Toes

If you are a track and field athlete, you’re likely familiar with stress fracture. It is a tiny crack in a bone, usually in the weight-bearing bones of the lower leg and foot, like the tibia (bone of the lower leg) and metatarsals (foot bones). Whereas regular fractures involve major trauma or force like a car crash to break a bone, stress fractures come from a much lighter impact, but occurring repetitively for a much longer period of time. The muscles surrounding the bones become so worn down, fatigued, or overloaded from the constant pounding, they cannot absorb the shock completely and transfer the stress to a nearby bone, causing it to slowly crack. The crack could be so fine that sometimes it is called a “hairline fracture.”

A stress fracture is a common overuse injury most often seen in athletes, stemming from repeated impact or pressure on “overused” muscles. It rarely occurs in the upper extremity because the weight of your body is not supported by your arms as it is in your legs. As a result, these “fatigue fractures” often plague those who run and jump on hard surfaces regularly, such as distance runners, basketball players, and ballet dancers.

When most people think of a broken bone, they picture an incident where the bone takes a lot of force directly at once and breaks. A stress fracture, however, is quite the opposite. The impact is not significant but persistent. The cumulative force built up over time eventually tires out the muscles like water running over rocks and eroding them piece by piece. Naturally, weakened muscles cannot absorb stress like strong or even normal ones, so a neighboring bone has to pick up the slack and begin taking the pressure more and more for the muscles. Since the traumas add up and a bone can only take so much, it eventually cracks from the excess stress.

Repetitive application of force, such as repeatedly jumping up and down or running long distances, is the primary culprit for stress fractures. Certain fractures are more sports-specific: runners tend to develop stress fractures of the tibia (shin bone), tennis and basketball players often injure the navicular bone in the foot, etc.

In addition to muscle fatigue, the constant impact forces bones to lose cells. Because you only add new bone cells when you’re at rest, without sufficient time for recovery you’ll be losing bone cells faster than you can replace them. As a result, you develop “bone fatigue,” impairing the bones’ ability to repair the tiny chips and cracks of a stress fracture that start to form.

Not wearing the properly cushioned footwear or adequate equipment capable of absorbing shock can obviously lead to stress fractures, as the feet are not protected from impact. Increasing the time, type, or intensity of a physical activity too much, too soon is another cause, when the muscles and bones simply cannot handle the greater demand.

Dietary abnormalities and menstrual irregularities can contribute to the development of a stress fracture, too. Because both factors are relevant to bone health, any problems with diet (for example, poor nutrition, anorexia, bulimia) or menstruation (amenorrhea) can cause this type of injuries. A bone that’s been weakened by a condition such as osteoporosis (thinning of the bones) may not be able to endure even normal physical tasks, and thus a prospect for stress fracture.

Stress fractures happen when the lower extremities of the body are overburdened. This includes the bones of the feet, shin, thigh, and pelvis. For that reason, the injury usually affects those who engage in an extraordinary amount of high-impact exercise (e.g., Olympic-class athletes), sports or activities requiring quick movements (basketball, soccer, tennis, gymnastics, ballet), distance running with high weekly mileage, and long marches (like military soldiers). People who sit a lot or are inactive can be prone to the condition as well when they suddenly undertake a flurry of exercise.

Body design is also a concern: The taller or heavier you are, the more force your legs have to absorb; improper muscle or bone alignment from the back to the feet decreases the bones’ ability to mitigate impact; weak muscles will absorb less force and thus heighten the stress transferred to the bones; weak bones will not accept the pressure well.

Age is certainly a factor, as bone mineral density declines as we become old.

Because of the increased potential for osteoporosis in women, they are twice as likely as men to sustain a stress fracture. This may be rooted in the combination of poor nutrition, eating disorders and infrequent menstrual cycle called the “female athlete triad,” which predisposes women to early osteoporosis.

Previous stress fractures have been identified as a risk factor. If you don’t let a prior injury heal completely, you’re especially susceptible to getting it again.

People who have flat feet or high, rigid arches are more likely to develop stress fractures from the abnormal walking/running motion that puts additional pressure on the bones.

Those of African descent are less likely to suffer stress fractures when compared with Caucasians, due to a generally higher bone mineral density.

