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My Aching Bunion!

(My blog is not to be used as medical advice. You need to go to your doctor for that. Instead, this is information to encourage you to investigate certain topics that may improve your health and well being. I use a casual style of writing with anecdotes from over 30 years of podiatry practice so that you know that this was not written by AI.)

A bunion is a bulging prominence over your big toe joint on the side of the foot. The big toe can also be leaning toward the little toe. Sometimes it leans so far over that it starts to slide under the second toe. Depending on the position of the big toe, you could have a mild, moderate, or severe bunion.

How do you know if you need to fix this surgically? Does it get worse over time? Maybe it gets so bad, it's too late. Now you can't fix it anymore. You blew it. This is what patients tell me. They also ask if they can get rid of the bunion without surgery. There are a lot of these cures on the internet. Some of them are hysterical: before- bad bunion, really crooked! After rubbing on cream- Bingo! Completely straight!

Let's start with the surgery question. My advice is to never have bunion surgery unless you have considerable pain.

A bunionectomy can get rid of pain. But it doesn't really make your foot look very different or become significantly more narrow. The appearance post operatively can be very disappointing. And you can't start wearing high heeled shoes again.

If you wear high heeled shoes after bunion surgery, the bunions will come back worse than before. Ugly shoes before bunion surgery. And ugly shoes after bunion surgery.

Bunion surgery can make the big toe joint stiff. So a good candidate for bunionectomy already has a joint that no longer works and is frozen. This foot may have better range of motion after the surgery.

Can you wait too long to fix a bunion? Yes. Over time, when you get older, health concerns can make it impossible to have foot surgery. If you are having significant bunion pain and the big toe joint is stiff, you should look at your calendar, plan a couple of months off, and call your regular doctor to recommend a foot surgeon.

What about occasional pain and a crooked looking toe? My advice is to get orthotics which are custom made insoles that go into shoes.

Bunions are usually caused by your foot type. There's too much pressure on that part of the foot and the big toe is pushed out of joint. This is a progressive situation, with bunions getting worse over time. The idea of orthotics is to realign the pressure on the foot and slow down or stop the progression of the bunion. This may prevent the need for foot surgery. Orthotics can also get rid of the pain.

Another helpful tip is to use a toe spacer. The most popular ones are the small, simple, clear, gel spacers that you can get on the internet. The other devices hook over the big toe, some cover the bunion area to protect it from the shoe, and some have a portion for the second toe to fit into. There are also night splints. Some of them look like Torquemada devices with a knob that you can turn until the big toe is really straight. I don't know about those. They don't seem very comfortable.

I sometimes make custom Pediplast bunion spacers in the office. But first I always like the patient to try the cheap, online products first before I make a custom made device. I also know how to make a really old fashioned latex rubber shield that goes over the bunion. But I only make that for someone who is sick, can't have surgery, and there is skin breakdown over the bunion. The latex shield looks yucky over time. Once a patient told me that her latex shield looked "disreputable". I felt bad for her so I experimented in adding color to the latex.

When I was done adding color, it looked shiny and silver, like shark skin. So I decided to make a 10 foot long shark costume out of it. I entered the Greenwich Village Halloween Parade with it and won the grand prize out of 50,000 or more contestants in 2002

(see picture with Nick, Mariska & Emma Kop in a boat chased by a shark=me)

I got to meet Jean Fleming, the director of the parade and got a whole bunch of cool prizes like air fare, a key to New Orleans, an Irish band for 2 hours, and a chocolate Buddha. All because of a latex bunion shield.

That was before the internet. Now patients can find "reputable" bunion shields at reasonable prices.

What are good shoes to wear if you have bunions? I like Naot Celesta, a dress casual slip on with a wide forefoot, narrow heel to stop the forefoot from grinding, and a removable insole to get your orthotic in there. Many of the Orthofeet shoes work well. There is also Dr. Comfort shoes. You wouldn't wear these shoes under your bridal dress or the honeymoon outfit, but they would look professional at work with dress slacks and a Kamela Harris suit jacket. There's usually a comfort shoe store in every good sized town and a salesperson can really help you. It's always good to try a mess of shoes on before you choose.

Lastly, we can cover injections. If you are in a lot of pain, but you can't get time off from work to do the surgery, you are wearing the ugly shoes with your orthotics, and still have a lot of pain- then you might want to have a cortisone injection. Cortisone is an anti-inflammatory and can give a lot of short term relief. It lasts for one to three months when long acting cortisone is used. Don't get too many of these injections, no more than two or three in a year. The medicine is crystalline and can build up in the joint. Over time, too many crystals will cause more pain than the original bunion pain. But as long as you only do this rarely, a cortisone injection can really help.

Good luck with your bunions. If you are in the NYC area, you can come in to see me and we can pow wow about your options. In other cities, please see your local podiatrist to learn more.

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