A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes . The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Varus. Bunions can also lead to other toe deformities, such as hammertoe.
Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult--all contributing to chronic pain.
Bunions have been with mankind since the beginning of time. Undoubtedly they have received more attention since shoes have become a vital part of our fashion. It is generally recognized that those who have a bunion deformity most probably inherited the tendency from an earlier generation. So often people are told "don't have anything done until you can't stand the pain"! This is a misconception! Our rule of thumb is that when it becomes obvious that you have a bunion, that is the time to correct it!
Treatment for Bunions
Certainly the goal in bunion treatment is to limit the deformity and to stop the progression if it has already begun. This can only be done in the very beginning stages. When it is seen that the deformity is beginning in children and young adults, often the use of a good custom orthotic will stop the progression of the deformity. Also wearing shoes that do not irritate the deformity is also wise.
The greatest hurdle that people with bunion deformities have to overcome is history. In most instances, these people have had a relative with the same deformity who years ago had surgery and they remember the pain and the weeks and months in casts and on crutches. They also remember that after going through all of this pain and suffering, in many instances the bunion came back.
The good news is that in the past 10 years new techniques and better instrumentation have been developed. Bunion correction of today involves the use of micro instruments with precise cuts in the bone to correct the deformity, thus limiting the rate of re-occurrence. The old days of the doctor saying "I'm going to have to break the bone and reset" it are gone. If anyone says that to you, run as fast as you can! Gone are the days of casts and crutches and wheel chairs post-operatively. Only in the most severe cases must the patient be "non-weight bearing". In most cases, the patients at the Ford Center can resume a fairly normal lifestyle in days or weeks rather than months.
At the Ford Center for Foot Surgery, the procedures are done with I.V. sedation administered by one of our qualified anesthesiologists. We also use a regional anesthetic which is much safer than a general anesthetic. We can do this because we do not use tournequets when we do foot surgery. This minimizes post operative pain as well as the risk of blood clots. The net result of this is that the patient is awake and can walk within minutes following the surgery but their foot is numb for 18 - 20 hours.
The procedure itself is accomplished through an incision on the inside of the foot, thus there are no unsightly scars. The capsule of the joint is exposed and is opened revealing the "bump" on the side of the metatarsal bone. The over growth of bone is removed. Next a very precise "V" cut is made in the bone from one side to the other and the end or head of the bone is moved over. This narrows the foot back down to its normal width. To maintain this, a small screw is placed in the bone to secure the correction. The skin and soft tissues are then sutured and the foot bandaged. The foot is then placed in a post op shoe that will be worn for several weeks.
As a general rule, our patients return to comfortable shoes in 2 to 3 weeks.
A large part of the attraction of golf is the time spent outdoors. During an 18-hole round of golf, the typical player walks four-to-five miles over the course of three-to-five hours. That's a lot of time spent on your feet. At the same time, the biomechanics of golf make your feet as important to the success of your swing as any other part of the body. Getting and keeping your feet in the right position to help carry the force of the swing through properly can be impacted by the shoes you wear.
Common foot injuries and problems associated with golf are related to overdoing it, particularly if an underlying structural problem exists in your feet. This includes tendonitis, capsulitis, and ligament sprains and pulls, which can keep a golf enthusiast off the green. Improper shoes can bring on blisters, neuromas, and other pain in the feet. Podiatrists see these problems daily and can treat them conservatively to allow for a quick return to the sport.
Remember that you'll spend a lot of time on your feet standing and walking during golf, so look for shoes that are comfortable. Golf shoes come in a variety of types, from the traditional oxford-style to sandals and even boots. Whichever style you choose, look for shoes that are lightweight, well-cushioned in the soles and heels, made from a breathable material, water resistant and offer traction. The middle of the shoe should feel a little tighter than your everyday shoes to support your swing. Be sure to try on golf shoes with the socks you will normally wear to make sure to get the right fit.
More serious golfers may be interested in purchasing spikes. Just give yourself time to adjust to walking wearing spikes and make sure you know the policy for wearing them on each golf course. Spikes give added traction and help stabilize the foot during play. Spikes are made from different materials. Soft, polyurethane spikes that are less damaging to the green and lightweight, but don't offer as much traction as a heavier material. Carbide or ceramic spikes are for serious golfers who spend a lot of time on the greens. They are made of durable materials that often outlast the shoe's upper. Metal spikes often last the life of the shoe, are very durable, give good traction but must be carefully maintained to prevent rust.