Scott Webb (Host): ​Bunions are a genetic condition that cause a bony bump that forms on the joint at the base of the big toe. And though there are some non surgical options to help people who suffer from bunions, permanent relief from the pain and discomfort may require surgery.

I'm pleased to welcome today Dr. Jason Rosenblum. He's a board-certified podiatrist with the Franciscan Physician Network. This is the Franciscan Health Doc Pod. I'm Scott Webb.

Host: So, doctor, thanks so much for your time today. We're going to talk about bunions, basically, all things bunions today. But before we get there, let's talk about your specialty of podiatry. Tell us, you know, who you are, what you do, and what conditions you treat.

Dr. Jason Rosenblum: Well, my name is Dr. Jason Rosenblum. I'm originally from the Chicagoland area. I have been practicing for almost 21 years. And I treat all foot and ankle ailments, but one of the most common ones that we see are bunions.

Host: So obviously, doctor, you treat all sorts of things related to feet, sports and otherwise and bunions, which we're going to talk about here in a bit, but do you have any other clinical interests, other things you're interested in?

Dr. Jason Rosenblum: Yeah. I'm part of a podiatry surgical residency program where we teach residents, clinical care and surgery. I've been doing it for over 13 years now. And we have put many fine residents that are now doctors out practicing.

Host: Yeah, that's great. And as I've teased here, we're going to talk about bunions. So, I know that taking diligent care of our feet is important. We hear a lot about bunions and maybe there's some misconceptions. In fact, before I did my first bunions podcast a couple of years ago, I thought they were something that they're not. So, that's why we have experts. So, just wondering in detail, if you can, what are bunions? Are there different types of bunions and how do we know if we have them?

Dr. Jason Rosenblum: A bunion is a deformity of the first big toe joint of our feet. It is actually hereditary. So, someone gave it to you.

Host: Okay.

Dr. Jason Rosenblum: There are different degrees of bunions. There are mild, moderate, and severe ones. And I could have patients come in with a really severe bunion and no pain, and I could have patients come in with a very mild bunion with severe pain. So, that kind of helps us decide on what we need to do to treat it. But essentially, in the deformity, the long bone, which is called the first metatarsal, over time, many, many years, starts drifting outward, and it causes the big toe to start drifting inward and kicking the second toe out of its spot, essentially, and that can cause pain.

Host: So, it's not something then we really do to ourselves. It's not behavior and lifestyle or anything like that, that it really is genetic. It's a family history type thing, right?

Dr. Jason Rosenblum: It is. There definitely can be made worse by poor shoe gear and, you know, different degrees of activity and how much you're on your feet. But if you're going to get it, you're going to get it.

Host: You're going to get it. Yeah. Well, I'm glad you mentioned shoes, because I know that a lot of the shoe companies advertise that they have the perfect solution for us, whether it's a cure or just to help us with the symptoms, but maybe you could tell us what not to do when it comes to shoes, especially as it relates to bunions.

Dr. Jason Rosenblum: The thing not to do with shoes is not to wear shoes that are too tight, not to wear shoes that aren't going to give you the proper arch support. Flip flops definitely keep me in business. Those are kind the main ones that I would avoid.

Host: All right. So, we have a sense of how folks get bunions, what they can do to make them maybe a little better or worse. Let's talk about is there anything that we can do? Short of seeking medical attention, short of coming to the office to speak with you, is there anything that we can do at home to help with bunions?

Dr. Jason Rosenblum: There's really not a lot. I've always told my patients that come in for bunions, in terms of conservative treatment, it is mostly dealing with the symptoms of a bunion, which is pain. The one thing that's been known to kind of slow down the progression of bunions is good shoe and arch supports. An arch support is also called an orthotic and you can get what's called a custom-molded orthotic where we take a mold of your foot and we make an arch support that's specifically designed for your foot. And that has been known to slow it down a little bit. But again, as I said earlier today, if you're going to get it, you're going to get it.

Host: Yeah. It seems to be. Like if it's going to happen, it's going to happen. Maybe we can, again, make it a little better or a little bit worse. So then, let's talk about when folks should, you know, reach out to their providers, be seen, and what you can do to help them.

Dr. Jason Rosenblum: It kind of is broken down to two groups. I do see pediatric bunions, and I do see adult bunions. Kids who come in with bunions, we definitely want to treat conservatively with the aforementioned custom orthotics, because that will help slow it down. I generally don't recommend any type of surgery for children until their bone stops growing because we don't want to hurt that for a deformity that we can fix at any time. In regards to adult treatment, for me, it's pain. It's pain and issues with quality of life. That's the main reason to come in.

