Bunions and Bunion Surgery

A bunion is not simply a bump on the side of the foot. It is a complex change in the shape of the big toe joint (first metatarso-phalangeal joint) that leads to increasing pain and arthritis as it gets worse. Though many bunions are not painful, as they get worse they can become more and more painful, which leads to difficulty in walking and doing the normal activities of life.

The medical name for a bunion is Hallux Abducto Valgus, which means the big toe and the bone behind the big toe (called the first metatarsal) become angled and the cartilage, which provides the lubricant for the joint to move smoothly, becomes shifted. This happens because the big toe moves away from the center of the body and the first metatarsal moves closer to the center of the body. Because the cartilage is shifted, it wears away at a faster rate than normal and can lead to early arthritis and severe pain as time passes. Usually as the bump gets larger and the toe gets pushed over farther, the pain and arthritis get worse.

There are several causes of bunions, most of which are hereditary. Flat foot and flexible flat foot are among the most common causes. Other causes include trauma/fracture, high arches (also known as cavus foot), hereditary nerve problems and in some cases there is no known cause. The reason a flat foot most often causes a bunion is because of the way a person walks when there is not an arch to properly support the foot. Normally the arch helps the foot push the body forward during walking or running. With a flat foot, there is no arch to help push the body forward, so the foot turns outward instead, which puts the big toe in a bad position and the body pushes on the big toe from the side, instead of from the bottom. The big toe is not designed to be pushed from the side, so it gets forced away from the center of the body, leading to a shift in the toe and a larger bump on the side of the metatarsal bone.

So, the strategy to help improve the pain and prevent the bunion from getting worse is to support the arch. This support can come in the form of shoes, pre-made orthotics and custom orthotics. A shoe alone is usually not enough to properly support the arch if someone has a very flat foot or very flexible foot. Shoes are made as a blank and usually have very little arch support. Orthotics provide a better and more custom fit to any shoe. Pre-made orthotics are designed as an average of everyone’s foot type, but some can be selected for certain foot types to fit a person somewhat better. Many people do extremely well with pre-made orthotics. Custom orthotics are made by taking a mold of the foot and making an orthotic that is exactly made for the person. They are made of stronger and more long-lasting materials also.

There are other devices that are made to help with bunion pain. A bunion splint is a brace that helps straighten the big toe, which helps to put the cartilage back where it belongs. This splint does not make the toe grow back where it belongs, but it does help to make the toe work better as long as it is worn. A toe separator is a device that is put between the big toe and 2nd toe, keeping them separated. This can also help the big to cartilage be in a better position, but like the bunion splint, it only works when worn and will not permanently fix the bunion.

Also, there are medications and injections that can help the pain of a bunion. The pain from a bunion is most often due to inflammation (swelling of the joint and tissues) and medications can help to slow it down. Non steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help with the swelling that is the cause of the pain. An injection of steroid into the joint also can help reduce the inflammation.

If the treatments listed above do not work well enough, surgery to correct the position of the joint is the next step. Many different operations can be performed to place the joint in the right position to keep the cartilage from wearing down and decrease the pain. Which operation is chosen is based on many things and x-rays of the foot are very important in making the decision. The doctor looks at the position of the big toe and metatarsal as well as the other joints of the foot to decide which operation is best. The recovery time is different depending on which operation is needed.

In most cases, the operation needed is a shifting of the metatarsal bone, to bring it back to where it belongs. To do this, the bone must be cut and held in place with screws. These screws stay in the bone and usually don’t have to be removed. The big toe must also be shifted, but usually doesn’t need a bone cut. The large bump on the side of the foot is also removed. When finished, the big toe is straighter and the bump is gone. The joint also moves more smoothly and the pain is improved. The recovery period for this operation is a little different for each person, but on average the patient walks with a special shoe for about 4-6 weeks, which is the time it takes for the bone to heal. After that, the patient starts wearing a tennis shoe and slowly goes back to regular activities. The patient will also need to do exercises to keep the big toe joint moving and may need to have physical therapy for the best results. The incision for this operation is usually around 2 inches long and is put in an area where it heals very well with a small scar.

In some cases, the operation needed is a little more complicated. In people with very flexible feet, or for bunions that are very large, a different operation is needed. This operation has a bone cut also, but it is done in a different area and it is necessary to take away one of the joints to make the flexibility of the foot more normal. Screws and a plate are usually used to hold the bone in the right position and bring the metatarsal back where it belongs. The big toe is straightened and the bump is removed, just like in the other operation. The recovery time for this operation is a little longer. Usually the patient is in a cast for 6 weeks, followed by walking in a boot for a few weeks. Because this operation is a little more complicated, the scar is usually a little longer, but is still small and most often heals so that it is not easy to see.

There are many other operations for bunions but these two are the most commonly used at Advanced Foot and Ankle Center. With every bunion, the doctors at Advanced Foot and Ankle center take great care when looking at all parts of the problem and then select the best treatment. Whether you need orthotics, a splint or surgery, you and your bunion will be given the time and care they deserve.