Stress fractures are typically differentiated by the affected location:

• Metatarsal bones of the foot
• Navicular bone in the foot
• Calcaneus (heel bone)
• Tibia (shin bone)
• Fibula (calf bone)
• Femur (thigh bone)
• Femoral neck in the hip
• Pubic rami of the pelvis
• Sacrum
• Pars articularis of the lumbar spine

Stress fractures usually have only a few symptoms. The signs include:

• Pain. This is the primary sign of a broken bone. Pain often begins toward the end of an activity and stops with rest. If the injury or symptoms are ignored, the pain will begin earlier during the exercise and continue even after completion. Eventually, the pain will become persistent with minimal activity. Pain at night is a common complaint
• Swelling at the injured region
• Tenderness in a specific spot when it’s touched

A stress fracture is almost impossible to diagnose on your own since the break is miniscule and all you may experience is pain. Hence, physical examination by a medical professional is important. During the exam, you doctor will ask about your symptoms, level of physical activity, and general health. He/she will press on the bones and soft tissues around the site of your pain, trying to pinpoint what exactly has been injured.

X-rays usually do not show a stress fracture, but may reveal evidence of bone attempting to heal around the injury. Bone scan or MRI (magnetic resonance imaging may be more effective in unclear cases.

The best treatment is almost always resting the injured leg. If there is no evidence that the stress fracture may shift (the bone edges move apart and out of proper alignment), simply avoiding the activity that caused the injury may just be sufficient. Otherwise, you should avoid weight-bearing on that foot by using crutches, or even putting it in a cast. The rule of thumb is “if there is pain, don’t do it!”

You can take these measures at home to speed up the recovery:

• Rest. Avoid activities that cause pain, swelling or discomfort — but don’t give up exercising altogether! During the recovery, try low-impact, nonweight-bearing endeavors like stationary bicycling, swimming, or pool running. These will let you maintain a level of cardiovascular fitness. Don’t resume your former training routine until the fracture is completely healed, otherwise it will only prolong the pain. If the pain has you limping, consider using crutches until you can walk normally without pain.
• Elevate your injured toe as much as you can. Lift your foot above the level of your heart. Prop your foot up on a table or chair when you sit, and on a stack of pillows when you lie down. Rest your toe and do not exercise with that foot until the toe heals. Sometimes rest is all you need to treat a stress fracture.
• Do calf and anterior (front of) leg stretching and strengthening exercises twice a day.
• Apply an ice pack or cold pack to the swollen area. You can use a bag of frozen peas or corn for this. Be sure to put a thin cloth between the pack and your skin to avoid nerve damage and frostbite. Ice for 15-20 minutes at a time, at least three to four times daily or as often as hourly while letting your foot warm up to normal temperature between icing, until pain and swelling start to subside.
• Avoid walking barefoot. Wear proper shoes, one that is suited for your foot type, stride, and particular sports. Your doctor should be able to make recommendations.
• Consider taking acetaminophen (such as Tylenol) to relieve pain if necessary, but not ibuprofen (Advil, Motrin) and naproxen (Aleve) because some research suggests they can interfere with bone healing.

Rest is the key to the initial treatment of a stress fracture. The doctor may prescribe a walking boot or brace along with a cast or crutches for 6-8 weeks to help rest the injured area and limit the amount of weight-bearing.

Your rehabilitation may also include physical therapy to increase muscle strength and flexibility, which will also help prevent future injury.

Typically, after 4-6 weeks you can resume physical activities gradually, as long as they do not cause pain.

Most stress fractures heal with time and rest. Occasionally, though, some fractures refuse to heal or displace. Such cases may require surgery. The procedure may involve pinning the fracture site, and rehabilitation can take up to a half year.

The best treatment of a stress fracture is prevention. Just follow these advices:

• Make changes slowly. Start any new exercise program or impact sport slowly and progress gradually. A good rule is never increase the intensity, time, or distance by more than 10% each week.
• Get proper nutrition. Eat healthy. Include foods that are rich in calcium, vitamin D, and other nutrients in your diet, especially if you are a female athlete.
• Use proper footwear. Make sure your shoes fit well and are appropriate for your activity.
• Build muscle strength in the legs with strengthening exercise to prevent them from tiring too quickly and enable them to absorb greater strain for longer time. Replace shoes when needed (usually every 300-400 miles for runners). If you have flat feet, ask your doctor about arch supports for your shoes.
• If pain or swelling begins, stop the activity immediately and rest for a few days. If pain persists, see a physician.

