Oh, My Bunion!
Dr. Hanif Hussaini discusses minimally invasive bunion surgery.
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Learn more about Hanif Hussaini, MD
Hanif Hussaini, MD
Dr. Hanif Hussaini is a fellowship trained orthopaedic foot and ankle surgeon. He earned his undergraduate degree from Duke University in Durham, North Carolina, and attended medical school at Saint Louis University School of Medicine in St. Louis, Missouri. Dr. Hussaini returned to North Carolina to complete his orthopaedic surgery residency at Wake Forest Baptist Medical Center in Winston-Salem. Afterward, he completed a subspecialty fellowship in the Washington D.C. area with the Orthopaedic Foot and Ankle Center.Learn more about Hanif Hussaini, MD
Transcription:
Oh, My Bunion!
Alyne: It looks like a bump at the base of your big toe and, as your toe inches over toward the one next to it, that developing bunion feels pretty sore. Here to talk about what you can do about it is Dr. Hanif Hussaini, a foot and ankle surgeon at Wake Orthopaedics. This is WakeMed Voices, a podcast by WakeMed Health and Hospitals. I'm Alyne Ellis. Welcome, Dr. Hussaini. It's so nice to have you here today.
Dr. Hanif Hussaini: Thank you so much for having me. I really appreciate it.
Alyne: So let's begin with what are bunions and how do they develop?
Dr. Hanif Hussaini: A bunion is basically a deviation of the big toe. There are two main bones that make up a bunion. The longer bone that's more kind of in the back of the foot is the first metatarsal, which deviates inwards away from the other toes. And so to kind of balance for that, the proximal phalanx, which is one of the bones that make up the toe itself, that tends to deviate inwards towards the other toes. And so that angle between those two bones is what makes the bunion. So it's not really a growth per se, it's more just a prominence where those two bones angle away from each other.
Alyne: And basically it looks like a bump right there at the base of your big toe.
Dr. Hanif Hussaini: Yeah. That bump, if the angle that those two bones make is pretty significant, then that bump looks pretty large and can get irritated very easily. And over time, if that bunion gets severe enough, that big toe can kind of start crossing over and crowding out the second toe. And then the second toe might start floating upwards, just cause it's getting squashed by the big toe, and that can develop into what's called a hammer toe, which can also become painful and irritating and can also rub up against shoes,
Alyne: But not all bunions affect your feet necessarily in that way, in the sense that has to go that direction or does it just slowly inexorably get worse?
Dr. Hanif Hussaini: Some patients, it's kind of over time with tight shoes or just naturally over time that bunion can get worse. And if it's that long enough and if it's severe enough, yeah, that can start crowding out that second toe over time, but these are gradual changes over time.
Alyne: So what can we do about it? I know one thing at least in the short run is to have a shot to prevent pain.
Dr. Hanif Hussaini: For bunions typically, honestly, shots don't necessarily help for bunion pain per se. If there's some associated arthritis or wear and tear of the cartilage in the big toe, we can certainly talk about doing a shot to get rid of some of that pain from the arthritis, but for the bunion itself, the main things that over time that we're able to do, first of all, is just modifying shoes. Tight shoes that don't give a lot of space for the toes can exacerbate the bunion and lead to pain associated with that.
Secondly, there are a variety of kind of inserts that can straighten out the toes, inside of shoes or in sandals that can minimize the irritation that prominence on the inside of the foot can cause. After those two treatment options, honestly, probably the next best option is probably just talking about surgery.
Alyne: And there's more than one kind of corrective surgery for this issue.
Dr. Hanif Hussaini: Yes, there are lots of different types of surgeries, depending on what exactly is the culprit that causes the bunion. Classically, surgery for bunions consisted of a big open incision, on the top or on the inside part of the foot to facilitate making a cut in the bone and shifting the bone over and getting the foot more straight. It's a big surgery that takes a long time to recover from. Patients had to stay off their foot for a while to let everything heal. Sometimes they had to have pins in the foot. And, yeah, the surgery works, but it's a big surgery and takes a while to recover from.
But however, with new technology and new techniques, we're able to do all that surgery through very minimally invasive techniques that are a lot less painful for patients. They're a lot faster to recover from. We don't need to use pins and patients are much happier and recover faster from the surgery now with those minimally invasive techniques.
Alyne: Can you describe that procedure?
Dr. Hanif Hussaini: Basically, it's called the minimally invasive chevron Akin technique, and through three to five little tiny poke holes in the skin, we're able to use a tiny what's called a burr to basically make a tiny cut in the bone and shift it over. And then we use screws that go underneath the skin as opposed to the pins that stay outside the skin for four to six weeks that was used in the past to stabilize what's called the osteotomy or the shifting of the bone over to the straighten out the toe. And patients are able to put weight on the foot immediately after that surgery in a shoe or a boot for about six weeks total. After that time, they are able to start utilizing normal shoes again. But there's no need for crutches or anything like that. Patients are able to start putting weight on their foot immediately after the surgery.
