Joey Wahler (Host): It's an improved treatment method, so we're discussing minimally invasive bunion surgery. Our guest is Dr. James Hayes. He's a Podiatrist with Southwest General Health Center. This is Southwest General Health Talk from the specialists at Southwest General Health Center. Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Hayes. Welcome.

James Hayes, DPM: Good morning. Thank you for having me.

Host: Thank you for being with us. We appreciate the time. So first, in a nutshell, for those that don't know, we've all heard of it, what exactly is a bunion and what usually causes it?

James Hayes, DPM: So bunions tend to be a genetic situation, so usually if your mother, father, or grandparents had one, there's a high chance that you may develop one in the future. That's contrary to the old thought that your shoes caused it to happen. So what typically happens is, the bone right behind your big toe starts to drift towards away from the middle of your foot, and then to compensate your big toe kind of falls back to fill that space.

And then so you end up having this large bump on the inside of the foot and it can be quite painful for people.

Host: Absolutely. Now, you mentioned shoes. Is that a misconception that footwear can cause it, or is that sometimes a factor as well?

James Hayes, DPM: So it's typically more shoes can make them feel worse or maybe potentially make it worse. But if you were going to get one, unfortunately you probably were going to get one.

Host: Gotcha. So it's not going to be the actual cause of it then.

James Hayes, DPM: Correct? Yep.

Host: Okay. So how does minimally invasive bunion surgery differ from traditional bunion surgery methods? And what are the advantages of that?

James Hayes, DPM: So the biggest difference between minimally invasive and the traditional bunion surgeries is the incision size. The more traditional procedures you'd have a three to four inch incision across the top of your foot. Now the way that I do mine with the minimally invasive technique is it's roughly a quarter of an inch incisions in two different spots on the foot. And then the recovery is significantly different than old styles of repairing bunions where there used to be long periods of non-weightbearing, having to use casts, crutches, boots, and things like that.

Whereas with a minimally invasive approach, you can weightbear immediately. You don't have to wear a boot. You wear a little surgical shoe and you can kind of be as active as you're comfortable to be during the recovery process.

Host: Great. Now you touched on it, but in terms of scarring, how about the advantage there.

James Hayes, DPM: That's one of the biggest ones is most people, after, you know, a few months of having had the surgery, you wouldn't even be able to know that they had it because you can't see the scars.

Host: And so people that don't want to have that aftereffect, certainly a great comfort to know that if you're on the beach or around the pool, only you and they will know. Right. Your little secret.

James Hayes, DPM: Mm-hmm. Yep. And then you reduce the risk of having areas where you have like a painful scar or an elevated scar that may rub in the future for some people.

Host: And then how about in terms of, you touched on this as well, that recovery period, recovery time. How about the mean difference there with this compared to the old way, so to speak?

James Hayes, DPM: Some of the older styles of repairing bunions could have a non-weightbearing period for up to six weeks, for some people where you're using casts and crutches and it can be a big hamper on people's lives and it's a lot more planning that has to go into it. Whereas when you do the minimally invasive, you're walking the day of surgery, you can walk on it.

You just have to wear this special little surgical shoe. Really no different than your normal shoe, just has a real stiff bottom on the bottom. So, it keeps your foot nice and straight.

Host: Is that right? So back to walking the very same-day.

James Hayes, DPM: And another big advantage too, because of that, you can do both feet at the same time if you're trying to only have one recovery period, instead of having to space it out by a few months.

Host: Wow. Okay. Because there are certain procedures in orthopedics where, for example, if you need both knees done, you are not going to get them both done at the same time for obvious reasons. It's way too much for anyone to bear, literally. But, here the opposite is true, you say, right.

James Hayes, DPM: Yeah, if you have both, you know, not everyone wants to do that. Because they'd still rather space it out just for their own comfort level and have one foot that feels better. And this situation I've done several times where people just want to have one recovery. They don't want to have to take off work twice, so they kind of schedule their time around it and just do both at the same time because you're allowed to weightbear right away.