Of the 26 bones in the foot, 19 are toe bones (phalanges) and the long bones in the midfoot (metatarsal bones). So, chances are good that when one of the bones breaks in a foot, it will be a toe.

A toe fracture is a break in a toe bone. Each toe is actually made up of several bones, and one or more of them may be fractured (broken) after an injury to the foot or toes. Fractures of the big toe can be much more serious than fractures of the smaller toes. Lesser-toe fractures where the bones are still aligned with each other (non-displaced fractures) usually heal successfully without many complications.

Toe fracture is a common injury that requires evaluation by a specialist. You should consult a foot-and-ankle surgeon for proper diagnosis and treatment, even if you already received initial treatment in an emergency room.

Because the toes are at the front of the feet, they are the most likely part of a foot to receive injuries. Almost all toe fractures happened from stubbing a toe or dropping a heavy object on a toe and crushing it. Sometimes when a toe is bent too far up or down, or the foot and toes are twisted, the trauma can cause the toe to break. Toes can also fracture after a fall or suffering a direct blow, while playing a sport, or when exercising.

Prolonged repetitive stress or movements, as in sports activities such as basketball, soccer, and running, may result in a broken toe. This is called a stress or hairline fracture.

While no one is completely immune, these risk factors do increase your chance of developing a toe fracture:

• Advanced age: the older you are, the weaker your bone structures tend to be
• Decreased muscle mass: your bones become more exposed when there’s less muscle to cushion them
• Not wearing shoes: shoes provide protection against trauma that can fracture the foot or toes
• Osteoporosis: the thinning of bone tissue and loss of bone density from this disease makes the bones more brittle and breakable
• Participation in contact sports: rigorous physical competitions always increase the chance of an injury
• Poor nutrition: inadequate or unhealthy diet deprives the body of the calcium and other nutrients necessary for strong bones, thus making the bones easier to break upon impact

Fractures can be divided into two categories: traumatic fractures and stress fractures.

Traumatic fractures, also called acute fractures, occurred from a direct blow or impact, such as seriously stubbing your toe. Fractures of the toe bones are almost always of this variety. Traumatic fractures can be “displaced” or “non-displaced”. In a displaced fracture, the bone is broken in such a way that it has changed its position (i.e., dislocated).

Stress fractures are tiny, hairline breaks usually caused by repetitive stress. When athletes increase their running mileage too rapidly, for example, they often suffer this injury because their feet aren’t ready for the intense pounding. An abnormal foot structure, deformities, and osteoporosis can cause stress fractures, as can improper footwear. Do not ignore stress fractures, as they require proper medical attention to heal correctly.

Moderate to severe pain over the fracture is the first sign. You may notice that pain lets up over a few hours and the toe starts throbbing and becomes swollen. The toe may hurt when you put weight on it or walk, especially if you’re barefoot, and you may not be able to bend or move it at all.

There may be bruises on the skin around the toe. The toe likely will not look normal — maybe even crooked, rotated in or out, or short compared to your other toes if you have a displaced fracture or a dislocation. If the big toe is fractured, the pain can make walking very difficult. You may feel numbness or loss sensation anywhere along the fractured toe, and develop a large, painful collection of purplish blood underneath the toenail. When you bend your toes or walk, you may feel crunching and grinding at the injured area, as well as tightness and increased pain, especially if the fracture is in a joint. As well, you can find the shoes painful to wear or a tight fit.

In addition, some other complications may develop, either immediately after the injury (minutes to days) or much later (weeks to years). The immediate complications include:

• Nail injury. This is in form of blood collecting underneath the toenail (called a subungual hematoma). If large enough, it will have to be drained, by a doctor making a small hole in the toenail to let the blood out. If the hematoma is very large or painful, the entire toenail may need to be removed.
• Open fracture. Rarely, the broken bone in a toe fracture may stick out through the skin. This is an open or compound fracture. Careful cleansing of the wound and possibly antibiotic medication are necessary to prevent the bone from becoming infected.

The later complications include:

• Arthritis, pain, stiffness, or even a deformity after the toe fracture heals.
• Occasionally, surgery may be called for to fix a fractures bone that would not heal completely (a nonunion), or healed improperly (a malunion).

