criteria to be a candidate for surgery, we turn them away.  I will jump right into the nitty gritty here folks.  Number one reason to not have surgery is NO PAIN!  Yes the old adage if it ain't broke don't fix it still stands. If you do not like the way your feet look, surgery is never the answer! Feet are for function not for entering beauty pageants.  If you want pretty feet, foot surgery will give you pain and may never guarantee a beautiful foot.

When do I operate on someone? The answer is simple: if they have pain that has not improved with a normal course of conservative care and I know that there is a great chance their foot will feel better after surgery.  I never tell someone that their foot will look so much better only that their foot will feel better. I believe the unrealistic expectation that your foot will look better after surgery plays a huge role in why some people are very unhappy after foot surgery.

Bunions are a great example of the type of deformity a lot of people have but do not have a lot of pain with it.  They present with the big bump on the side and want their foot to look thinner but have no pain.

A bunion is a enlarged bump on the inside of the foot at the base of the big toe.  A bunion, in its simplest definition, is a imbalance at the 1st metatarsal phalangeal joint(the big toe joint). A contracture of the lateral side of the joint and stretching of the  medial side of the joint further contributes to the bone getting more deformed.

Over time a bunion can become a progressive deformity that can lead to other deformities like hammertoes, blisters and more. But if you have no pain other than the bump being irritated in some shoe gear, then do not have surgery. The fix for the non-painful bunion is really an adjustment in shoe gear.  Go for a wider toe box and get a mesh sneaker like the one pictured here.  The mesh will give unlike a leather or pleather material. The less pushing you have on the big toe the better to prevent any further progression of the deformity. Also if you just have to wear those fabulous shoes for the day then we have some suggestions on how to cheat the system below!

Hammer toes are a very similar situation to bunions as far as a guide to when to fix and when to just wear a more suitable shoe for your foot type. The hammer toe that is most common is the 2nd metatarsal joint(joint at the base of the 2nd toe) hammer toe.  People often come in and complain of a contracted toe that rubs on shoe gear on the top of the toe.  After a thorough examination, if they have no pain but just the nuisance of shoes that they want to wear not fitting right, I tell them to get new shoes.  I explain that the pain they will have after surgery and the aesthetic result they want to have may not line up to what they expect in their mind.   There are many instances where people have hammer toe surgery and their toe is still kind of deformed looking and much stiffer than they would have expected.  My criteria, which if you are contemplating foot surgery please read closely, no pain in the toe means shoe gear adjustment and using gel sleeves to protect the toe with activity in enclosed shoes.  If there is real pain in the toe and the joint that is unable to be treated with conservative care, then we consider surgical intervention.  I tell all of my surgical hammer toe patients, "You may never be able to wear heels again, and all shoes will not be able to fit just because your toe was fixed."  I always explain the end result is functionality when you have foot surgery not beauty.  

Again, for hammer toes and bunions they make extra-depth and extra-width shoes, that don't look like ugly orthopedic shoes.  They just cheat the extra room where you need it in the shoe with out making the shoe look like it should be on Frankenstein!  

Now, I will tell you that I perform foot surgery weekly on people but only on those who truly need it. If you go see a foot an ankle surgeon and the first thing they offer you for your bunion or hammer toe deformity is surgery, you should run out on your non painful deformed feet and go get some new shoes.  I leave you with this last thought, feet are not pretty.  Feet are for transportation not to be entered in a beauty contest.  I have never seen the foot competition in Miss America for a reason, most people have ugly feet!

If you would like to learn more about other foot and ankle deformities visit our website at http://centeranklefootcare.com/

Michele McGowan DPM
Center for Ankle and Foot Surgery @2014