FREQUENTLY ASKED QUESTIONS
What is a bunion?
Appears to be a bony "bump" on the base or inside of the big toe. Inside the foot, what's happening is the bones of the big toe are leaning toward the second toe instead of pointing straight. Ligaments, tendons, and joint capsule along with vessels and nerves are being stretched. Over time, this leaning of bone inside the big toe puts other bones out alignment and creates the "bump." This leads to over or under lap of toes and progressive arthritis.
Without reviewing the entire website what are the highlights of Dr Thomas’ minimally invasive surgery vs traditional bunion surgery?
TRADITIONAL: pain 3-12 months, scars at least 2 inches (5cm) in length, dissection with scarring deep, decreased ROM post op, up to 12 months swelling, no weight on foot for at least 6 weeks.
MINIMALLY INVASIVE SURGERY: less post op pain, less swelling with return to regular shoes by 6 weeks post op, weight on foot day of surgery in post op shoe, decreased time away from work and activities, 5mm incisions with minimal to no scars, motion not as compromised at the joint, tested and proven technique with 50k prostep procedures studied in Europe and Australia, reproducible outcomes.
What causes bunions?
Scientific literature does not have one exact cause of a bunion, but it appears to be related to the genetic foot structure that you inherit from your family. Certain types of foot structures are more prone to develop bunions than others. Bunions are progressive disorders, meaning they will either stay the same or likely worsen over time in the way they look and feel. It doesn't fix itself and simply with time , therapy, strapping, bracing is not going to return to “normal.”
A bunion can worsen faster if the wrong types of footwear are worn. An example is a shoe with a narrow, pointed toe box that squeezes the toes into an unnatural position (i.e. high heels). According to the American Orthopedic Foot and Ankle Society, 88 percent of women in the U.S. wear shoes that are too small and 55 percent have bunions. Also, women get bunions nine times more often than men.
If your ancestors had bunions, you’re more likely to have them as well.
Though approximately 66% of bunion sufferers are women, there are plenty of men that develop them as well.
- Structural abnormalities
If you are missing bones, have flattened arches, a short first metatarsal, asymmetry of the legs, or prolonged healing of a foot injury, these can contribute to the development of a bunion. It’s interesting to note that bunions may occur in just one foot.
During pregnancy, the body releases a hormone called relaxin. This facilitates birth by relaxing the ligaments surrounding the pelvis. But relaxin also softens ligaments throughout the body, including ligaments in the foot. This can cause bones in the foot to spread and arches to fall. Both of these events can lead to bunions.
- Bad shoe choices
Yes, we are primarily talking about high heels. High heels cause weight-bearing to shift to the forefoot. People wearing high heels every day, or most days, can experience a gradual arch collapse over time which can contribute to bunion formation and chronic foot pain.
What are the different kinds of bunions?
"Hallux Abducto Valgus" is when a "bump" appears on the side of the big toe. This bump reflects changes inside the framework of the foot. The big toe leans toward the second toe, instead of pointing straight ahead.
"Hallux Limitus or Rigidus" is similar to a bunion that causes pain and stiffness in the big toe joint. Over time it gets increasingly harder to bend the toe. This is a form of degenerative arthritis.
“Buinionette or Tailor’s Bunion” is a bunion happening where the ‘pinky’ (5th) toe meets the foot at the 5th metatarsal bone. This causes a “bump” on the outside of the 5th toe and may lead to the 5th toe curling under the 4th toe.
How does a bunion develop?
We know from above bunions are linked to genetic inheritance and shoe wear. A bunion can begin to develop in early adulthood and get worse with age. It’s not uncommon to see bunions in pediatric patients and particularly those going through puberty. Neglected bunions lead to progressive osteoarthritis.
Wearing the wrong kind of shoes, such a high heels with pointed tips and other footwear that is too tight can also help develop a bunion. These shoes can gradually help push the foot bones out of alignment. Biomechanically the ankle is a modified hinge joint made up of three bones (tibia, fibula, talus) that are connected by ligaments, muscles and tendons. The foot itself is made up of 26 bones. The joints between these bones allow the foot to be a rigid lever and a shock absorber adjusting to ground surfaces.
The gait cycle is what happens to the foot and ankle when someone walks. This cycle is made up of two phases, the swing phase and the stance phase. While in the swing phase, the foot does not come into contact with the ground, but rather swings forward or backward. During the stance phase, there are three stages: The heel strike, mid-stance, and heel lift.