It is not true that “if you can walk on it, it’s not broken,” so it’s best to seek medical evaluation of a foot specialist soon after injury to ensure proper treatment and healing. At the very least, the injured toe should be checked every day. Call a doctor immediately if any of the following occur:

• A cast or splint is damaged or broken
• Blue- or gray-colored skin
• Cold, numb, or tingling toes
• Bleeding, drainage, redness, sores, or open wounds near the injured toe
• Worsening or new pain not relieved by pain medication and conventional treatment

The doctor will ask about your symptoms, level of physical activity, how the injury occurred, and will examine the injured toe and possibly check for other injuries. X-ray is not always necessary to diagnose a broken toe, especially if the break is in one of the smaller toes.

Due to overuse or repetitive movement, stress fractures may require an MRI (magnetic resonance imaging) for diagnosis.

Treatment for a toe fracture depends on the injury’s location and severity. The doctor may need to put the fracture back into place and in a splint or cast. If there is an open wound near the injured toe, it can necessitate a tetanus shot and antibiotic medication.

Broken toes usually take about six weeks to heal. Simple fractures normally heal well without problems. A severe fracture or a fracture that goes into a joint, however, put you at risk for arthritis and perhaps even a deformity. Proper treatment can prevent these and other long-term complications with the toe joint, such as misalignment and immobility.

You can take these measures at home to help decrease the pain and swelling, and help the fracture heal properly.

• Avoid putting weight on your injured toe by sitting until your symptoms improve or by using crutches. You can usually rent or buy crutches at a drug or medical supply store.
• Elevate your injured toe as much as you can. Lift your foot above the level of your heart. Prop your foot up on a table or chair when you sit, and on a stack of pillows when you lie down. Rest your toe and do not exercise with that foot until the toe heals. Sometimes rest is all you need to treat a traumatic toe fracture.
• Apply an ice pack or cold pack to the swollen area over your toe. You can use a bag of frozen peas or corn for this. Because the skin on your toes is very thin and the nerves are sensitive, put a thin cloth between the pack and your skin to avoid nerve damage and frostbite. Ice for 15-20 minutes at a time, at least three to four times daily or as often as hourly while letting your toe warm up to normal temperature between icing, until pain and swelling start to subside.
• “Buddy-taping” the fractured toe to another toe with cloth athletic tape or two small Velcro® straps is sometimes appropriate to stabilize the injured toe, though it does not work well if the injury is to your big toe. Put a small piece of cotton or gauze between the toes that are taped together to prevent the skin from developing sores or blisters. Use as little tape as necessary, loosely tape the broken toe to the healthy toe next to it, above and below the middle toe joint. If the toes are taped too tightly, it leads to additional swelling and can cut off circulation to the injured toe.
• Avoid walking barefoot. If you have only mild pain and swelling and are able to walk, wear a firm-soled shoe with a good amount of space for the toes to protect the injured toe and help keeps it in the proper position.
• You may consider taking a fast-acting anti-inflammatory medication such as ibuprofen (Advil or Motrin) for pain and swelling.

Professional treatment for a toe fracture depends on which toe is broken and the type of fracture. In any case, schedule an appointment with a doctor to evaluate the injured toe and make sure it is healing properly.

Options for professional treatments include:

• Ice, Elevation, and Rest. This follows the similar guidelines as for at-home care.
• Buddy Taping. The doctor may only need to tape the injured toe to the one next to it for support if the toe fracture is minor and in one of the small toes. It is usually safe to bathe and then replace the tape afterward, but check with the doctor to make sure.
• Casting. A cast is usually not required for a simple toe fracture, and a hard-soled, sturdy, supportive shoe may be used instead, or a specially customized shoe if the foot or toes are very swollen. You may need a cast if your big toe is broken, the fracture involves a joint, a lot of small fractures occur at once, or a bone in the foot or leg is also broken.
• Reduction. You may need this if your toe bone is displaced (the two ends of the broken bone are out of place) or rotated (the toe is pointing in the wrong direction). During this procedure, the doctor lines up the broken parts of bone so they can heal normally. If the toe bone is badly injured, you may need surgery.
• Medication. Antibiotics may be prescribed to help treat or prevent an infection. A tetanus shot may be given if you scratched or tore some skin to protect you against tetanus (the bacteria that causes lockjaw).