Host: Now, let's say you undergo the surgery. Does that cure it for life or might it come back?

James Hayes, DPM: So with some of the older styles, there was a higher risk for possible recurrence, whereas with the minimally invasive, I haven't had any that I've seen come back and I know lots of other providers that are doing that, that don't have recurrence. Technically, there's always a risk that it may happen, but the technique that I use is called the bunionplasty technique, where they minimize the risks of possible recurrence in the future.

Host: Gotcha. How about someone being prone to getting this more than once, perhaps in a different spot, though.

James Hayes, DPM: So an actual bunion, there's really only one spot you can get it, and that's on, the surrounding the big toe. You can also get what's called a Taylor's bunion, which is on the opposite side of your foot, where the little toe starts to drift similar too. And that can be treated in the same way.

Host: Any preventative measures people can take to delay or avoid the necessity of bunion surgery altogether?

James Hayes, DPM: For sure. So if you do know you have a bunion and it starts to become painful, that's when shoe gear choice comes into play a lot. Wearing a shoe with a little bit more of a softer top that can stretch a little bit, doesn't put as much pressure on there. Avoiding real stiff shoes with hard leather tops may be beneficial for you. Just so it doesn't rub. And then there are some other things out there that you can use, like some bunion splints that are like a silicone cover that may cover it. So, it just takes away some of the pain. It won't reduce or remove the bunion, but it'll help you feel more comfortable while you're kind of delaying surgery if you end up having to go that route.

Host: Now speaking of which doc, we don't want to do a commercial right here, but when people come to see you, can you recommend some particular footwear, maybe brands or types or materials or what have you that would be better suited to this?

James Hayes, DPM: Dress shoes in general are challenging because those tend to have a lot more of that rigid structure that can make people uncomfortable. But with running shoes, I always recommend people go to a good running shoe store, pick a place that they'll actually walk you through it.

They'll measure your feet. They really have a good selection process. So I'm not one that really says get this particular shoe necessarily. There are definitely good brands like Asics and Brooks and Hokas are really popular. And they do a really good job of having a lot of variety for people to choose something that's going to be more comfortable for them.

Host: Now to be clear though, let's say you've not had surgery, you have a bunion, you try some improved footwear. Is that merely going to help you deal with it to manage it or might it help it to actually heal?

James Hayes, DPM: So unfortunately, it's a bony problem. So, it will only manage the symptoms and hopefully make you feel more comfortable. The only true way to remove a bunion is, surgically.

Host: So what makes a patient a good candidate for this procedure? And are there any patients that aren't good candidates?

James Hayes, DPM: This procedure's great for if you're healthy enough to have surgery at all, then you'd be a good candidate for this surgery. That's kind of the thing I like the most about the minimally invasive approach is, in the past with some of the older bunion procedures, based on how severe the bunion was, you had to kind of change what your procedure would be.

But when I do the minimally invasive approach, it doesn't really make a difference how bad the bunion is. It can be a more mild bunion, that's painful. We can do the same technique. Or if it's a very large one, I can still use the same techniques.

Host: In terms of the procedure itself, anything people should know about the actual procedure?

James Hayes, DPM: So the procedure that I, I perform, it's, called the bunionplasty, and it's, a single screw construct. So when you do the bunion procedure, you just have one screw inside. There's no pins, no wires sticking out. So that's a big draw for people. Because historically some people would have pins that would stick out of their foot or out of the tip of their toe that you have to have in place for, you know, several weeks afterwards, that can be a little uncomfortable. And that's the biggest route for a lot of people is avoiding that stuff that sticks out of the foot.

Host: Anything people should know about, quote unquote, prepping for this procedure?

James Hayes, DPM: Prepping for the procedure is really just setting up a situation where you know that, if you can set some more stuff up that one floor of your house, you can avoid steps if you need to. You don't have to avoid steps, but some people are just more comfortable to kind of have things a little bit easier.

