Jonathan Salute: Well, there are different types of Bunions. There are bunions in children, which will call Juvenile, Hallux Valgus Bunions and also bunions in adults which are usually acquired deformities.
Women usually come in my office complaining of pain in their bunion as well as difficulty fitting normal shoes. There are many types of procedures for fixing a bunion. The most common one I use is what we call a First Metatarsal Osteotomy.
Now, that is basically a long word for cutting the bone and shifting it over. Almost a 100% of my procedures do not need a transfusion. We do most of our procedures under what we call a tourniquet. In other words, we exsanguinate the leg, which means that we use a rubber wrap to squeeze the blood the out of the leg and there's a cough sort of similar to a blood pressure cuff that we inflate, which leaves the leg almost bloodless. A very simple procedure can take 30 minutes.
A lengthy procedure for a very severe bunion, sometimes we have to cut the bone in more than one place in order to get it straight. In that case, it can take up to an hour-and-a-half. For the simpler procedures, I can usually weight-bear. In other words somebody can put most of their weight on their foot right away, even after surgery.
For the more complex procedures, sometimes I'll keep the people off their feet for six weeks. It is definitely an elective surgery. So if somebody has a bunion problem, the best way to treat it is conservatively. What they should do, is go buy better shoes.
If you have already done this and this conservative treatment has failed, then you become a candidate for surgery. The problem with bunion surgery is that some of them tend to recur. And what you need to do is follow your post operative guidelines to the tee in order for this not to happen.
I usually have pretty close follow-up with all my patients. I see them every one to two weeks after surgery. I incorporate what's called a bunion wrap. In other words, a wrap that pulls the toe in the opposite direction, so that this does not recur.
I also incorporate exercises for patients so that they get their motion back and their toe is not so stiff. And also, of course, you have to follow your weight bearing restrictions. In other words, if you weight bear too fast or too hard, you may shift the bone, you may break the hardware.
So I think you have to be very diligent about what the doctor tells you. I think the most important thing actually is the shoe wear. I think that because of today's society, women feel pressure to have very high heels, very narrow toe box shoes and I think that's okay, if you want to do it for church or if you have special event. But I think the most important thing really is to buy some comfortable shoes and there are some comfortable nowadays that are very stylish, you just have look for them.
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