Bunions can range from mildly unattractive to a major source of pain. When you notice that bump in the area around the base of your big toe, questions start to pile up.
What caused this? Which shoes best minimize the pain? At what point should I consider surgery?
Katherine Raspovic, DPM, a podiatric surgeon at MedStar Washington Hospital Center, tackles these questions and more.
Selected Podcast
When Should You Start Considering Surgery To Treat Bunions?
Featured Speaker:
Learn more about Katherine Raspovic, DPM
Katherine Raspovic, DPM
Katherine Raspovic, DPM, is a board-qualified podiatric surgeon at MedStar Washington Hospital Center and MedStar Georgetown University Hospital. She is an assistant professor in the Department of Plastic Surgery at Georgetown University School of Medicine.Learn more about Katherine Raspovic, DPM
Transcription:
When Should You Start Considering Surgery To Treat Bunions?
Melanie Cole (Host): Whether it’s sandal season or boots season, you may be thinking it’s time to do something about that large bump that juts of the base of your big toe. It can also be quite painful when exercising or wearing certain shoes. My guest today is Dr. Catherine Raspovic. She’s a podiatric surgeon with MedStar Washington Hospital Center. Welcome to the show, Dr. Raspovic. So, what is a bunion?
Dr. Catherine Raspovic (Guest): Sure. So, a bunion is a large prominent area on the forefoot area at the first metatarsophalangeal joint region and, basically, some patients are born with them; some people develop it over time, and it’s a little bit different for everyone. Some people say they have no pain at all, and others complain of a great deal of pain with their bunions. So, it’s something that’s very different when it comes to size and also symptoms for each patient.
Melanie: Is there a genetic component to bunions?
Dr. Raspovic: We do think that there is a genetic component. So, oftentimes, a lot of my patients say, “Yes, my mom or dad has bunions,” grandparents, so a lot of it does depend on the foot structure that you inherited. So, yes, there definitely is the genetic component to developing these.
Melanie: And is it something you’d start to see in your children? Will you start to notice if they’re developing a bunion, and if we notice that, is there anything we can do to stop it from continuing?
Dr. Raspovic: Absolutely. So, there are some cases where children do develop bunions early and in situations like that, I always recommend to children go get evaluated by a foot specialist for advice in terms of treatment and what to look for but, most often, we see these present in older patients. There are patients even in their 20s, 30s, 40s, or even older. And, if anyone has pain or just notices the development of a bunion, I always recommend to go see a foot specialist like a podiatric surgeon who can give you education about what is happening, why it’s happening and what treatment options that there are.
Melanie: Let’s bust up a myth. Do high heels cause bunions?
Dr. Raspovic: That is a myth that is very common. We can't say for sure that they do, but they likely contribute to the development. However, I do have patients who say they wear heels all the time and don’t have bunions, but I would have to say they more than likely do contribute to the development of bunions.
Melanie: So, if someone comes to you, what’s the first line of defense? Do we look at the shoes that they’re wearing? Do orthotics help to lift the weight off that base of the big toe? What do you tell people about the shoes and possible orthotics in first line of defense?
Dr. Raspovic: Absolutely. So, first line of defense, when a patient comes into the office for the first time for their first evaluation for a bunion, I always ask them what they have done already and then give them treatment options based on what they have and haven’t done. So, on the initial visit, we look at the patient shoes. I always advise patients to wear shoes that aren’t causing a lot of pressure over the area. Sometimes an arch support will help, sometimes it won't. So, orthotics may be an option to help patients feel better in the early stages. Sometimes we recommend patients to modify their activities if a certain sport or activity causes pain, we’ll ask them to take a break from it for a period of time. Anti-inflammatories can also be indicated. Some patients rely on these every now and then if they have discomfort and they need just something a little extra to help. But, I think the most helpful thing for a patient is picking out a good shoe that doesn’t put pressure over the area and some people do benefit from an orthotic to take pressure off the area as well.
Melanie: You mentioned good shoe and, as somebody who likes to walk a lot, I’m lucky I get to wear running shoes. They really help my bunions a lot. Now, do you tell people about certain shoes that are better than others?