From a conservative standpoint, it's dealing with the pain. There's topical anti-inflammatories, there's oral anti-inflammatories that you can take. And there's injections that we can do of an anti-inflammatory if it gets severe. There's padding that can be dispensed to help deal with it, wider shoe gear, arch supports. It's living with the deformity, and all dependent on how painful it is and how much issue it's causing with shoe gears and putting on shoes, and affecting patient's life in that way.

Host: All right. So as you said there, doctor, obviously you don't do surgery on children because they're still growing. But with adults, you've tried the conservative treatments, orthotics, injections, pain relievers, all of that. Now, we get to surgery, and I'm assuming that's a bunionectomy. What does that mean? What does that entail?

Dr. Jason Rosenblum: Bunionectomy is the name of the procedure to remove the bump and to fix the deformity. One misnomer out there is that a bunion is just a bump. And as I said earlier, it's actually a drifting of the long bone, the first metatarsal outward. So to fix the bunion deformity, we need to take a proper x-ray and do a proper exam to see how extensive that bone has drifted out. And also, what is the integrity of the joint space? Is there arthritis that has been sent in?

So, when it comes to bunions, there are mild, there are moderate, and there are severe bunions. A mild bunion often can be treated with a procedure that's more towards the toes, and that usually consists of a surgery where you have to break the bone, actually move the bone over back into its normal alignment and insert some sort of hardware like a pin or a screw or a plate to hold that. The more severe the bunion, the farther back on the foot we have to go to actually fix it.

One of the biggest procedures out there that's had some amazing advertising for our profession is Treece Medical has introduced what's called the Lapiplasty. And we have patients coming in asking, "Could I get the Lapiplasty performed?" The Lapiplasty is actually a very old procedure, but it's a newer way to do it. And it definitely has provided very good outcomes. We've been doing it for a few years in our office now, and the main advantage of it is be able to get a patient a reproducible improvement of their bunion and also, on their feet and walking sooner than that procedure previously was able to do.

Host: Yeah. I was going to ask you about recovery time, healing time. And sometimes, we say get people back on their feet, but we literally mean that here. In this case, we talk about the bunionectomy. So, how fast are folks back on their feet and what's the recovery time like?

Dr. Jason Rosenblum: It, again, really depends on the patient, the patient's age, their activity level and what they do. And it's also related to which procedure that we perform. So again, going back to a more mild bunion, I usually will keep a patient off their foot on crutches either way for about two weeks because we are moving the bone. So, they're going to be on what's called a cam walker, which is a boot to keep pressure off the foot, and crutches for about two weeks. And then, depending on which bunion procedure we performed, you could be out of those crutches in the two weeks, then in the walking boot, as we talked about, for about another two to four weeks. And then, for the more severe procedures, we keep them in that boot anywhere from four to eight weeks. So, depends on x-rays and followup. And I generally keep a very close eye on my patients, and try to get them in their shoes as soon as possible.

Host: Well, it's good to hear that folks are, you know, pun intended, back on their feet fairly soon, somewhere between two and eight weeks, not one-size-fits-all, of course. Just wondering, since you're removing bone and there's different procedures, just generally speaking, do bunions return? Do you have return or repeat customers on the same foot?

Dr. Jason Rosenblum: It's not a common thing that can happen. It is important after you have a bunion surgery to wear good shoes and good arch supports. That's one thing that will help prevent it. Also, we will often, during the foot evaluation, check if the foot is what's called hypermobile where it's moving too much. If it is moving too much, we tend to do the previously mentioned lapidus or Lapiplasty procedure. With that procedure, it is very rare for a bunion to come back.

Scott Webb: Okay. Just give you a chance here as we wrap up here. And this has been really educational. I feel like we don't talk enough about bunions and probably should, just generally speaking, what do you want folks to know about the pain that they're experiencing and how you can help them.

Dr. Jason Rosenblum: Yeah. So again, we're here to help anything foot or ankle. Bunions are an everyday occurrence in my office. I've done many procedures, I've done them many different ways, and my goal always is to help patients decrease their pain and improve their quality of life. So, if they're having bunion pain, I always encourage them to come in for an x-ray so we can evaluate the foot and give patients all their options. It's definitely something that is not emergent. A bunion procedure, if you're having pain, could be done that year, five years, ten years down the road.

My goal is to work with the patient, help them with their daily activity to try to decrease the pain. And then if we are unable to, then we will talk about surgeries and ways to improve it that way.

Host: Yeah. It's one of those things that folks live with and they try to manage the pain and eventually maybe it just becomes too much and they've tried conservative treatments and maybe it gets to a bunionectomy. But good stuff today, doctor. Thank you so much.

Dr. Jason Rosenblum: Thank you. I appreciate it.

Host: And to learn more, visit franciscanhealth.org and search bunions. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.