surgery
I will offer the most basic advice regarding surgical
options for foot problems.
Bunions
When should someone with bunions consider their surgical options? This
is not an easy question to answer. Many people have heard horror stories
about other peoples' bunion surgeries. These stories will always be
out there. However, in the hands of a qualified foot surgeon, bunion
surgery is usually highly successful. Bunions are treatable using conservative
options in many cases. Those treatment options include, custom orthotics,
shoe change, padding, regular podiatric care and activity modification.
Some people may not be willing to try these options. Some people have
already tried orthotics, changing their shoes and various options and
they don't want to have to deal with the pain anymore. Basically, there
are 2 reasons to have surgery,
PAIN
Over the years you've watched your bunion grow. You've tried all the
conservative options. You love to walk and you are in almost constant
pain whenever you walk, despite wearing good custom orthotics and athletic
shoes. The bunion is starting to hit the 2nd toe which is now hammering.
Your quality of life is significantly affected by the pain caused by
your bunion. It's time to consider surgery.
Pain is very subjective. A little pain is enough for some
people to have surgery. Others wait until their altered gait pattern
(due to chronic foot pain) has lead to knee, hip or back pain. This
may be going a little far. But, everyone has to decide for themselves
how much pain they are willing to tolerate. You should discuss this
with your podiatrist. It is also helpful to talk to other people who
have had bunion surgery, if possible by the same surgeon who you are
considering.
Bunion surgery does not guarantee pain relief, but when
done by a qualified foot surgeon, it is very successful in relieving
pain. Any foot surgeon should describe the potential risks of surgery
very clearly for you. You need this information in order to make an
informed decision.
Remember that all orthotics are not created equal. If
you tried orthotics from a shoe store, for example, they may not be
as effective as those made by a professional such as a podiatrist. Orthotics
that do not properly control your pronation will not likely help with
bunion pain.
DEFORMITY
Your foot is so wide at the bunion joint that you cannot fit any shoes
other than runneres and sandals. You have changed your wardrobe to accommodate
your footwear. Any pressure from a shoe on the bunion causes pain. The
second toe may be so hammered (often associated with bunions) that it
always hits the top of your shoes. You may hate your shoes and feel
that the bunion is affecting the quality of your life as a result. It's
time to consider surgery.
It is important to remember that a bunion is not simply
a bump. There is an underlying deformity in the joint which must be
addressed when taking a surgical approach. The bumps associated with
bunions create a deformity that can be of any size and it can be on
the side or top of the bunion joint. Any bony deformity can make life
miserable. . Fitting feet into shoes can be a painful or depressing
experience. Only you know how much your bunion is affecting the quality
of your life and you are the best judge of whether or not you want to
consider surgery. A podiatrist should offer you the medical information
you need in order to determine whether surgery is what you really want.
Simply removing bumps surgically is often not successful
in the long run. Most bunions need to be corrected at the joint as well.
Your surgeon should explain exactly what will be done to reduce the
deformity and how successful the procedure should be over the long term.
Summary
Bunion surgery is a very personal choice. You need clear and detailed
information in order to determine if this is the best choice for you.
If you feel the need, get several opinions. Talk to people who have
had the surgery and find out what their long term result really is.
It may not be an easy decision, but like anything else, it's best to
make your decision and then stand behind it. Don't be hard on yourself,
regardless of the outcome. I highly recommend you find a foot surgeon
with whom you feel completely comfortable asking all your questions.
It should be someone who gives you as much time as you need in your
appointments and who does not seem to be in a hurry for you to have
surgery. You may be seeing alot of this surgeon, especially if you have
complications.
Hammertoes
Toes can become curled and bony prominences stick up into your shoes.
Usually there will be painful corns or joints, possibly ulcerations
(skin breakdown that does not heal easily). This problem can be genetic
or it can be developed over years of wearing inappropriate shoes. High
arched feet and people with arthritis tend to develop hammertoes more
commonly. They are often treatable using conservative methods - padding,
shoe change, orthotics, regular podiatric care. If the hammertoe is
creating ongoing problems, such as pain or ulceration and this problem
is affecting your life on an ongoing basis, you may be considering surgery.
This problem must be evaluated thoroughly by a podiatrist
or other foot surgeon to determine if surgery is your best option. Usually
only rigid hammertoes are operated on (flexible ones often respond to
conservative options). The surgery usually involves removing a joint
and often pinning the toes to keep them straight. A procedure where
the tendon is cut does not offer usually long term relief.
Neuromas
Inflammation of nerves in the ball of the foot lead to burning, tingling,
pain and general discomfort in the ball of the foot. They can be debilitating.
Neuromas should be treated by conservative methods for at least 6 months
before surgery is considered. Nerves can take a long time to respond
to treatment and they should be given this time to respond. I have never
known a neuroma that didn't respond to conservative treatment in my
hands. Some people still opt for a surgical approach and this is appropriate
in some cases. I feel this should be done as an absolute last resort.
The reason is that post-surgically the toes will be numb permanently.
Also, the nerve can be very reactive to the cutting that takes place.
Some people develop nerve reactions that are more painful than the original
pain. Neuroma surgery can be highly successful if it is done by an experienced
surgeon and performed on patients who have truly exhausted their conservative
options.
Heel Spur
There is a remarkable misunderstanding within the medical community
and the general public of what causes most heel pain. Very often, x-rays
are taken in the evaluation of heel pain. The x-ray may show a "heel
spur". This is a small piece of bone that juts off the bottom of
the heel in the area of the heel pain. People mistakenly believe that
this heel spur is the cause of their pain. This is simply not true,
most of the time. Heel pain is caused almost always by soft tissue inflammation
of the plantar fascia where it inserts into the bottom of the heel.
Sometimes, the fascia can become very tight and start to pull at the
lining of the bone. This can create a bone spur. When the bone spur
is seen on x-ray it is considered to be the cause of the pain, when
in fact it is a result of the soft tissue pulling. The bottom line is
this: x-ray is rarely helpful in evaluating heel pain. Even if you have
a heel spur, it doesn't mean it is the cause of your pain. The presence
of a heel spur and belief by many people that it is causing their pain
is counter-productive to following effective treatment plans. The treatment
should be directed at alleviating stress on the plantar fascia, not
at padding or removing the heel spur. Heel spur surgery is rarely done.
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