And that's really the situation is just making sure your lifestyle is going to fit having a little bit of potential uncomfortableness or slowing yourself a little bit. We've had some patients that can walk up to 10,000 steps a day during their recovery period.

Host: Wow. So that's one of the big advantages here, right? The fact that it doesn't take long at all to be mobile again, and then thereafter to being your old self again, right?

James Hayes, DPM: Exactly. Yep. And the whole procedure in the operating room only takes about 30 minutes or so.

Host: Okay. A couple of other things for you. Any risks associated with this?

James Hayes, DPM: So there's always any kind of surgical procedure has its own inherent risks. One, you know, it is under general anesthesia, so you have to make sure that you're healthy enough to have general anesthesia, which we have you looked at by preadmission testing and the anesthesiologist before we have any kind of surgery.

The other bigger risk is, you know, anytime you have an incision in the skin, no matter how large or small, there is always a risk or possible infection. But if that happens, it's quite uncommon and we treat it pretty aggressively with antibiotics just to make sure that it goes away. And then the lastly, anytime you have any kind of implant in your foot or body anywhere, there is a chance that it may become painful afterwards.

I personally haven't seen this in minimally invasive bunions, but that is always one of the risks of having it.

Host: We're talking about all the great benefits of doing this compared with the old-fashioned way, so to speak. In your practice, are you seeing greater numbers of people taking advantage of this and or people having it done sooner as opposed to waiting as a result?

James Hayes, DPM: I definitely have. I've had a lot of patients that were coming in to have their bunion looked at that they waited 10 years since they had their last one done because they had so much pain and discomfort and after the first-time, and then after we do the minimally invasive approach, they're so happy they did it. And they all say they wish they would've done it sooner.

Host: How about, just to go back to something you had mentioned briefly earlier, you talked about this being hereditary, that if your parents, your grandparents had it, any numbers, simply put that, kind of give people an idea of how much more likely it is that they might get it if their relatives, their close relatives had it?

James Hayes, DPM: It's hard to say exactly as far as that goes. And the challenge with a bunion is just because you have one doesn't mean it's going to be painful. So there's lots of people that have fairly large bunions or in general that don't have pain associated with it, so that they don't necessarily need to worry about having a procedure done.

But you know, there is a high likelihood that someone in your family will have it at some point in time. Unfortunately just the way that genetics are passed down, there's not a great, percentage point to put on it, but more than likely that if you notice something in your family, there's someone in your immediate family will probably have one.

Host: And then in summary here, Doctor, you led me beautifully here into my last question because you just mentioned this. You said some have bunions, but they're not painful. Is that where the line is in determining whether or not to get this minimally invasive surgery? If someone has a bunion and they're not feeling any discomfort, can they let it go?

Or is it just a matter of time before it will become painful and it's better to just get it done sooner rather than later?

James Hayes, DPM: So anytime we do any kind of a surgery, pain is always the big driver to do so because regardless of how minimally painful a surgery or procedure may be, there is always some level of pain associated. We don't want to take a foot or a joint that's non-painful and then do something that causes pain and potentially could have a problem in the future. So typically pain is the driver, and with bunions they may progress and get worse, but it doesn't necessarily mean they're going to get more painful, as time goes on. So there are some people that are a little more aggressive because it is already getting sore and they want to preserve their joint, or they want to make sure that they're not going to have it become severely debilitating in the future.

But, pain is definitely the biggest reason to go. We don't do a lot of cosmetic style surgery, but there is a cosmetic component to a bunion, but the big driver is the pain.

Host: Understood. Well, folks, we trust you're now more familiar with minimally invasive bunion surgery and all the advantages that Dr. Hayes has just gone over. Doctor, keep up all your great work and thanks so much again.

James Hayes, DPM: Thank you for having me.

Host: Absolutely. And for more information or to make an appointment with Dr. Hayes, please visit swgeneral.com.

If you found this podcast helpful, please do share it on your social media and check out all our other podcasts in the full library for topics of interest to you. Thanks so much again for being part of Southwest General Health Talk.