By Dr. Sherunda. S. Josey, DPM, MPH & Neal Mozen, DPM, FACFAS
 
Women, including myself, love to wear high heel stylish shoes”, states Dr. Sherunda S. Josey, a podiatrist inSouthfield,Livonia, andNovi. For us girls, a shoe can give us a sense of sophistication, beauty and confidence, especially when they match a new outfit. Shoes can “make an outfit.”  A common condition that we see in our office and that often limits the kind of shoes women want to wear, is a bunion. Although bunions do affect both men and women, the majority of patients who present complaining of bunion pain are women.
 
A bunion is an enlargement of the big toe joint where a large bony prominence can stick out on the side of the foot causing the joint and skin to be irritated. A bunion deformity can deform your shoes and cause the big toe to lean abnormally towards the second toe. Bunions are not only unsightly and distressing to many people, but can also progress to a significantly painful arthritic condition which often limits one’s activity and shoe wear.
 
You basically have three options in choosing how to treat your bunion:
 

1. Ignore the problem.

 

2. Treat the symptoms non-surgically with anti-inflammatory medication like Motrin, put padding around or on the painful bone, injections, orthotics, physical therapy, soaks, wear wide supportive shoes “old lady shoes”, etc.

 

3. Surgical correction of the deformity.

 
Although shoes can often aggravate a bunion condition, it is generally felt that a hereditary predisposition is the primary etiology of bunion development. Some people are born with a certain instability in their feet which predisposes them to bunion formation.  With or without surgical correction, orthotics can address and improve the stability of your foot and often relieve the mechanical stress on the bunion.  Orthotics are “custom made” arch supports which help hold the foot in its proper anatomic alignment. When the foot is properly “balanced” and stabilized with an orthotic it will usually improve the way you walk and limit the wear and tear on your feet.
Although for some people over the counter “drugstore” supports can provide some relief, in general, custom orthotics are more effective. A podiatrist can make orthotics for all different types of shoes including high heel, dress, casual and sports shoes.  Wearing supportive athletic shoes for at least part of the day is a smart way to keep your feet healthy and feeling good.  Some of the new surgical techniques we have helped develop not only relieve bunion pain and correct the deformity, but also allow patients to wear the stylish high heel shoes so many women crave. 
 
One of the misconceptions that often prevent people from seeking effective surgical correction of their bunion is the unfounded fear of pain after surgery. If you see a board certified podiatric foot and ankle surgeon, who is well trained and experienced with the newer surgical modalities for bunion correction, postoperative pain is usually minimal. 
 
“Dr. Neal Mozen, Podiatric Foot and Ankle Surgeon states there are several techniques for bunion correction that we utilize in our practice. One of the most popular is the tri-correctional bunionectomy where the deformity is corrected in three different planes. Another newer procedure gaining popularity is the mini tight-rope bunion procedure.  The tight-rope procedure has been very exciting to many of our patients because we are able to correct the bunion without having to “break” or create an osteotomy/ surgical fracture in the bone. “
 
After most procedures, patients are allowed to walk in a special boot for up to six weeks and then transition into an athletic shoe.  After minor bunion procedures (those performed without an osteotomy or surgical fracture) patients can often get back into a closed shoe in as little as two weeks. On rare occasions when a bunion deformity is severe, a patient may be in a non-weight bearing situation, putting absolutely no weight on their feet, for up to six weeks.  Most surgical procedures should be performed in an accredited outpatient surgical facility usually affiliated with one of the major local hospitals. Bunion procedures are generally performed under sedation with local anesthesia on an outpatient basis with patients going home on the same day.  Patient satisfaction is often very high. A recent patient relayed a common sentiment when she stated, “I have had these bunions for about 15 years. My fear of having someone cut into my feet was terrifying to me. It was so bad that I had to start cutting my shoes on the side to even be able to wear shoes. After I had one foot done, I had no more fear.” Another typical patient stated, “I couldn’t wear a pair of shoes for 20 minutes without having pain. I decided to have the surgery done. I have to say my foot is now absolutely pain free and beautiful. Now I can take my dog for a walk, spend the day walking at the mall without the pain that I had everyday.”
 
Patients need to be wary of the so-called bunion correction using “laser.” Laser is never used on a bunion. It is used on soft tissue, not on bone. A bunion is a bone deformity. Anyone who tells you that they are going to “fix” your bunion with a laser is misleading you. 
 
Although, “cosmetic” foot surgery has been recently written up and featured in various popular magazines and TV shows, most experienced foot and ankle surgeons believe that foot surgery in general, and bunion surgery in particular, should only be performed when a patient has an actual complaint of pain or discomfort.  The American College of Foot and Ankle Surgeons and The American Podiatric Medical Association, our most respected national professional organizations, have emphatically stated their opposition to foot surgery performed for cosmetic reasons only. 
 
Dr. Josey states however “as a woman, how something looks is very important to me and my partners; we make sure that we do everything we can to maximize the aesthetic appearance of the foot after surgery.” One technique is the so-called “invisible scar” where the incision is hidden on the side of the bunion, so when you look down you can’t see the surgical scar. Small incisions and very fine sutures are used whenever possible.  So women don’t let fear prevent you from having the pain-free, beautiful feet that you desire.

For more information, please visit the following websites:
www.MichiganPodiatry.com
(Foot Healthcare Associates)
www.acfas.org
(American College of Foot and ankle Surgeons)
www.apma.org
(American Podiatric Medical Association)
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