Alyne: And can this procedure be done as an outpatient or in a hospital?
Dr. Hanif Hussaini: Absolutely. Pretty much every single of my patients that I do this for goes home that day. The surgery itself takes about an hour and a half, probably even less, to get that surgery done. And then they're going home to recover.
Alyne: And so that is done in a hospital and the patient is completely sedated or partially sedated?
Dr. Hanif Hussaini: It's done at surgery centers or at hospitals, but regardless patients are able to go home that day. And then they are partially sedated. Their foot is numbed up with anesthesia to provide a good pain relief for after the surgery for half a day or so after the surgery. And then they start taking oral pain medication by mouth for whenever they do need some additional pain medication. And they're sedated for the surgery. So they're not hearing all the work that we're doing. They're asleep. They're not aware of what's going on.
Alyne: So it sounds like with this particular procedure that the odds that you would have any recurrence of this are pretty much taken care of.
Dr. Hanif Hussaini: Patients that we've done the surgery for have been very happy with the appearance of their foot, with their recovery. There's certainly a risk of recurrence with any of these bunion procedures. if patients were to continue to wear very tight shoes. But, no, the risk of occurrence is very low and the patient have been very satisfied with it
Alyne: And what about physical therapy? Is that required after this procedure?
Dr. Hanif Hussaini: After the surgery, I typically give my patients a couple of exercises to work on at home. But the vast majority of patients do not require physical therapy after this procedure. They get good range of motion back in that big toe. Classically, with the open more invasive procedures, we had to make incisions that involved the actual toe joint itself and that could lead to some stiffness. But with this procedure, we're able to avoid damaging and irritating joint itself, which I think also helps improve patient's range of motion and helps them avoid stiffness after the surgery.
Alyne: This is very encouraging news. Is there anything that you'd like to add?
Dr. Hanif Hussaini: Looking at scientific data, comparing kind of both the classic open procedure and the minimally invasive procedure. I think, the studies have suggested that patients have very good long-term correction of their bunion with the surgery. And that there's a significantly less amount of pain, significantly less amount of infection risk and just overall very high satisfaction rates with procedures.
Alyne: Thank you very much, Dr. Hussaini, for joining us today.
Dr. Hanif Hussaini: No, I really appreciate the time you guys took to speak with me. Thank you so much.
Alyne: Dr. Hanif Hussaini is a foot and ankle surgeon at Wake Orthopaedics. To learn more about orthopedic services offered at WakeMed, visit WakeMed.org. I am Alyne Ellis with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Stay well.
Oh, My Bunion!
Alyne: It looks like a bump at the base of your big toe and, as your toe inches over toward the one next to it, that developing bunion feels pretty sore. Here to talk about what you can do about it is Dr. Hanif Hussaini, a foot and ankle surgeon at Wake Orthopaedics. This is WakeMed Voices, a podcast by WakeMed Health and Hospitals. I'm Alyne Ellis. Welcome, Dr. Hussaini. It's so nice to have you here today.
Dr. Hanif Hussaini: Thank you so much for having me. I really appreciate it.
Alyne: So let's begin with what are bunions and how do they develop?
Dr. Hanif Hussaini: A bunion is basically a deviation of the big toe. There are two main bones that make up a bunion. The longer bone that's more kind of in the back of the foot is the first metatarsal, which deviates inwards away from the other toes. And so to kind of balance for that, the proximal phalanx, which is one of the bones that make up the toe itself, that tends to deviate inwards towards the other toes. And so that angle between those two bones is what makes the bunion. So it's not really a growth per se, it's more just a prominence where those two bones angle away from each other.
Alyne: And basically it looks like a bump right there at the base of your big toe.
Dr. Hanif Hussaini: Yeah. That bump, if the angle that those two bones make is pretty significant, then that bump looks pretty large and can get irritated very easily. And over time, if that bunion gets severe enough, that big toe can kind of start crossing over and crowding out the second toe. And then the second toe might start floating upwards, just cause it's getting squashed by the big toe, and that can develop into what's called a hammer toe, which can also become painful and irritating and can also rub up against shoes,
Alyne: But not all bunions affect your feet necessarily in that way, in the sense that has to go that direction or does it just slowly inexorably get worse?
Dr. Hanif Hussaini: Some patients, it's kind of over time with tight shoes or just naturally over time that bunion can get worse. And if it's that long enough and if it's severe enough, yeah, that can start crowding out that second toe over time, but these are gradual changes over time.
Alyne: So what can we do about it? I know one thing at least in the short run is to have a shot to prevent pain.
