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Ask Our Doctor About: Bunions

The questions on this Website have been answered by Board Certified Foot and Ankle Specialists associated with OurHealthNetwork.com. The foot and ankle physicians and surgeons in this group have a combined 100 years of practice experience. The information and opinions expressed below should not be viewed as diagnoses and treatments, but rather as information to help you understand your foot or ankle related problem. All medical problems should be diagnosed and treated by a foot and ankle specialist in your state, or your family doctor.

Subject: Bunions on the top of the foot

"I think I have bunions on both feet, but they appear to be on top of the joint between my big toe and foot, rather than at the side. I used to run marathons and the toe would be be very sore at the end. Now, if I wear shoes that press down on the top of the bunion, I have pain. The pain is fairly constant now. Would sandals help? Or orthotics?"

Dr. Kasdan's response: "When bunions, or bumps, form on the top of the joint where the big toe joins the foot, it is due to bone which forms at the joint and gradually becomes larger. This bone bump will usually interfere with movement at the joint, causing pain when the toe is flexed upward, as it does when walking. This produces a painful problem called Hallux Limitus, which causes pain with each step. Sometimes these bumps become so large that the top of the shoe will put pressure on the bump, causing pain.
  This problem is usually due to one of the following causes: a long 1st metatarsal (the bone which connects to the big toe); a rigid forefoot, usually associated with supination (a turning in of the foot); or an injury to the joint. In the early to middle stages of the development of this problem (when pain is present only when walking in a shoe), custom-made orthotics will help to keep pressure off of the joint; and they'll accommodate for the long 1st metatarsal, a rigid forefoot, and supination. Custom-made orthotics cannot only relieve your pain, but in most cases they can stop the problem from becoming worse.
    In the later stages of this disorder, when the bump (bunion) is very large and always painful — both in and out of shoes — surgery is sometimes suggested to relieve the pain. Then, to prevent the problem from returning after surgery, you must have custom-made orthotics made for the foot. Please click here for more information about custom-made orthotics.

Subject: Keller bunionectomy
"What is a Keller bunionectomy? My father is having surgery soon and would like to know more about it."
Dr. Kasdan's response: "A Keller Bunionectomy is a procedure where the bump on the side of the big toe is removed; and a portion of the base of the proximal phalanx (the toe bone which connects to the foot... or metatarsal) is removed, inorder to straighten the toe." 

Subject: Alternatives to surgery

"I have bunions and I really don't want the doctor to put a chip in my foot. Is there any other way that the bone can be made straight again without surgery?"

Dr. Kasdan's response: "Bunions are considered to be a progressive disease; they usually become worse. Once the deformity begins, it will continue to produce more deformity, and eventually pain. It is possible that the progression can be stopped with proper shoes and custom-made orthotics. The orthotics you use must be made for your feet, because your problems are unique to you. When properly made, they support the entire foot, but especially the 1st metatarsal (the area where the bunion is); and they correct the basic biomechanical problem which caused the bunion, which is usually pronation (a turning out of the foot, so you walk on the inner border of the foot, thus applying pressure to the bunion area). In 30 years of practice, I have succesfully treated many patients with bunions, and they have usually responded well to this treatment. Please click here to learn more about custom-made orthotics."

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