Sometimes a foot and ankle related problem requires surgery. You want to place your care in the hands of a medical expert trained in caring for the complex structures of the foot and ankle.
Dr. Tammy Gephart is a residency trained surgeon with years of experience. She was expertly trained in diabetic limb salvage, bunions, hammer toes and injuries. During her residency, Dr. Gephart studied with some of the best New York area podiatric and orthopedic surgeons.
A bunion can be a debilitating deformity of the foot for some patients. A bunion is a boney deformity at the base of the big toe. Bunions have both a genetic predisposition and can be from in correct shoe gear over time. Bunions tend to get worse with time and or neglect or stay the same. The structural deformity does no improve without surgery. That being said the criteria to correct the bunion is not the deformity but the level of pain. For those who cannot continue with the level of function they desire for their life style surgery may be the only option. Corrective surgery can be a rewarding experience if the expectations of the patient are meet and the post op experience goes as planned.
If your bunion is causing a significant amount of pain and affecting your quality of life, you may be referred to us for bunion surgery.
The aim of surgery is to relieve pain and the deformity of your big toe. Surgery isn’t usually carried out for cosmetic reasons alone. Even after surgery, there may still be limits to the styles of shoe you can wear.
Bunion surgery is often carried out as a day procedure, which means you won’t have to stay in hospital overnight.
When deciding whether to have bunion surgery, there are several things to consider including:
- Age – in children, bunion surgery is often delayed because of the risk of the bunion returning.
- Medical History and General Health – problems with wound healing and infections are more likely in certain conditions such as diabetes. You’re also more likely to develop problems if your bunion is caused by a condition such as Rheumatoid Arthritis
- Occupation and Lifestyle – bunion surgery can make your toes less flexible, and you may be unable to return to the same level of physical activity, or you may have to take more time off from a physically demanding job then is immediately possible. Bone can take 6-10 weeks to heal fully.
- Expectations of Surgery – bunion surgery has about an 85% success rate, but there’s no guarantee that your foot will be perfectly straight or completely pain-free; the success of surgery depends on the type of procedure, the experience of the surgeon and your ability to rest after the operation. Patient compliance is a key to your success. At our office you are required to be seen by the physician on a weekly bases for the first month to make sure during those critical first weeks to make sure verything is going well. If this is not possible for you, delaying the surgery may be the prudent decision for you. There are conservative treatments available to relieve pain on a short-term bases.
- Symptoms – Depending on the severity of your symptoms – surgery will usually only be recommended if your bunions are causing considerable pain and non-surgical treatments have been unsuccessful
There are a number of different surgical procedures used to treat bunions. The type of surgery recommended for you will depend on the severity of the deformity and location of your pain.
Your surgeon may use pins, wires, plates or screws to hold the bones in place while they heal. Depending on the type of surgery you have, these may be left in your foot or removed later on.
Osteotomy Bunion Procedure:
Osteotomy is the most commonly used and proven type of bunion surgery. Although there are many different types of osteotomy, they generally involve cutting and removing part of the bone in your toe.
During the procedure, your surgeon will remove the bony lump and realign the bones inside your big toe. They’ll also move your toe joint back in line, which may involve removing other pieces of bone, possibly from the neighboring toes.
Soft Tissue Realignment
A procedure called distal soft tissue realignment may be combined with an osteotomy. This involves altering the tissue in your foot to help correct the deformity and improve the stability and appearance of the foot. Generally speaking, think of this procedure as getting the cartilage to line up as much as possible to relive the pain and correct the deformity.
Arthrodesis involves fusing together two bones in your big toe joint (metatarsophalangeal joint).
The procedure is usually only recommended for people with severe deformities of the big toe joint, which make it too difficult for doctors to completely fix the joint, or when there’s advanced degeneration of the joint. Many of these patients have already lost a significant amount of movement in the big toe prior to surgery.
After arthrodesis, the movement of your big toe will be severely limited and you won’t be able to wear high heels.
An excision arthroplasty involves removing the bunion and the toe joint. A false joint is created by scar tissue that forms as a result of the operation.
The procedure can involve pinning the joint in place with wires, which will be removed around three weeks after surgery is carried out.
An excision arthroplasty can only be used in certain circumstances, and is usually reserved for severe, troublesome bunions in the elderly, or those with severe arthritic conditions.
After bunion surgery, your foot and ankle may be swollen for three months or longer. While you’re recovering, you’ll need to keep your foot raised to reduce swelling, and you’ll need crutches to move around in some severe cases. A majority of patients are off their feet for the first 4 days after surgery after that they can walk in a Walking Boot on a limited bases for 4-6 weeks before being transitioned into shoes.
It’s likely that you’ll be unable to wear all your normal shoes for at least six months after surgery. You may have a cast or bandage and postoperative shoes (shoes specially designed to allow heel walking and protect the bone cuts) before you can start wearing regular footwear. This will keep the bones and soft tissues in place while they heal.
This condition is actually a deformity that happens when one of the toe muscles becomes weak and puts pressure on the toe’s tendons and joints. This pressure forces the toe to become misshapen and stick up at the joint.
There is frequently a corn or callus on top of the deformed toe. This outgrowth can cause pain when it rubs against the shoe.
The term, hammertoe, is commonly used as a general classification for any condition where the toe muscle weakens, causing digital contracture, and resulting in deformity.
Clawtoes are bent at the middle and end joints, while hammertoes are bent at the middle joint only. When it’s mallet toe, the joint at the end of the toe buckles. The skin near the toenail tip develops a painful corn that can eventually result in an ulcer.
Doctors further categorize all forms of hammertoe based on whether the affected toe is flexible, semi-rigid or rigid. The more rigid the toe, the more pain it will cause.
Why hammer toes happen:
Your shoes, your genetic predisposition, an underlying medical condition or all of these can make you susceptible to developing one of these deformities of the toes. The foot type you’re born with predisposes you to developing this type of joint deformity over a lifetime. For many, a flat flexible foot leads to hammertoes as the foot tries to stabilize against a flattening arch. Those with high arches can also form hammertoes as the extensor tendons overpower the flexors. This can also lead to bunions. Hammer toe and bunions do happen in both women and men..
Other ailments. Neuromuscular diseases can contribute to the development of hammertoe, too. People with diabetes can be at increased risk for complications from a hammertoe. Corns can lead to ulceration, which can lead ot infection. Diabetic neuropathy can make it difficult to feel an ulcer.
Hammertoe prevention and treatment tips:
Surgery is the best way to permanently fix a hammertoe. The simple procedure straightens the toe, which makes shoes fit better. And your foot will look more attractive, as well. There are other fixes besides surgery.
These include: Wear sensible shoes. If you don’t want to have surgery to fix your hammertoe, padding along with proper shoes made with a wider and deeper toe box to accommodate your foot’s shape.
Use a pumice stone. The corn or callus that forms on top of the hammertoe can cause discomfort when you wear shoes. Using silicone or moleskin padding on top of the area when wearing shoes.
Do foot exercises to keep toes supple and strengthen the muscles that move them. Exercises like extending, then curling the toes, splaying the toes, and moving the toes individually may help prevent the digital contracture that causes hammertoe. Try these suggestions and see what works best for you
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