Bunions and Hammertoes

Stroud 200x300Bunion comes from the Greek word meaning ‘turnip’. Commonly seen as a ‘bump’ about the inner aspect of the great toe, this prominence can be a very common condition. Arthritis, a cyst and/or deviation of the toe from the normal straight alignment can present as a ‘bunion’. Generally speaking, there are two causes: 1) intrinsic, or genetic, causes and 2) extrinsic ones, or those caused by ill-fitting shoes. Most bunions are not painful and are well tolerated by those with this affliction. However, some bunions cause pain with shoewear and with increased activity. Hammertoes, or a ‘bent’ toe, are commonly associated with this condition. Hammertoes can be inherited, can develop from repeated use of a narrow shoe toebox or can develop as the great toe deviates to the side, as in a classic bunion deformity.

As mentioned most prominences about the foot do not cause pain and as such, do not require any treatment. Proper fitting shoes and avoiding the repeated, long-term use of a heeled shoe with a narrow toe-box will be ones best bet to avoid the development of these conditions. However, if the prominences become painful, there are several options available for treatment.

Nonsurgical treatment generally revolves around appropriate shoewear, ie those with a wider and deeper toe box. The so-called bunion straps and stretching devices that one occasionally sees on late night commercials are generally useless in correcting the condition. Pain about a hammertoe can be improved with a corn pad placed directly over the prominence to limit rubbing on the shoe. Toe sleeves can be placed over the affected toe to limit friction. The toe can be taped down in a figure-of-8 manner to place the toe in the appropriate alignment.

Surgical treatment is indicated for pain and perhaps with the inability to wear a reasonable shoe. Surgical treatment for cosmetic reasons, if poorly performed, can result in a painful condition that otherwise was not present initially and is strongly discouraged. One often hears horror stories about friends and family that have undergone a procedure on the foot only to have continued pain and a recurrent deformity.

However, if the foot prominence is painful and the condition limits activities or reasonable footwear, surgery can improve or eliminate the problematic situation. Advances in anesthesia, postoperative pain control as well as the multitude of procedures available to correct the condition has vastly improved patient recovery and outcomes from a foot procedure. While the surgical procedure is generally quick, the recovery usually takes around 3 months for most people to recover fully and notice the benefit. During this time, one is able to ambulate, however slowly. Proper preparation for this time period, should it arise, can ease the recovery.

In summary, knowledge about the condition, its causes and consequences and the treatment options available, will help improve patients appropriately manage this condition. Two reputable websites that explain foot/ankle problems in-depth include www.aofas.org and www.orthoinfo.org.

Dr. Christopher Stroud is certified by the American Board of Orthopedic Surgery, a Fellow of the American Academy of Orthopaedic Surgeons, and a member of the Medical Staff here at UnaSource Surgery Center. His office is located at 4550 Investment Drive, Suite 240 in Troy. To learn more or schedule an appointment with Dr. Stroud, please call 248.792.9881.

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