Surgery is usually necessary only when the break involves a joint, several small toe fractures, or if a bone in the foot or leg is broken too. Sometimes it is needed for a broken big toe. Surgery often involves inserting pins and screws into your bone to keep the broken parts lined up and stabilized so the toe can heal correctly.

You can take these steps to help cut down the chance of getting a toe fracture:

• Wear shoes to protect your feet, and always wear well-fitted, supportive athletic shoes when performing physical activity.
• Eat a diet rich in calcium (leafy green vegetables, almonds, shellfish, etc.) and vitamin D (egg yolks, butter, fish oil) to maintain bone density and better resist impact.
• Do weight-bearing exercises to build strong bones.
• Build strong muscles to prevent falls.

A bunion (from the Latin “bunio,” meaning enlargement) is a protuberance of bone or tissue around the joint. A bunion is one of the most common foot problems. Your big toe does far more work than the lesser toes. Every time you take a step, the big toe supports most of your body’s weight. It is indispensable to foot movement, and problems with it can make walking or even stand painful.

A deformity of the big toe joint, bunions are usually visible as a “bump” on the inside of the foot just behind the big toe, ranging in size from hardly visible to the size of a quarter or half-dollar. The bony bump can be accompanied with bursitis which is a “cushion” created by the body to protect the affected area from excessive pressure or friction.

This deformity can cause a deviation of the big toe as it moves toward the second toe, sometimes underlapping the second toe. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion’s “bump.”

Bunions are a progressive disorder and can be degenerative, most often caused by an inherited faulty mechanical structure of the foot.

They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent.

In addition to causing pain and discomfort, the changes bunions make to the shape of your foot, can make it harder to find shoes to wear, and in severe cases can make walking extremely difficult.

Bunions are a common problem usually affecting women. The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by improper fitting shoes. Tight, narrow dress shoes with a constrictive toe box can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Women who have bunions normally wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot.

Bunion pathology is also related to foot structure and function both of which are inherited features.

Feet that have a tendency to excessively pronate cause an over-flattening of the foot. This excessive flattening causes tension on the extensor hallucis tendon (the tendon on the top of the foot that enables you to bend your big toe upwards). This causes the tendon to “bowstring” and in doing so forces the big toe to be pulled laterally, toward the second toe. This is what causes the initial deviation.

Over time, there is a retrograde (or backward) force placed on the first metatarsal bone by the big toe and the first metatarsal bone begins to move medially (or away from the second metatarsal bone). Due to these changes, there is now more pressure on the side of first metatarsal bone from shoe pressure and this causes a hyperostosis or thickening of bone and this results in the formation of a bunion deformity.

Excessive rubbing of the bunion against the top of the shoe can lead to pain and the development of acorn. The tip of the toe is often turned down against the shoe causing pressure and discomfort.

Arthritis can also lead to deformities including bunions. Bunions can cause extreme discomfort and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.

Women who spend a lot of time wearing tight or ill-fitting shoes are most often susceptible to bunion. Tight fitting shoes cause muscles to lose their function for straightening the toes. Wearing tight shoes for long periods of time can also shorten the tendons and over time the muscles will not be able to fully straighten on their own, forming bunions.

Bunion deformities are also often caused by the biomechanical functions of the foot and hereditary conditions such as flat foot, high arch and pronation, which can put excessive stress on the joints causing the buckling.

Are there different types of bunions?

If your big toe bends up to fifteen degrees toward your second toe, it is considered normal. Once the angle is more than fifteen degrees then it is considered hallux valgus. Bunions can start out mild and progress to severe. Unfortunately there is no way of predicting how rapidly a bunion will progress or worsen. The severity of the symptoms will vary. You and your podiatrist must determine what treatment is best for you.

Mild: New bone growth stretches and stresses the joints, pushing the big to towards the lesser toes. The inside tendons tighten, pulling the big toe farther out of alignment. Mild or beginning bunion deformities should be observed to determine the rate of progression of the deformity. It is beneficial to perform corrective surgery early on before the deformity becomes severe. This will avoid a more involved surgery with a longer recovery necessary for the severe deformity.

 Moderate: Most bunions fall into this category. At this stage of deformity, it is difficult to find shoes that fit comfortably, due to the difference in the width of the forefoot compared to the width of the heel. If the shoe fits in the forefoot, the heel of the shoe will typically slip up and down. If the heel is fitted properly, the forefoot is cramped.

