A common misconception is that bunions are just a simple overgrowth of bone that can be simply “shaved off.” In reality, however, bunions are complex deformities caused by an unstable joint in the middle of the foot. With an unstable foundation, the bone can rotate out of alignment and form the painful “bump” at the base of the big toe. They can cause a lot of pain and become debilitating.
Anyone can develop a bunion, though they are more common in women than in men. They are hereditary by nature and can be worsened by tight fitting shoes. Wearing wider shoes and using simple strategies to relieve pressure on the big toe helps some people “live with” the problem. But these workarounds are not an option for about 400,000 Americans who must turn to bunion correction procedures each year to relieve their pain.
Up until recently bunion surgery has not addressed the root cause of the problem. As a result, the problem can reoccur. But now there’s a new three-dimensional bunion correction procedure that allows for rapid recovery and allows you to walk within days of surgery.
Listen to this interview with Edward Henrich, DPM about your options for dealing with a bunion and whether it’s even warranted if the bunion is not painful or adversely affecting your life.
Welcome to Mason City Docs On Call, a podcast series with north Iowa specialists who educate us about how to stay healthy. I’m your host Carol Gifford. Today, we’re going to talk about a very common condition many of us develop on our feet, bunions. They tend to be unsightly protrusions of the big toe bone and many times they can be very painful and interfere with one’s quality of life. So with us today is an expert in taking care of bunions, podiatrist Edward Henrich at the Mason City Clinic, who’s using a new procedure for removing bunions, which gets people up and walking sooner. Welcome to the program, Dr. Henrich.
Hey, thank you very much.
Tell us, define for us, what is a bunion and how do people get them?
Basically a bunion is a bony prominence or a protruding bone right behind your big toe joint. It is sometimes going to be unsightly. It can be large. It even can be somewhat small, but they kind of come in different shapes and sizes, mild to moderate and kind of moderate to severe. Most of the bunions people get are actually hereditary, believe it or not. They are something that gets passed onto the gene pool. People that are like 7, 8, 9, 10 years old can have them. I’ve even seen them come in when you’re 70, 80 years old.
But it’s mostly hereditary and people that get them, some people have pain, some people do not. It’s one of those things where people come to see me if they bother them quite a bit.
Right. If someone’s coming to you with a bunion, you take a look at their bunion, and then what are the next questions that you have for someone? If they say, “I want to get rid of this bunion. I’m tired of looking at it. I can’t wear the sandals I want to wear,” what is the discussion you have with a person?
Where I first go with that is I say, “How does this really affect your life? Does it affect you from the standpoint of what you wear, what you do for your job, what you do extracurricular activities, shoe gear? Where does it really hurt you? Where does it bother you?” If the person says, “Hey, it doesn’t really bother me much at all. I see it down there. What’s it doing?” I say, “Well, honestly, if it does not really bother you, I really tend not to fix it,” or to steer them in that direction because I hate to cause them more problems than what they’ve got.
Most people that I do see with a bunion does not need them fixed. But if they do need them fixed, we do have certainly surgical options for them to do.
You’re saying you really recommend fixing or operating on a bunion if it hurts the patient.
Correct. My favorite line, I guess, Carol is to say, if it hurts you more often than not, it affects what you do, it affects what you put on, or it affects your job, then it’s worth fixing it.
Okay. Let’s say you’re going to move forward with a patient and it is painful and it’s interfering with their life. What are the options for dealing… What do you say? Are you removing a bunion? Are you fixing a bunion? What is the terminology?
The terminology mostly is we are actually correcting the bunion. We’re trying to remove a bunion. We, first of all, have to take an x-ray. If they’re really serious about it, we start getting into taking x-ray and showing them the bunion. What we do is they say, “What does it look like?” We take them in front of an x-ray finder, a view finder, and say, “What is actually happening?” You have a difference in the different positions of the bones.
They called the metatarsal bones in relation to your phalanges, which is your toe bones themselves. I show them the structural change of the bones themselves, which are the metatarsals, and they start to spread out or splay out. And we say we have to kind of move them over. As I was saying before, sometimes you have like mild bunions, so you’re not going to get as much splaying of the bones. The more severe bones and bunions that you have slaying, then you have to cut the bone in different positions.
But all the cutting and the surgical discussion is based on what kind of a structural bunion that they really have.
Right. There’s different ways to approach it. Do you have different types of treatment to take care of the different types of bunions?
Sure. Some of the conservative things we talk about would be anti-inflammatories, making sure their shoes are not too pointy, watch out for seams in shoes, are they wearing tennis shoes, dress shoes, have a high heel. We approach it from that standpoint first. Sometimes we might try some anti-inflammatory medications. Sometimes even physical therapy, ultrasound, iontophoresis helps them out decrease the inflammation around that joint.
And if those things fail, they say they’ve tried that, or they want to try those sort of things, we institute those treatments. And if that doesn’t work, then we talk about some surgical correction if the conservative measures have failed.
Tell me about the different bunion procedures that you perform, including this newest 3D procedure.
There’s a lot of different procedures out there. Historically, as the decades have gone on, they’ve done a lot of engineering, a lot of design on different bunions from the mild to moderate, and then the moderate to severe. They’re what they call head procedures that you can do, which just involves the head or the bump of the bunion. And then now the newer procedures that I’ve been doing, which is a 3D type correctional bunionectomy, involves more of the base of the metatarsal, which is designed more for the moderate to severe bunion procedures that are out there.
