Bunion Surgery – A Painful Choice
Deciding to have bunion surgery can be one of the most difficult health decisions to make. 'Bunions' are a cause of distress to many thousands of people -mostly women -worldwide. Last year, I wrote about bunions and my opinion was and still is – "avoid bunion surgery if at possible, unless it is ruining your life and crippling you with pain".
The 'bunion' referred to here is the bony deformity characterized by a big toe that deviates towards the rest of the toes, possibly accompanied by a second toe which is bent and overlies it.
When any surgical intervention is considered, be it the podiatrist enucleating a corn, removing part of a toe-nail or the orthopaedic surgeon realigning the foot in bunion surgery, all of us strive to do our best to achieve a satisfactory outcome, by exercising our skills to the utmost.
So you can imagine my concern to have two patients recently complaining bitterly about their unhappiness with the result of their bunion surgery. Add to this my surprise at the 'twenty-something' who wants surgery because she doesn't like the look of her feet and her bunion (this one is the small thickening of the metatarsal bone with no deformity), prevents her from wearing the high fashion shoes she needs for work.
What can you say to a middle-aged, active woman who decided to have her bunion (deformed type) corrected, but after three months can only wear trainers with the toe cut out, has a swollen foot, pain and discomfort, difficulty driving, plus all the associated emotional stress? Or how do you respond to a similar woman who is now in constant pain and has had altered her walking style because the foot is rigid at the big toe joint?
To the best of my knowledge the procedures were technically successful and there is no deformity anymore. In addition we all react differently to a surgical "assault" and time does allow better healing. Also, there are numerous variations of operations and techniques available for bunion correction surgery.
Firstly – go back to the surgeon and discuss your options.
Secondly – see if a podiatrist can assist with biomechanical correction or alignment and footwear advice.
With my 2 patients, one has had orthotics made and the other I referred to the surgeon, who has recommended further physiotherapy, with the possibility of another operation to remove the steel plate that is in the foot.
I will still refer patients who meet my criteria outlined above for consideration for surgery, because the final decision to undergo sugery is always taken by the patient. Unfortunately, there can be no absolute guarantees since the structure of each foot is so complicated.
So what to do about 'bunions'? Is there an underlying systemic disease such as rheumatoid arthritis?
We must consider the patient's age. Is the patient overweight? What is the biomechanical structure and function, not only of the feet but lower limbs and body? Have all possible conservative measures such as night splints, orthotics, insoles, appropriate footwear, been exhausted?
Be guided by the severity of loss of function, pain, discomfort and limitation of daily activities. Will the patient be able to adhere to all the post-operative requirements, expected by the surgeon?
Eventually, all these factors (plus others), must be seriously thought about before undergoing bunion surgery.
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Comments on Bunion Surgery – A Painful Choice
Hi,
I used to run daily about 15 kms. Have bunions on both feet – the one being progresivly worse. Have seen a few orthaepedic surgeons. They all suggest surgery. The one surgeon Dr Saragas – was prepared to do both my feet and not straightening all my toes.
The last surgeon I saw Dr Ferreira in Pretoria -advises severe arthritis in big toe joint and all toes need to be straightened. Only the last few months has my running being affected. My foot (because the joint does not work anymore) is very sore under the arch. I am in such a quandry whether to have the op. Do you think I will ever run again. Apart from being in a cast for 3 months – my biggest concern is the running.
I am sure you are not able to comment without seeing my foot. It is bad – besides the big toe, the second toe is a hammer toe and the others are curling downwards.
I would appreciate your reply.
Susan,You are faced with the recurring problem facing people with bunions – to cut or not! Your have consulted 2 highly respected specialist foot surgeons so that you have a good idea of your options. Whether you will still be able to run depends largely on the technique used and what range of movement the surgeons leave you with. You need to ask. However, firstly you must ask "what caused the bunions?" I assume you have what we also call hallux valgus so they are significant. Secondly, have you exhausted your conservative options? Thirdly, what type of arthritis? My guess is osteo-arthritis. Fourthly,(Don't answer this one!) How old are you?
Remember that surgery is the last resort.
Hi Susan,
Have a look at the comments(my reply) on the website. If you can't email me again.
Andrew
@susan traub:
Hi Susan
I am trying to get hold of Dr Ferreira, mentioned in your blog above, do you have any detials for me please? i belive he comes very highy reccomended for foot problems?
Charles, Dr Fereirrra practices at The Little Company of Mary Hospital in Waterkloof, Pretoria.
Andrew
I have very painful bunions , the one on my right foot it is so painfull the Dr suggested that it should be removed. There are also pains under the second toe when my shoes are on they pain is needdle like pain it is so bad i cannot walk properly and i love beautiful shoes , pls help
Hi susan, did you have the op, are you running again and howlong was your recovery, I have bunions on both feet and very nervous of have a op after reading how long the recovery takes, as I to am very active and might go nuts not being able to run or cycle@susan traub:
Hi Thembi,
Your Dr is probably right! If you are in such pain then surgery should be considered, BUT just make sure that you have tried all the alternatives and when/if you see a Surgeon, make sure that he/she is a foot specialist and is able to explain not only the operation, but also how long the recovery period is and what you can and cannot do!
Those needle pains might be caused by a pinched nerve and that needs to be confirmed. Perhaps you should have an Ultrasound Scan of your foot.
Finally, you might still not be able to wear beautiful shoes, so get well-informed.
Good luck
Andrew
Hi Andrew,
I have a bunion on my left foot. which is very sore.
I've tried the bunion pads, it felt better but halfway through the day it acts up again.
My foot is fine insoft shoes.
I've read up a little on bunion treatment and i'm keen to buy a splinter.
Where can i find 1 in South Africa?
Hello Avasha
Find the address of an Orthotist/Prosthetist in your area.
They will supply and fit OR get help from a podiatrist OR phone 011 726 6363 and ask Lauretta to give you some names.
Regards
Andrew
monring Dr Andrew,
I am finalyy going for surgery tomorrow I hope I will be better after six weeks, the bunions has affected me so much such that I can only wear sleepers even at work because shoes make my feet sore.
I need all the luck
Kind regards
Thembi
Hi all, I have had my bunion removed from my left foot by Dr Ferreira, have completed my 2 weeks flat on my back in bed and about to have my plaster changed.
I can honestly say, that although I have experienced some discomfort and swelling, the pain has been minimal. I've only had painkillers on 4 occassions and I don't have a very high pain threshold. I am an extremely active person, but I'm taking this enforced rest period in my stride, after all, it was my choice to have this operation, I'm NOT ill.
should you be wondering whether you should have this operation, I can only tell you that it is totally bearable.
Well done Karin. Great discipline to REST! As you know , I think many of the problems/disappointments associated with bunion surgery come from the difficulty of doing what the surgeon wants you to after the operation.
I wish every success and look forward to the following episodes on your road to recovery!
Andrew
Hi Thembi
How's it going? Are you managing to keep weight off the foot? Do you want to tell us what it has been like?
Wishing you all the best for a "bunion-free" future!
Andrew