During the heel strike, the foot begins pronation (a rolling motion of the foot inwards). Pronation allows the foot to act like a shock absorber. During midstance, the entire foot contacts the ground and the entire weight of the body is on the foot. When body weight shifts forward, the foot returns to a neutral position to prepare for the heel lift, which happens at the end of the stance phase.
During heel lift, the foot supinates (acts as a rigid lever). The plantar fascia, a strong tissue along the bottom of the foot, works with bones and muscles to form this rigid lever.
Can bunions be corrected?
Many times bunions can be managed, but not cured or corrected, with non-surgical treatments including: wearing the right footwear shoes (good padding/arches and the correct size), placing bunion shields over the area of the bunion, avoiding activity that causes bunion pain, taking anti-inflammatory drugs such as ibuprofen, applying ice packs and injections of corticosteroids (by a doctor) to reduce the inflammation. Custom inserts or orthotics, splints, and bracing have shown to reduce symptoms but do not change the abnormal position of the bunion.
Custom orthotics are custom-made devices that are designed to support your feet. Orthotics are manufactured to match the contours of your feet and the way you walk. Orthotics are created for you after a foot and ankle doctor examines of your foot. Orthotics may be used to treat bunions, depending on the severity of the bunion, by providing pain relief and decreasing progression of their deformity.
If a bunion becomes symptomatic (painful), alters activities of daily living (changing shoes or activity to avoid pain or pressure), or is cosmetically concerning to the patient then surgery is likely to be the only option. Traditional bunion surgery leaves scars on the outside of the foot and scar tissue inside the foot, which results in more pain and swelling. This can be painful post op and long-term and commonly requires revisional surgeries to correct in future. There may also be a loss of range of motion for the big toe and chronic deformity and pain with high likelihood of recurrence.
Are there alternatives to traditional bunion surgery?
Fortunately, Dr. Thomas’ MIS (Minimally Invasive Surgery) for Bunions uses minimal skin incisions with minimal to no scarring inside the foot as this is corrected extra articulations (outside the joint). Traditional bunion surgery involved opening the joint and in many cases removing joint capsule which inevitably leads to decreased motion, more scar tissue, and long term pain. Dr. Thomas’ patients normally experience far less swelling and pain than people who have traditional bunion surgery. Additionally Dr. Thomas’ patients are able to walk early post op and return to activities of daily living much quicker than with traditional bunion surgery.
How soon after my surgery can I go back to work, driving, and/or participate in sports?
Every patient is different, but usually the bunion Minimally Invasive Surgery patients are back on their feet in 2-4 weeks. Most commonly patients walk the day of surgery in a post op shoe with or without crutches. In contrast traditional bunion surgery can keep you off your feet for up to 3 months on crutches, scooters, walkers, or wheelchairs.
Once you are back on your feet, it really depends how you feel as far as engaging in sports, but you should be able to do normal daily activities within 6 weeks with bunion minimally Invasive Bunion Surgery. Dr. Thomas has operated on high level athletes and for high impact running and jumping sports expect 3 months to full return to sport.
Minimally invasive surgery bunion patients with sedentary jobs can return to work as early as the day after surgery. Those with more physically demanding jobs typically take one week off work. Commonly paperwork is completed for employers to make accommodations if needed. Dr. Thomas recommends being off pain medication prior to returning to work. On average patients stop pain medication within 24-48 hours post surgery.
Patients need an adult to drive them home after the procedure. Typically within 48 hours post op patients are off pain medications and can drive themselves. This is helpful for post op appointments.
Do splints and bunion shields work?
Bunion pads can help cushion the irritated area of a bunion and help keep a bunion from brushing against the inside of the shoe. A gel-type bunion shield usually provides the most relief, but silicon-based are more durable. A bunion shield is placed over the bunion at the base of your big toe. It is also important to wear comfortable shoes because you do not want to add more pain and pressure to your bunion in cramped shoes.
What are the best shoes for preventing a bunion?
Best shoes to avoid are high heels, small or pointed toe boxes, shoes that don’t fit or there is overlap. It’s common for bunion patients to cut wholes in their shoes to allow bunion to not have pressure. Ballet dancing or similar activities that include wearing constrictive shoes can help develop and irritate bunions. Some ill-fitting tennis shoes and other athletic shoes can also make your bunions worse.
