Having  been in podiatry practice for over 20 years, we have both seen and heard a lot of misinformation out there about bunions and how to fix them. Below are a few of the most common myths and our explanation of the facts of the matter. We hope this helps you make an informed decision about your foot health. Wishing you Happy Feet,

–Dr. Roy Mathews DPM and Dr. Victor Quintoro DPM, Vancouver Podiatrists.

Myth #1 A bunion is a bump or growth of bone.

A bunion, or hallux valgus, is a mal-aligned joint where the big toe is drifting towards the second toe. The bone that extends from the arch to the big toe joint (the metatarsal bone) progressively drifts out of the foot as the joint buckles. The bunion “bump” is actually a normal sized bone that has drifted out of the foot and must be relocated.

Myth #2 Wearing high heels causes bunions.

Wearing high heeled, tight or improperly fitting shoes only helps the progression of the bunion formation and increases the symptoms of a bunion. Hallux valgus, or the mal-aligned bunion joint, is usually genetic. Tight shoes and high heels will usually put pressure on the big toe, forcing it towards the second toe and worsening the mal-alignment of the joint.

Myth #3 Bunion surgery involves cutting off the bump.

Proper bunion surgery involves realigning the first metatarsal-phalangeal joint (the joint between the big toe and the long metatarsal bone), by bringing the first metatarsal head back into the foot. The big toe must then be relocated on the metatarsal head to make a straight joint. This is achieved by either cutting a wedge of bone out of the base of the metatarsal and swinging the entire bone back into the foot (typically called a base wedge bunionectomy) or by shifting just the head of the metatarsal bone back into the foot (typically called a metatarsal head bunionectomy). Only a small amount of bone should be shaved from the bunion at the end of the procedure, to leave a smooth surface. Simply cutting off the ‘bump’ would leave the joint out of alignment and continue to cause pain and allow the deformity to increase. Cutting large amounts off the ‘bump’ will also cause instability to the joint and lead to degenerative arthritis.

Myth #4 Bunion surgery is painful and takes a long time to recover from.

Modern surgical techniques have made bunion surgery easier for both the patient and the surgeon. The most common type of bunion surgery where the bunion, or metatarsal head, is shifted back into the foot is performed as outpatient day surgery under local anesthetic. Frequently there is no cast needed and the patient can return to casual shoes within two to three weeks, resuming most physical activities within six weeks. Surgical screws are used to realign the bones and hold them firmly in place, which allows patients to bear weight on their feet almost immediately after surgery.

The more complex base wedge bunionectomy, where the entire bone must be swung back into the foot, does require six weeks in a cast from the knee down. This is only used for severe bunions.

Liz Broughal, of Surrey B.C, had both of her bunions corrected with metatarsal head bunionectomies in 2002 and states
“This was my first surgery in my life and anticipated pain during the procedure. It felt like a vigorous foot massage. After surgery the pain wasn’t even close to what I expected, a migraine is more intense than what I experienced. I was back into sandals and runners within three weeks. I was able to resume normal activity level within 4 weeks of surgery without any pain.”

Myth #5 All bunions should be corrected with surgery.

Only if a bunion is painful and prevents the patient from wearing certain shoes or limits physical activity should it be corrected. As mentioned above, bunions are not removed but realigned. Bunion surgery should not be performed for cosmetic reasons alone, as with any surgery there are always risks and potential complications involved. Other treatments, such as orthotics, can be helpful in reducing symptoms and slowing the progress of the bunion formation. Foot orthotics, however, will not correct or realign the bunion joint.

In the interest of providing our patients with the very latest and most effective and minimally invasive procedures, we are currently performing two new surgical procedures for the treatment of Morton’s neuroma and hammertoes. These new procedures offer better surgical outcomes with shorter recovery periods and reduced rates of complications. Please make an appointment with us to discuss your options. No referral is necessary.

• Dr. Roy Mathews DP and Dr. Victor Quintoro DP

1. Minimally Invasive Nerve Decompression

Minimally Invasive Nerve Decompression (MIND) for the treatment of Morton’s neuroma differs from the traditional procedures in that the damaged nerve is not removed. Traditional neurectomy surgery is a relatively invasive surgery requiring longer recovery periods, and often causing a loss of sensation in the foot and potential complications such as stump neuromas.