Toenails got you down?

Do you have a thick, discolored or missing toenail that you hate looking at? Do you have an event where you wish your toenails looked better? Was your toenail damaged requiring it to be removed? If so, there is a solution that can make your nail look like new.

At Advanced Foot and Ankle Center we understand that many people want their feet to feel good AND look good. We provide comprehensive care of the foot and ankle, including techniques that can enhance the appearance of those areas you wish would look better.

With a fusion of medical knowhow and an artistic eye we hand-craft a nail that looks and feels real, while reducing the risk of infection that can happen when improperly applied. Using the latest techniques, this nail will last for up to two months and can be touched up if damaged. All you have to do is paint it and wear the shoes of your choice!

Although this is not a permanent solution to your damaged or missing nail, it is a safe and effective way to get through the open toed shoe season with a nail that even a well trained eye will have difficulty spotting!

No matter what the cause of your nail problem, we can help. Call us for a consultation today. You don’t have to hide your toenails anymore!

Painful Bunion?

I see many patients on a weekly basis that have postponed seeking treatment for their painful bunions because they have heard “horror stories” from their friends or family about having them surgically corrected. Of course since bad publicity is more often remembered than good these concerns continue to come up. As a result, many ask what can be done non-surgically to alleviate the pain and throbbing associated with this common condition and the good news is that there are many!

Although most bunion procedures have a relatively short recovery time and fewer complications than many other problems in the lower extremity, they are not without their risks. For this reason it is best to first try a non-surgical approach to alleviating the pain, and often surgery is not necessary if these conservative therapy regimens are closely followed.

But to understand when and why these non-surgical treatments will work, it is important to first understand the reason for the pain. A bunion is not simply the bump on the side of the big toe joint. It is actually a partial dislocation of the joint, resulting in excessive pressure on one side, leading to arthritis with chronic swelling and pain. This partial dislocation is slowly developing over the course of years and is a result of poor foot mechanics, leading to an unstable arch. This instability of the arch, causing collapse when standing, causes excessive pressure on the side of the big toe, pushing it over and creating stress on one side of the joint.

Therefore, the non-surgical approach to bunions begins with proper arch support in the form of either a prefabricated or custom made orthotic, along with the proper shoe. I use the analogy of a pair of prescription glasses to help illustrate the importance of both. The shoes are like the frames of glasses, they are necessary to hold the lens on the face, but do not correct the vision themselves. The orthotic is like the prescription lens, and just like correcting vision, they must be made for your particular foot type to have the best function.

Once the arch is supported, the big toe joint is able to function in its proper form and the abnormal stress on the joint is relieved. In mild bunion deformity, this may be the only treatment necessary to improve the pain. In long-standing or more severe bunions, other devices must also be used. A bunion splint is designed to relocate the joint by placing a sleeve over the big toe, supporting the joint much like an ankle brace does. There are also types of pads that can be placed between the toes to accomplish the same goal.

However, the most common complaint I hear is that patients don’t like wearing “constrictive” or closed toed shoes, especially in the hot Texas summer, and resort to wearing flip flops or sandals which do not provide any arch support, leading to increased stressed on a painful and tired joint. But there is good news! We offer a line of custom molded flip flops and sandals that are both functional and fashionable. They function as a built-in orthotic that gives the proper arch support, but allows for wearing an open toed shoe without pain. They are much more durable than a standard flip flop and come in a variety of styles and colors for every fashion sense.

And although surgical correction is not high on your list of fun things to do, don’t believe the horror stories. It is a very safe and successful procedure. The recovery time in most cases is 6-8 weeks and since it is not a life-threatening condition, the procedure can be timed at your convenience.

No matter the severity or age of your bunion, there is a non-surgical solution that can help alleviate that aching, throbbing pain. Call for an appointment today. You don’t have to live with the pain anymore!

Thick, Painful or Ugly Scar?

You don’t have to live with that thick, painful and/or ugly scar. Whether it be from a cut, burn, surgical procedure or scratch, there are methods of improving both the color and raised nature of scars.

There are different types of scars and the treatment and prognosis differs depending on the type. Many normal scars can be darker or lighter than the surrounding skin. This is often due to sun exposure during the healing phase. It is caused by the new melanin (which gives the skin color) being exposed to the sun while it is maturing, leading to discoloration.

A more severe form of scarring is called hypertrophic scarring, which can be genetic or the result of poor healing in certain areas of the body, the foot being one of the most common locations. Hypertrophic scars are raised and can have color changes. However, they do not exceed the boundaries of the original wound (cut, burn or surgical).

The most severe form of scarring is called keloid scarring. This is a genetic condition that leads to severely enlarged and pigmented scarring that exceeds beyond the borders of the original injury. They can be caused by very small injuries, even a small scratch. Most people are aware by the teenage years that they are prone to keloid formation.

