When a patient elects to surgically correct a bunion deformity, both the physician and the patient invest so much time and energy. In addition to performing the bunion correction, the physician analyzes angular deformity and chooses from multiple different surgical procedure options to fit the patient and the patient’s expectations. Moreover, the patient makes a commitment to rest the operated extremity and wear protective devices religiously for several weeks. Sometimes this even requires the patient taking time off from work. Because one of the main complications of corrective bunion surgery is recurrence, I feel that it is equally necessary to stress and dedicate that same effort to prevent this unwanted and avoidable complication.
To review, a bunion deformity is when the big toe presses upon the second toe and adjacent digits. There is a mal-alignment of the big toe joint where one can even notice a prominent bone bump at the top or at the side of the joint. A patient can even notice stiffness or painful and decreased motion at the joint. In some patients, this deformity can be treated with oral or topical medications, shoe gear modifications, padding, and shoe inserts (custom or “off the shelf”). Surgical correction of a bunion deformity is usually warranted when these non-surgical options fail to provide relief or if the deformity is more advanced or severe.
There are many ways to help prevent recurrence of a surgically corrected bunion. Just like a dentist usually fits a patient with a mouth retainer braces, that same concept applies to a nighttime bunion splint. When healed after surgery, a patient can wear a soft, comfortable splint to prevent shifting of the newly re-aligned toe. This is usually worn when the patient is non-ambulatory or during sleeping hours. It is also necessary to focus on what caused the bunion in the first place.
Usually, bunions are caused by an abnormal foot structure or abnormal walking/gait pattern that causes instability at the big toe joint. If the abnormal foot structure or gait pattern can be corrected with custom orthotic shoe inserts, it is definitely worthwhile to be fitted for these. A custom orthotic is made from a mold or impression that captures the foot abnormality. The insert device is then made from that mold, effectively producing a comfortable insert that is placed in the shoes. This insert is designed to place the joints of the foot in correct alignment, which provides stability to the big toe joint and the rest of the joints of the forefoot.
Finally, wearing good, supportive shoes will reduce the risk of recurrence. For example, you should pick a shoe with a firm back and one that provides good arch contact. I know that all the ladies are thinking, “What does this mean for high heels or cute dress shoes!?” My answer to this is…High heels apply to our same rules for all our guilty pleasures in life! Wearing high heels “in moderation” means that these are reserved for 1-2 occasions a week and usually for 2-3 hours at a time. And these should never be used for walking long distances or more than 4-5 blocks. So ladies, enjoy those fabulous pumps or awesome strappy sandals while using those same rules that apply to delicious things, like chocolate cake!