Dr. Hanif Hussaini: For bunions typically, honestly, shots don't necessarily help for bunion pain per se. If there's some associated arthritis or wear and tear of the cartilage in the big toe, we can certainly talk about doing a shot to get rid of some of that pain from the arthritis, but for the bunion itself, the main things that over time that we're able to do, first of all, is just modifying shoes. Tight shoes that don't give a lot of space for the toes can exacerbate the bunion and lead to pain associated with that.
Secondly, there are a variety of kind of inserts that can straighten out the toes, inside of shoes or in sandals that can minimize the irritation that prominence on the inside of the foot can cause. After those two treatment options, honestly, probably the next best option is probably just talking about surgery.
Alyne: And there's more than one kind of corrective surgery for this issue.
Dr. Hanif Hussaini: Yes, there are lots of different types of surgeries, depending on what exactly is the culprit that causes the bunion. Classically, surgery for bunions consisted of a big open incision, on the top or on the inside part of the foot to facilitate making a cut in the bone and shifting the bone over and getting the foot more straight. It's a big surgery that takes a long time to recover from. Patients had to stay off their foot for a while to let everything heal. Sometimes they had to have pins in the foot. And, yeah, the surgery works, but it's a big surgery and takes a while to recover from.
But however, with new technology and new techniques, we're able to do all that surgery through very minimally invasive techniques that are a lot less painful for patients. They're a lot faster to recover from. We don't need to use pins and patients are much happier and recover faster from the surgery now with those minimally invasive techniques.
Alyne: Can you describe that procedure?
Dr. Hanif Hussaini: Basically, it's called the minimally invasive chevron Akin technique, and through three to five little tiny poke holes in the skin, we're able to use a tiny what's called a burr to basically make a tiny cut in the bone and shift it over. And then we use screws that go underneath the skin as opposed to the pins that stay outside the skin for four to six weeks that was used in the past to stabilize what's called the osteotomy or the shifting of the bone over to the straighten out the toe. And patients are able to put weight on the foot immediately after that surgery in a shoe or a boot for about six weeks total. After that time, they are able to start utilizing normal shoes again. But there's no need for crutches or anything like that. Patients are able to start putting weight on their foot immediately after the surgery.
Alyne: And can this procedure be done as an outpatient or in a hospital?
Dr. Hanif Hussaini: Absolutely. Pretty much every single of my patients that I do this for goes home that day. The surgery itself takes about an hour and a half, probably even less, to get that surgery done. And then they're going home to recover.
Alyne: And so that is done in a hospital and the patient is completely sedated or partially sedated?
Dr. Hanif Hussaini: It's done at surgery centers or at hospitals, but regardless patients are able to go home that day. And then they are partially sedated. Their foot is numbed up with anesthesia to provide a good pain relief for after the surgery for half a day or so after the surgery. And then they start taking oral pain medication by mouth for whenever they do need some additional pain medication. And they're sedated for the surgery. So they're not hearing all the work that we're doing. They're asleep. They're not aware of what's going on.
Alyne: So it sounds like with this particular procedure that the odds that you would have any recurrence of this are pretty much taken care of.
Dr. Hanif Hussaini: Patients that we've done the surgery for have been very happy with the appearance of their foot, with their recovery. There's certainly a risk of recurrence with any of these bunion procedures. if patients were to continue to wear very tight shoes. But, no, the risk of occurrence is very low and the patient have been very satisfied with it
Alyne: And what about physical therapy? Is that required after this procedure?
Dr. Hanif Hussaini: After the surgery, I typically give my patients a couple of exercises to work on at home. But the vast majority of patients do not require physical therapy after this procedure. They get good range of motion back in that big toe. Classically, with the open more invasive procedures, we had to make incisions that involved the actual toe joint itself and that could lead to some stiffness. But with this procedure, we're able to avoid damaging and irritating joint itself, which I think also helps improve patient's range of motion and helps them avoid stiffness after the surgery.
Alyne: This is very encouraging news. Is there anything that you'd like to add?
Dr. Hanif Hussaini: Looking at scientific data, comparing kind of both the classic open procedure and the minimally invasive procedure. I think, the studies have suggested that patients have very good long-term correction of their bunion with the surgery. And that there's a significantly less amount of pain, significantly less amount of infection risk and just overall very high satisfaction rates with procedures.
Alyne: Thank you very much, Dr. Hussaini, for joining us today.
Dr. Hanif Hussaini: No, I really appreciate the time you guys took to speak with me. Thank you so much.
Alyne: Dr. Hanif Hussaini is a foot and ankle surgeon at Wake Orthopaedics. To learn more about orthopedic services offered at WakeMed, visit WakeMed.org. I am Alyne Ellis with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Stay well.