Severe: When the angle between the bones of the first and second toes is greater than normal (more than fifteen degrees), the big toe slants toward the lesser toes. In severe cases, this may also cause the second and third toes to buckle. Severe bunion deformities require surgery at the base of the metatarsal.  Because of the severity of the deformity, the location of the osteotomy (cut in the bone), patients are not allowed to walk on the operated foot for several weeks.  Crutches, cast, and sometimes a wheelchair is needed during the recovery period.

• Deformed shape: Bunions exhibit a deformed bumped curve at the joint of the big toe, pushing the toe towards the lesser toes.
• Redness: Redness and tenderness at site location or inside of the foot at the big toe joint are also usually present.
• Pain and tenderness: There will commonly be a pain in the toe joint and difficulty wearing shoes, sometimes causing difficulty walking, cramping in toe, foot and leg. The bursa (fluid-filled sac) on the inside of your foot at the big toe joint may also become painful and tender to the touch.
• Swelling: Inflammation may be present on the inside of the foot at the big toe joint.
• Numbness: Tingling, burning or total numbness in the big toe (hallux).
• Immobility: Decreased motion at the big toe joint.
• Corn: A corn can develop in between the big toe and second toe from the pressure caused by the bunion moving the toes.
• Callous: formation on the side or bottom of the big toe or big toe joint Callous under the second toe joint

To diagnose bunions, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a bunion.

Pathological exam: Direct observation of the bunions, typically makes the diagnosis. Your doctor will ask you questions about the symptoms you are having while examining your foot. You may also be asked to stand and walk barefoot to further assess your foot function. Bunions are usually termed mild, moderate or severe.

X-rays: May often be necessary to get a better understanding of the deformity and what the best type of treatment is. The podiatrist will measure angles between the bones to help determine the stage of the bunion.

• Foot problems causing pain should be given prompt attention. Ignoring the symptoms can aggravate the condition and lead to a breakdown of tissue, or possibly even infection.
• Conservative Treatments
• Padding: A doctor may fit your foot and show you how to properly pad it to reduce friction and minimize pain.
• Corticosteroids: Injections of cortisone steroids may be administered at an office visit if the bursa sac is excessively inflamed. Corticosteroids can suppress inflammation, reducing pain and easing discomfort.
• Functional orthotics: prescribed and cast by your doctor are designed to relieve pressure within the big toe joint.
• Shoe Therapy: including supportive shoes or modifications for your foot type and activities.
• Activity modifications: By avoiding strenuous foot activity, you may be able to slow the development of bunions and bring relief to those already formed.
• Injection therapy: Corticosteroids may help in treating an inflamed bursa, but because of the risks of further damaging the foot, injections are not most commonly recommended.

• High Toe Box Shoes: To prevent further irritation to the toe, shoes with a high and broad toe box (toe area) are recommended. Shoes such as Crocs, clogs or Birkenstocks may be enough of a change to allow pain free walking.
• Icing: Treat the affected area with ice packs daily by raising the feet above the heart, resting them comfortably and gently massaging with an ice pack or even a bag of frozen vegetables can work. It is best to ice 15 minutes at a time with a 15-minute break in-between.
• NSAIDS: Take over the counter medications such as ibuprofin or acetaminophen to reduce inflammation and manage pain.
• Foot Spacer: The doctor may recommend you use toe/foot spacers to prevent underlapping.

• Who should have bunion surgery?
• If a deforming or potentially deforming bunion has been determined by your podiatrist (by clinical exam /x-rays).
• You have a bunion but your podiatrist feels conservative care is not working.
• Bunions prevent normal daily activity. Shoes no longer fit properly or excessive pain is involved.

Different people will respond to different types of surgeries. Some procedures allow you to walk much sooner and avoid crutches, but run an increased risk of the bunions returning. Other procedures may require crutches for a few weeks, but may offer longer lasting results.

Head osteotomy procedures (around the great toe joint): the bone is cut and the head of the metatarsal moved over to correct the bunion. Various types of bone cuts can be performed depending on the necessary correction. Some cases of flexible bunions will respond to a release of the flexor tendon. This procedure releases the tight tendon allowing increased range of motion. The procedure may be performed in office or as an outpatient procedure. Head procedures are usually performed for mild to moderate bunions, or for patients who cannot be off their feet for any length of time. Typical healing time can vary from several days to several weeks. Return to a loose fitting shoe such as a tennis shoe would begin approximately 3-4 weeks.

