Scott Webb (Host): Have you ever wondered what a bunion is? I have, and as it turns out, I was wrong. And that's why we need guests like my guest today, so we can get properly diagnosed and treated for things like bunions. And I'm joined today by Dr. Colin Graney. He's a fellowship-trained foot and ankle surgeon This is the Inspire Health podcast from Upland Hills Health. I'm Scott Webb. Dr. Graney, thanks so much for your time today. I was just joking that I think I might have a bunion, but I'm not really sure what a bunion is. So, it's good to have your expertise here today. What are bunions, what causes them, and are there different kinds of bunions?

Dr. Colin Graney: So ultimately, a bunion is something where the great toe or the big toe begins to essentially drift and starts to crowd on the lesser toes, more notably the second digit. So ultimately, what happens is that this is a progressive deformity where the big toe will gradually, slowly begin to drift, and it just causes more crowding with the toes. But the main thing that people typically complain about is that it will feel tight within their shoes, where the bump itself is kind of at the base of that big toe. When we talk about bunions, it's one of those scenarios that typically as time goes on, it does get worse. And there's very little that we can do to prevent it or make it better, other than just accommodating with wider shoes or essentially living with it until it becomes increasingly painful.

Host: Yeah, it does seem like one of those things that gets progressively worse and folks probably live with it for a very long time because it just seems like a lot of work to go in and have it looked at and treated and all that. So, is there a thing where these things will just sort of go away? Will it shrink back to its normal size? In other words, are there any sort of long-term effects of not treating a bunion?

Dr. Colin Graney: As far as the bunion going back to where it was, unfortunately not. As the big toe begins to drift further and further, it becomes not only a bony abnormality, but what happens is that all the muscles and tendons, they essentially gain a mechanical advantage, so they start to pull harder and harder. So normally, a bunion will start relatively gradual, and it may even start in adolescence. But then as the years go on and it becomes a little bit more prominent, then we start to see a little further drift that becomes a bit more aggressive, and that's typically when pain begins to start.

Host: Yeah. Nothing worse than an aggressive big toe, right? That's just something we don't need. Something we don't need down there.

Dr. Colin Graney: That's something we never need.

Host: Yeah, we don't need that. All right. So, let's talk about the treatment options then. It sounds like it's a good plan to be seen, to have it diagnosed, to be treated. So, what are the most effective treatment options? What can patients do for themselves? Are there some non-surgical, minimally invasive options as well?

Dr. Colin Graney: When it comes to bunions, there's ultimately not much that we can do conservatively, meaning non-surgical, to have the big toe become straight again. There are several things that people will try that are over-the-counter, or little devices or splints. Unfortunately, those just aren't really effective because as the bump becomes larger, it's now a bony abnormality. So once we start to get that bony prominence that's starting to cause more discomfort, it's essentially a fixed position that won't get better spontaneously. Now when we do talk about those conservative options, essentially we're talking about wider shoes, shoes that have a softer material where the toes are. They do sell little bunion shields and bunion guards, but the problem with those I've learned is that then we're putting more stuff in the patient's shoes, and then an area that's already crowded becomes even more crowded with more things in their shoes.

Now if the bump is starting to rub on the second toe as the big toe adjusts further, that's where simple things like a cotton ball or gel toe spacers can start to alleviate some of the rubbing and pressure that people can get as the bunning starts to progress and become larger and larger.

Host: All right. So, there's some things that we can do and some things that you can do sort of in the nonsurgical, minimally invasive realm. Let's talk about surgery. You know, what do you actually do when you perform surgery? Is it a long recovery time? And, you know, I feel like I know the answer, but will the bunions return even if we have the surgery?

Dr. Colin Graney: That's one of the biggest questions that people always ask is, will the bunion return? And the ideal answer is no, a bunion typically should not return. As long as these bunions are addressed properly to match the level of contracture of the big toe, these bunions should not return. Now, we do have several options, some of the more traditional approaches where a patient may be younger and we need a stronger repair based on the severity. But we also do have newer, minimally invasive options, and this is some of the latest cutting edge type technology where essentially we're able to realign and repair bunions through a series of small little tick mark incisions ultimately that are less invasive with a quicker recovery. And of course, when we talk less invasive, we're also typically talking less discomfort. And again, the biggest thing people care about is we're able to get you moving sooner and back in shoes sooner.

Host: Yeah. It's been really educational today. As I told you before we got rolling here, it's like, I pretty sure I know what a bunion is, but I'm going to need your expertise. And, you know, it sounds to me like ultimately it's one of these things that folks just suffer from because they just don't go in and have it looked at and diagnosed and treated. So maybe as we finish up here, doctor, just words of wisdom in terms of, you know, encouraging folks that they don't need to suffer, that they don't have to have any whatever associated pain or trial these home remedies, that there's actual experts who can help and maybe we can encourage them to make that phone call.

Dr. Colin Graney: Exactly. It never hurts to have a bunion evaluated, at least just to give you options and talk about the different treatment options that we have, because not every bunion necessitates something surgical. We don't need to be as aggressive. But when that option does become something that becomes a viable way of treating it, then we can start talking about the different ways we can correct it. So that way, it also doesn't progress to the point where you have the big toe underlapping or crossing over the second or third toes because then it becomes a longer recovery if surgery ever needs to go down that route. So if we can address these sooner than later, sometimes we're able to do a less aggressive approach and not have to discuss any additional procedures to straighten out a second, third or fourth toe as our foot continues to contract and this bunion progresses as time goes on.

Host: Yeah, that's perfect. Great advice from an expert today. You know, it's just there's so many things that folks just deal with. Sometimes they suffer in silence, sometimes not so silent. But these are the types of things that affect our quality of life, because we need our feet, right? We walk. We run. We really rely on them for so much and being able to be treated surgically, non-surgically, and it sounds to me like, you know, early diagnosis would be the key. So, thanks so much. You stay well.

Dr. Colin Graney: Thank you very much. Appreciate it.

Host: And you can find out more about Dr. Colin Graney and how to make an appointment at uplandhillshealth.org. And if you found this podcast helpful, please share it on your social channels. This is the Inspire Health podcast from Upland Hills Health. I'm Scott Webb. Stay well.