All forms of poor scar formation are treatable, with keloid scarring being the most difficult and least responsive. The treatments range from injection with steroids or chemotherapeutic agents, steroid gels or creams, silicone pads and/or surgical removal.

There are several ways to help prevent poor scarring, whether from a genetic condition or not. Avoiding sun exposure during melanin maturation is very important. I recommend sunscreen on a healing area for up to 6 months after it has healed to allow normal maturation. Using silicone padding over the scar can help reduce the thickness and raised nature of scars. Silicone has been found to reduce the formation of excess collagen that is attributed to causing a thickened scar. These can be used for a year or more to help improve scar appearance since skin healing and remodeling can last for up to 18 months.

Prevention of scarring by early recognition and intervention is the key to decreasing poor appearance. If you have a painful, enlarged or ugly scar, give us a call. You don’t have to live with it!

Wintertime Foot Care

It may still be warm in November but soon December will sneak up on us and it will be time to tuck our sandals away and pull out our bulky shoes for the cold weather.  Cold temperatures, even in Texas, can be hard on the feet.  The experts at Advanced Foot and Ankle Center in McKinney and Prosper, Texas are used to treating feet with “winter time blues.”  Cold weather can restrict blood flow to our feet, especially our toes.  This can in turn cause issues with dry skin since the decreased perfusion limits dermal nutrition.

A solution to cold feet, states Dr. Silvers, is to dress warm and to also wear a thick cotton sock.  In addition, the head is very vascular and wearing a winter had helps to warm the toes since the body does not have to keep the head warm when head heat escapes from the scalp. If patients complain of cold feet at night, many times wearing a hat to bed helps with this problem.

It gets pretty dry here in Texas and for that reason, dry, cracked skin is a common problem.  Dr. Silvers states that daily hydration with a good hydrating cream is helpful. In addition, a foot and ankle evaluation by a McKinney and Prosper, Texas podiatrist is also advised to rule out a fungal infection.  Our office carries great product that treat dry skin and skin fissures very well.  These products that you can find at our McKinney and Prosper Locations include Idonia Foot Cream and Lantiseptic Cream.  In addition, we offer a Sleep N Heel sock that provides occlusion to the skin so that deep fissures can heal quickly.  Please call our office at 972-542-2155 for more information.

Dr. Silvers states that he sees dry skin being a problem in post-menopausal woman due to the hormone changes that are occurring in their bodies.

We see ingrown toenail more often at the beginning of the colder season due to many people getting back into closed toed shoe gear more often.  A tight or constricting shoe can place pressure on the side of the toes forcing the nail fold into the toenail edge.  If a sore develops between the toenail fold and the toenail, and bacteria enters the skin, an infection can ensue.   It is not advised to try to dig out ingrown toenails on your own.  Many times nail salons do not have the appropriate tools and/or their instruments may not be sterile.   If your toenail looks red and is painful, consultation with a McKinney or Prosper Podiatrist is advised.

For more information on ingrown toenails please visit our website at www.nomoreingrown.com

Advanced foot and Ankle Center has offices in McKinney and Prosper Texas.  Dr. Silvers and Dr. Hadfield are residency trained foot and ankle specialists.

Is walking “in toed” or “pigeon toed” normal?

I get asked this question all the time by parents.  And the answer is not a simple yes/no, in fact the answer is, it depends.

 

It is normal for a child to walk in toed at certain developmental stages and many pediatricians dismiss it for this reason.  However, once a child reaches the age of 11 (girls) or 12 (boys), in toeing should no longer be present.

 

The normal kind of in toeing comes from an internal rotation at the hip joint from birth which slowly rotates outward as the child grows.  The abnormal kind can come from the hips as well, but can also be from the lower legs, ankles and/or feet.  These types appear very similar to the normal kind but have differences.  If addressed early, these issues can be improved, helping to avoid problems in adulthood.

 

The evaluation for abnormal in toeing focuses on the various joints that create the abnormality.  These joints are examined while sitting, standing and walking as well as with x-ray.  The most common sitting position is a “reverse Tailor’s” or “scissor” configuration where the child sits on their feet, which are turned outward.  This is the opposite of a “pretzel style” or “Indian style” sitting.  When standing, the child may exhibit no signs of toes pointed inward, but they often have a flat arch (or a very high arch) and parents notice that their tendons or muscles are very tight (the Achilles Tendon is often tight when standing in these children).  When walking, the child will turn their toes toward the center line and sometimes the feet will cross one another.  Many times this walking leads to tripping and parents often are concerned that their child is clumsy.

 

The treatments for abnormal in toeing depend on the type but range from over-the-counter or custom insoles to surgical correction.  Surgery is the last resort in nearly all cases, and most children respond very well to conservative care.  If you have a concern about your child in toeing, the evaluation is fast and pain free.

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McKinney Office
5531 Virginia Parkway
Suite 100
McKinney, TX 75071

Prosper Office
301 North Preston Road
Suite A
Prosper, TX 75078

(972) 542-2155

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