Dr. Raspovic: I do. So, if patients are active, like to run, in a lot of sporting activity, and I don’t know if I can talk about brand names, but I always point them towards a shoe like the ASICS or New Balance. I’m a fan of ASICS just because of the wide variety that they have that accommodate both wide and narrow foot types. I always advise people to go to a good running store or athletic type store where the people who work there can accurately measure the foot and fit them in the properly sized fitting shoe because, I think, a lot of people have difficulty with the bunion and a shoe fit because oftentimes, the front of the foot can be little bit wider than the middle of the foot or the back. So, going to somebody who can really help pick the proper size with a running shoe is definitely helpful.
Melanie: So, then, if it gets really bad and it becomes so painful that they just really can't stand it and the shoes don’t seem to be helping, anti-inflammatories aren’t helping, what kind of procedures can take care of bunions?
Dr. Raspovic: Yes, so, I only recommend surgery to patients when they start to have pain with their bunion that’s impacting their daily life and their quality of life. If a patient comes to me and says, “I have this bunion but I don’t like how it looks and it doesn’t hurt me,” then I don’t advise surgery. I think, surgery is definitely the most beneficial when you’re in a situation where you are having pain. Now, in terms of surgical intervention, there are different options, and those options depend on how severe or how advanced the bunion is. So, what we typically do in the office if we’re discussing surgery with a patient, is we’ll thoroughly evaluate the foot, the bunion itself, and then, we take full weight-bearing x-rays, and we measure different angles on the x-ray to determine what exact procedure needs to be done to give the patient the best bunion correction possible.
Melanie: And, then, what are the procedures like for the patient? Are you off your feet for a while? Is there a boot? Tell us about the procedure.
Dr. Raspovic: Absolutely. So, in general, we have to keep in mind, when we do these bunion procedures we’re almost always cutting bone, and/or fusing bone, we’re doing some sort of work on the bone and the tissue as well. The bone, in general, takes about six to eight weeks to get nice and strong again after we operate on it. So, in general, usually when we do a type of bunion procedure, we’ll keep patients off of their foot for about six weeks, depending on what was done, and then, we transition them, typically, to walking in a walking type boot. So, for a more aggressive type bunion procedure, the reality is that sometimes it could take up to 10 to 12 weeks for patients to get back into a comfortable shoe and that, a lot of times, is dependent on the swelling that they have afterwards. For something less aggressive, it can be a little shorter than that. But the biggest challenge, I think, in foot and ankle surgery in general, is the swelling after surgery. Some people’s swelling goes down very quickly; for others, it can even take a few months or longer. So that, oftentimes, can be the limiting factor with getting back into a shoe.
Melanie: So, then, what about after the fact? What’s the recovery after that? Can they grow back or is this something that it’s just once it’s done, it’s done, and will they have any limit in their range of motion?
Dr. Raspovic: Now, that’s a great question. So, there certainly is always a chance that we do a bunion type surgery--a bunion reconstruction--that they could grow back, but what we always do is we pick the best procedure based on the patient, the x-ray, the clinical findings, and the patient age and activity level, so that we are minimizing any chance of the bunion returning. So, anytime we operate, there’s always a small chance, but the vast majority, people do very well. The one thing that could happen is definitely some stiffness of the joint after surgery and what I encourage my patients to do once the incision and bone is healed, I oftentimes get patients into physical therapy or show them how to do range of motion type exercises at home because, not only will the big toe joint become stiff after bunion surgery, but if we have the patient immobilized for a while, the ankle joint can also become stiff if it’s not bending. So, definitely, I’m a big fan of physical therapy because I think that is really the key to getting patients back to where they want to be faster.
Melanie: So, give your best advice and wrap it up for us for people that are starting to see that bump, that bunion, and what you tell them every single day about it.
Dr. Raspovic: Yes, so, if you’re starting to see that bump, it never hurts to go be evaluated by a foot doctor like a podiatric surgeon or specialist, just to become educated and discuss all your treatment options. If you’re not having pain and you can wear comfortable shoes and you can be active and participate in whatever sports or activities that you’re currently doing, chances are you do not need surgery, and you’re going to be just fine, but I only recommend surgical intervention if it gets to the point where the pain from the bunion is starting to impact your daily lifestyle.