Base osteotomy procedures (near or at the joint behind the great toe joint): Base procedures are commonly indicated for a moderate to severe bunion. They are performed around the base of the bone behind great toe (the 1st metatarsal). Base procedures can involve cutting a wedge shape out of the bone, a crescentic osteotomy, which involves making a semi-circle cut and rotating the bone, and Lapidus bunionectomy—fusing the joint behind the big toe joint. Once realigned, the bone is held in place with surgical pins.

You are about to have surgery. As you may already know, nutrition plays a very important role in proper healing. One of the most important benefits of proper nutrition is maintaining a right pH balance in your body. pH is the measurement of acidity and alkalinity. pH ranges are from one to fourteen with fourteen representing most alkaline. Seven is neutral. The most optimal pH level for humans is slightly more alkaline than acidic at around 7.36.

Undergoing surgery can increase acid levels in the body. Emotional and physical stress from both the surgery and recovery time changes your metabolism, which increases acid production. The use of both general and local anesthesia, pain medication, anti-inflammatory medications and other medications such as antibiotics will also introduce more acid to your system, lowering the alkalinity. This will delay healing and prolong recovery time.

To maintain your body’s proper pH, keep yourself well hydrated prior to and after surgery. Water helps to dilute the acid build up in your body and release it through urination. Eating alkaline rich foods such as dark, leafy green vegetables will add alkalinity. Avoid acidic foods such as meats, fried foods, coffee (and other caffeinated drinks), carbonated beverages, cigarettes and alcohol.

• Many people may need medical clearance through their Primary Care Physician, especially if taking medications such as Coumadin.
• Stop using anti-inflammatory medication 5 – 7 days before surgery. These include: aspirin, ibuprofen, Advil and Aleve.
• Arrange for a ride home from surgery and for someone to look after you for at least the first 24 hours.
• Avoid long trips for at least two weeks after surgery.
• Avoid eating and drinking anything after midnight the night before surgery.

Most foot and ankle surgeries are day surgeries, which means you will go home the day of surgery. You will generally be given a local anesthetic and anesthesia. After surgery you will receive pain medication and care instructions.

• The best results and quickest healing is achieved when patients follow after surgery instructions.
• Keep your foot elevated as much as possible for the first week after surgery.
• Keep your foot dry for at least 2 weeks after surgery.
• One week after surgery you will have your dressing changed by coming to see your attending physician.
• The sutures will be removed after the second week.
• Your doctor will advise you when you can increase weight and activities on the foot.
• Take pain and anti-inflammatory medications as prescribed by your physician.
• Vitamin C is important to heal scar tissue. It is vital in aiding in collagen formation. Take 4,000 mg spread out over each day in 500 mg doses taken for several days to several weeks after surgery.
• Omega 3 fatty acids, such as flax or fish oil, vitamin A and beta-carotene aid in the skin healing and lessen the appearance of scars.

Wear comfortable, wide shoes to prevent uneven or excessive pressure on the foot.

Avoid wearing tight-fitting, pointed toe shoes, such as women’s high heels or pumps as these will cause your foot to stay in an unnatural shape for too long, which can increase the risk of developing bunions.

Treat and prevent bunions at the onset to reduce the risk of them causing deformity. This is key to your foot health. See a podiatrist right away and make any necessary changes to your footwear and activity.

Treat foot irregularities such as flat feet or high arches as they may also contribute to the development of bunions by affecting how shoes wear on your feet.

Regularly visit your podiatrist to manage your foot health.

Forefoot problems causing pain should be given prompt attention. Ignoring the symptoms can aggravate the condition and lead to a breakdown of tissue, or possibly even infection. Treatment may take considerably longer to effect a cure, if it is not possible for you to avoid the causes of your mallet toe, such as neurological disorders. Additional causes, such as pressure and friction on the foot may also make it more difficult to heal a mallet toe.

Most foot and ankle surgeries are day surgeries, which means you will go home the day of surgery. You will generally be given a local anesthetic and anesthesia. After surgery, you will receive pain medication and care instructions.