You want shoes that provide good arch support, include padding, can stretch and "breathe." When trying on shoes, the big toe should not touch the end of your shoe. Make sure there is a thumb's width of room between the tip of the big toe and the end of the shoe. The shoe should also be wide enough to provide you room and comfort. For more information on shoe selection please see Dr. Thomas’ blog post on this subject: https://www.ohiofootandanklesurgeon.com/blog/sport-specific-shoes
How should I select a surgeon for my bunion?
There are many factors that should go into researching, preparing/planning, and completing any surgery procedure no matter how big or smal the procedure may seem. Certainly recommend at minimum the surgeon be hospital credentialed, board certified, and you as the patient have trust in their care.
There are bunion surgeons that don’t have hospital privileges, certification, or commonly perform the procedure. It’s not uncommon for a foot surgeon (be that orthopedics or podiatrics) to perform less than 10 bunion surgeries per year. Recommend against anyone who dabbles in foot and specifically bunion surgery. Complexity of the procedures and correct patient selection are paramount to good outcomes. There is a science and art to correcting bunions and you want someone with experience and who can handle any complications.
With the higher volume bunion surgeons in town retiring over the past couple years and being the only provider certified to perform the prostep minimal invasive bunion surgery in Columbus Dr. Thomas has seen a significant increase in bunion patients. Dr Thomas is certified and credentialed, holds leadership positions, educates residents and other doctors, and performs over 400 procedures per year.
If neglected will my bunion cause any further problems?
Bunions don’t always lead to complications, however they can cause permanent damage to your feet if left untreated.
Untreated bunion complications include:
- Bursitis: fluid filled sac called bursa inflames between joints and muscles in the foot.
- Metatarsalgia: inflammation and transfer pain to the ball of your foot as the bunion causes an imbalance in the way the front of the foot distributes pressure.
- Hammertoes: an abnormal bend in your toes which can make shoes and activities painful and can lead to callous and wounds. Commonly the 2nd toe elevates flexing over top of the big toe bunion with overlap.
- Arthritis: progressive joint destruction from the bunion deformity leading to end stage procedures such as fusions or joint replacements.
Is bunion surgery covered by health insurance?
Yes. A bunion is a deformity and established medical condition. Diagnosis and treatment for bunions are covered by insurance including the minimally invasive surgery technique. At Clintonville Dublin Southwest Foot & Ankle most major insurances are accepted. There are also options for patients without insurance as self pay rates are established with the ambulatory surgery center and office.
What can I expect before, during, and after surgery?
The pre op consult typically lasts about an hour including standing X-rays, review of your foot and X-rays with Dr. Thomas along with a discussion of whether or not you’re a candidate and risks vs benefits to procedure, and discussing scheduling process.
The day of surgery the patient arrives on average 2 hours prior to surgery start time at either the hospital or ambulatory surgery center where the procedure is being performed. The patient is seen by RNs and the Anesthesiologist prior to being seen by Dr. Thomas.
During surgery you will likely be sedated and not remember anything while Dr. Thomas numbs you’re foot and performs the surgery. On average per foot the procedure takes 30 minutes. The numbing medication lasts 6-8 hours.
The patient wakes up comfortably in recovery and then is greeted by family and able to go home once cleared. This is typically an outpatient procedure. Prescriptions for antibiotics, blood clot prevention, and pain are given along with instruction sheet. The patient has a light wrap on the foot and a post op shoe. Assistive devices will be given if needed (crutches, walker) however these are rarely needed.
1st follow up appointment happens the week after surgery. The site is inspected to make sure no clinical signs of complication. Patient is able to advance activities and next follow up is 3 weeks later. Then another follow at 8 weeks post procedure. The post op visits are at the discretion of Dr. Thomas and can vary based on individual patient care.
Can I have bunion surgery on both feet at the same time?
The minimally invasive surgery was designed to allow quicker return to activity and ability to do both side surgery in one setting. You’re not alone as most bunion patients have the deformity on both sides. Although most patients elect for one side at a time surgery in some circumstances (depending on severity of bunion and risk factors) Dr. Thomas does both side bunion surgery at the same time.
How do I schedule a bunion consult with Dr. Thomas?
- Feel free to call the schedulers at any of the following numbers.
- Can submit a contact form under ‘Surgery Consult’ tab this website and a representative will call you by end of the next business day.
- Request an Appointment through the dublinfootandankle.com website
- Contact Dr. Thomas directly by mobile phone 740-318-1194 or email email@example.com
* Dr. Thomas traditionally has a long wait for a new patient visit, however for the bunion consults the office has opened additional blocks of time so same week appointments most of the time can be accommodated.