Melanie: Thank you so much for being with us today. It’s really important information. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to www.medstarwashington.org. That’s www.medstarwashington.org. This is Melanie Cole. Thanks so much for listening.
When Should You Start Considering Surgery To Treat Bunions?
Melanie Cole (Host): Whether it’s sandal season or boots season, you may be thinking it’s time to do something about that large bump that juts of the base of your big toe. It can also be quite painful when exercising or wearing certain shoes. My guest today is Dr. Catherine Raspovic. She’s a podiatric surgeon with MedStar Washington Hospital Center. Welcome to the show, Dr. Raspovic. So, what is a bunion?
Dr. Catherine Raspovic (Guest): Sure. So, a bunion is a large prominent area on the forefoot area at the first metatarsophalangeal joint region and, basically, some patients are born with them; some people develop it over time, and it’s a little bit different for everyone. Some people say they have no pain at all, and others complain of a great deal of pain with their bunions. So, it’s something that’s very different when it comes to size and also symptoms for each patient.
Melanie: Is there a genetic component to bunions?
Dr. Raspovic: We do think that there is a genetic component. So, oftentimes, a lot of my patients say, “Yes, my mom or dad has bunions,” grandparents, so a lot of it does depend on the foot structure that you inherited. So, yes, there definitely is the genetic component to developing these.
Melanie: And is it something you’d start to see in your children? Will you start to notice if they’re developing a bunion, and if we notice that, is there anything we can do to stop it from continuing?
Dr. Raspovic: Absolutely. So, there are some cases where children do develop bunions early and in situations like that, I always recommend to children go get evaluated by a foot specialist for advice in terms of treatment and what to look for but, most often, we see these present in older patients. There are patients even in their 20s, 30s, 40s, or even older. And, if anyone has pain or just notices the development of a bunion, I always recommend to go see a foot specialist like a podiatric surgeon who can give you education about what is happening, why it’s happening and what treatment options that there are.
Melanie: Let’s bust up a myth. Do high heels cause bunions?
Dr. Raspovic: That is a myth that is very common. We can't say for sure that they do, but they likely contribute to the development. However, I do have patients who say they wear heels all the time and don’t have bunions, but I would have to say they more than likely do contribute to the development of bunions.
Melanie: So, if someone comes to you, what’s the first line of defense? Do we look at the shoes that they’re wearing? Do orthotics help to lift the weight off that base of the big toe? What do you tell people about the shoes and possible orthotics in first line of defense?
Dr. Raspovic: Absolutely. So, first line of defense, when a patient comes into the office for the first time for their first evaluation for a bunion, I always ask them what they have done already and then give them treatment options based on what they have and haven’t done. So, on the initial visit, we look at the patient shoes. I always advise patients to wear shoes that aren’t causing a lot of pressure over the area. Sometimes an arch support will help, sometimes it won't. So, orthotics may be an option to help patients feel better in the early stages. Sometimes we recommend patients to modify their activities if a certain sport or activity causes pain, we’ll ask them to take a break from it for a period of time. Anti-inflammatories can also be indicated. Some patients rely on these every now and then if they have discomfort and they need just something a little extra to help. But, I think the most helpful thing for a patient is picking out a good shoe that doesn’t put pressure over the area and some people do benefit from an orthotic to take pressure off the area as well.
Melanie: You mentioned good shoe and, as somebody who likes to walk a lot, I’m lucky I get to wear running shoes. They really help my bunions a lot. Now, do you tell people about certain shoes that are better than others?
Dr. Raspovic: I do. So, if patients are active, like to run, in a lot of sporting activity, and I don’t know if I can talk about brand names, but I always point them towards a shoe like the ASICS or New Balance. I’m a fan of ASICS just because of the wide variety that they have that accommodate both wide and narrow foot types. I always advise people to go to a good running store or athletic type store where the people who work there can accurately measure the foot and fit them in the properly sized fitting shoe because, I think, a lot of people have difficulty with the bunion and a shoe fit because oftentimes, the front of the foot can be little bit wider than the middle of the foot or the back. So, going to somebody who can really help pick the proper size with a running shoe is definitely helpful.