MIND is a minimally invasive incision procedure performed between the toes. The enlarged nerve is decompressed by isolating and releasing the intermetatarsal ligament above the nerve. The nerve is relieved of the pressure from the metatarsal heads and ligament, thus removing the pain. The patient’s nerve is left intact with no loss of sensation. The procedure has a shorter recovery period and carries less risk of complications than neurectomies.

For more information visit http://www.osteomedcorp.com

2. Stay Fuse Inter-Digital Fusion

Traditionally, hammertoes have been corrected by fusing the joints using pins to hold the correction during the healing process. These pins (K-wires) would protrude from the end of the toe for six weeks, and pose a risk of infection. Additionally, physical activity was not permitted while the pins remained in the foot.

The StayFuse™ Inter-Digital Fusion System is a two-piece screw device designed to stabilize and hold small bones in alignment during the healing process. A unique Hex-Lok design feature improves product performance by controlling rotation, thereby improving the chances for a successful clinical outcome. This new surgery allows for faster healing time, earlier ambulation and a permanent correction.

For more information visit http://www.nexaortho.com

Sharp pain, aching or stiffness on the bottom of one or both heels (or arches) is a very common ailment. The pain is often at its worst upon first walking in the morning (or standing up after sitting), causing either hobbling or limping for a few minutes before a comfortable stride can be resumed. As weight continues to be applied during walking or standing, mild or severe pain may persist. Below, we explore some of the possible causes and treatments employed at Vancouver Podiatry to address heel and arch pain.

• Dr. Roy Mathews DP and Dr. Victor Quintoro DP

  

Causes

Heel pain originates deep within the foot, directly on the heel bone or most commonly within the foot’s fibrous band of connective tissues, called the plantar fascia. Several layers of fatty tissue surround the heel bone, softening the impact of walking and running and protecting the bones and muscles of the foot. Beneath this padding, the plantar fascia extends from the heel bone, supporting the arch and reaching across to the toes. As we age, gain weight or place excessive strain on our feet, the feet roll inwards causing the arches to lower and the foot to lengthen. This motion, called pronation, causes the plantar fascia to strain or tear from its insertion into the heel bone and results in the heel pain. Pain can also result when these tissues become irritated or inflamed.

Other Possible Causes

While injury, overuse or other temporary, mechanical causes can bring on discomfort in the heel, a painful heel may also indicate more serious conditions such as:

• Gout
• Nerve Injuries
• Arthritis
• Heel Bone Abnormalities
• Collagen Disorders
• Tumors
• Psoriasis

Treatments

In most cases, heel pain can be relieved without surgery by using one of more of the following treatments:

Strapping

Since the most common cause of plantar fasciitis is improper foot mechanics, control of the heel pain is often properly managed by controlling the motion of the foot. Strapping the foot with tape can reduce the pull on tissues and help support bones and joints. Strapping may temporarily improve foot function, thereby reducing pain and swelling. This can help determine whether custom orthotics are indicated for your condition as orthotics control foot motion in a similar way to strapping.

Orthotics

Custom orthotics are made from plaster impressions taken of your feet while they are held in the optimal position. Over a period of time, wearing custom orthotics may allow the plantar fascia to heal, thereby eliminating the need for orthotics other than for heavy walking or prolonged standing.

Injection

To control extreme or chronic inflammation, an injection of anti-inflammatory medication may be necessary. This can help to reduce pain and inflammation but is not a permanent solution, as it does not treat the cause of the pain.

Stretching

A tight achilles tendon and hamstring muscles in the leg and thigh can intensify the symptoms of plantar fascitis. Routine stretching exercises or physiotherapy can help heel pain if you have tight muscles or a limited range of motion in the joint.

Surgery

If the above treatments are unsuccessful in reducing the inflammation and eliminating the pain, surgery may be required to release the tight ligaments. This surgery is usually done on an outpatient basis under a local anesthetic.

Heel pain is a very common problem and can usually be treated quickly and easily. If you have any further questions or concerns, please ask the doctor during your appointment.