What happens is, as the bunion advances, as the bones splay out more or spread out more, or the bunion gets more prominent or prevalent, the further down the bone, you have to cut it. And then that bone also gets what they call hypermobile. When it gets hypermobile, then you get more pain in the midfoot where the bone intersects with the midfoot. This new 3D correction of bunionectomy allows me to correct larger bunions.
What I heard about this procedure is that I think a lot of people when they think about bunion surgery, me included, is that I’ve heard that the recovery time is long and it’s hard and you’re off your foot for a long time. Is it correct that you’re up and moving with this new 3D procedure in the recovery phase? Tell me a little bit more about that.
Sure, I can tell you. I’ve been practicing for like 31, almost 32 years. I’ve been fixing this kind of bunion for that length of time, but this newer 3D correctional procedure has allowed us to get people up and moving a lot faster. The traditional way, when you take a joint apart, such as this what I’m talking about, when you fix this bunion, you had to stay non-weight bearing for six weeks, cast, crutches, and no weight. What happens now, Carol, is that you can fix this bunion and I can get you back on the foot in three days.
If I see you postoperatively in three days, if everything looks good, the incision looks good, minimal swelling, minimal discomfort, I will start you walking in an Aircast Walker, a cam boot of some sort, and then you’ll progress to weight-bearing over time. I traditionally, in my practice, I have you go 30% weight for two weeks, 60% weight from day 14 to day 30. And at day 30, if you’re doing well, I do 100% weight.
With the 3D procedure, you’re talking about people can be up and mobile much quicker. That’s like the biggest… Is the recovery time still the same though overall?
That’s a good question. What I tell people is, is that my old traditional way, if you think about it, six weeks, no weight makes your calf muscle atrophy, your bone density go down because you’re not using it. This procedure lets you get on your foot, so you don’t lose the bone density or bone mass as much. You keep the tensile strength in the bone going. As long as the hardware stays in place, you can kind of proceed and let the person keep progressing. I think it’s knocked off about four and to six weeks of the recovery time…
Oh, that’s terrific.
…and getting you back into a shoe. Traditionally, around three months getting you back into a shoe, two and a half months. Sometimes I have people back in eight weeks in a shoe at this point.
How long have you been doing this procedure and how have the results been for patients?
I’ve been doing this procedure about four years now and the results I think have been really quite excellent. I’m just even discovering all new little pearls about doing it all the time. I think obviously since the patients have been pretty positive about it, I’m actually doing it even more and more for patients because I think they want to get back to work quicker. Their expectations at work are like, “Hey, we got to get back to my job faster, or the person wants me back at my job.” I think this has kind of revolutionized some of their healing.
Yeah. What do some of the patients say to you after they get the procedure?
The patients say that there’s less swelling, less discomfort. They like the fact they can actually get on their foot and they don’t have to worry about the cast so much because the cast can cause problems in itself. Itching. It gets heavy. You can’t shower. You can bathe and shower much easier after this, because you can get your foot wet after like a week or so. They can massage their foot, which is also very therapeutic in getting your foot better, increasing circulation, and that kind of thing.
That’s terrific. Now, are you the only podiatrist in North Iowa doing this procedure?
As far as I know, Carol, I’m the only provider in North Iowa that does this procedure.
Well, that’s terrific. I think that’s giving new hope to people with bunions.
Mm-hmm (affirmative), I think so. I like to do them. I think it’s very fun. I think it’s very exciting, and I think this has kind of revolutionized my way of thinking, because I did a lot of stuff when I was trained a lot differently and now I’m kind of going to this and I think people are much happier. I think the other thing I like to tell you is that I’m even doing some older people I never would’ve actually done years ago.
I did a 78 year old patient two days ago, and she’s a very active 78 year old individual who likes to garden. She likes to walk. This bunion is really bothering her, but her bone density is pretty decent, so I thought we’re going to do it. She even calls us says she’s doing better already.
Oh wow! That’s terrific.
It’s like getting even my older or elderly population, my geriatric population, a chance of this when in the past, I never would’ve done that.
Dr. Henrich, if I’m understanding you correctly, bunions are elective surgery. Bunion surgery is elective.
Correct. Bunions are strictly elective as far as I’m concerned, unless sometimes you’ll see a bone coming through an ulceration, but that’s kind of more rare than common, especially in young people. I have the patient pretty much decide after our discussion if they want to do that or not. It’s strictly an elective basis.
What you’re saying is if patients don’t have… If they have pain, that’s a reason to have the surgery. But if they don’t have pain, there’s really no consequence for not getting their bunions fixed.
Correct. I mean, I don’t see any reason they should do it. Even though they have a large bunion, if there’s no pain in it, as long as they’re functioning, doing their job, doing activities that they want to do, extracurricular, work activities, or wearing what they want to wear, then I don’t recommend them doing it. I don’t think there’s any consequences if they don’t do it.
That’s terrific. If someone has a bunion, the first step is to call your office, right?
Call the office.
And then you will have a conversation and sort of determine the next steps.
Correct. You get x-rays, evaluate them, and then to see if even this newer procedure… Certainly some procedure would work for them, but this newer procedure, this 3D procedure, has been working for the more severe bunionectomies.
Great. Well, thank you so much for talking to us about this and thank you for being on the program..
Absolutely. Thank you much for having me. Thank you.
Thank you for listening to Mason City Docs On Call. For more episodes, go to mcclinic.com/radio-podcast.