Melanie: So, then, if it gets really bad and it becomes so painful that they just really can't stand it and the shoes don’t seem to be helping, anti-inflammatories aren’t helping, what kind of procedures can take care of bunions?
Dr. Raspovic: Yes, so, I only recommend surgery to patients when they start to have pain with their bunion that’s impacting their daily life and their quality of life. If a patient comes to me and says, “I have this bunion but I don’t like how it looks and it doesn’t hurt me,” then I don’t advise surgery. I think, surgery is definitely the most beneficial when you’re in a situation where you are having pain. Now, in terms of surgical intervention, there are different options, and those options depend on how severe or how advanced the bunion is. So, what we typically do in the office if we’re discussing surgery with a patient, is we’ll thoroughly evaluate the foot, the bunion itself, and then, we take full weight-bearing x-rays, and we measure different angles on the x-ray to determine what exact procedure needs to be done to give the patient the best bunion correction possible.
Melanie: And, then, what are the procedures like for the patient? Are you off your feet for a while? Is there a boot? Tell us about the procedure.
Dr. Raspovic: Absolutely. So, in general, we have to keep in mind, when we do these bunion procedures we’re almost always cutting bone, and/or fusing bone, we’re doing some sort of work on the bone and the tissue as well. The bone, in general, takes about six to eight weeks to get nice and strong again after we operate on it. So, in general, usually when we do a type of bunion procedure, we’ll keep patients off of their foot for about six weeks, depending on what was done, and then, we transition them, typically, to walking in a walking type boot. So, for a more aggressive type bunion procedure, the reality is that sometimes it could take up to 10 to 12 weeks for patients to get back into a comfortable shoe and that, a lot of times, is dependent on the swelling that they have afterwards. For something less aggressive, it can be a little shorter than that. But the biggest challenge, I think, in foot and ankle surgery in general, is the swelling after surgery. Some people’s swelling goes down very quickly; for others, it can even take a few months or longer. So that, oftentimes, can be the limiting factor with getting back into a shoe.
Melanie: So, then, what about after the fact? What’s the recovery after that? Can they grow back or is this something that it’s just once it’s done, it’s done, and will they have any limit in their range of motion?
Dr. Raspovic: Now, that’s a great question. So, there certainly is always a chance that we do a bunion type surgery--a bunion reconstruction--that they could grow back, but what we always do is we pick the best procedure based on the patient, the x-ray, the clinical findings, and the patient age and activity level, so that we are minimizing any chance of the bunion returning. So, anytime we operate, there’s always a small chance, but the vast majority, people do very well. The one thing that could happen is definitely some stiffness of the joint after surgery and what I encourage my patients to do once the incision and bone is healed, I oftentimes get patients into physical therapy or show them how to do range of motion type exercises at home because, not only will the big toe joint become stiff after bunion surgery, but if we have the patient immobilized for a while, the ankle joint can also become stiff if it’s not bending. So, definitely, I’m a big fan of physical therapy because I think that is really the key to getting patients back to where they want to be faster.
Melanie: So, give your best advice and wrap it up for us for people that are starting to see that bump, that bunion, and what you tell them every single day about it.
Dr. Raspovic: Yes, so, if you’re starting to see that bump, it never hurts to go be evaluated by a foot doctor like a podiatric surgeon or specialist, just to become educated and discuss all your treatment options. If you’re not having pain and you can wear comfortable shoes and you can be active and participate in whatever sports or activities that you’re currently doing, chances are you do not need surgery, and you’re going to be just fine, but I only recommend surgical intervention if it gets to the point where the pain from the bunion is starting to impact your daily lifestyle.
Melanie: Thank you so much for being with us today. It’s really important information. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to www.medstarwashington.org. That’s www.medstarwashington.org. This is Melanie Cole. Thanks so much for listening.