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Bunion Breakdown · Meaningful Medicine with Novant Health

• 0:04
  Joey Wahler (Host): There are very common, often painful conditions.
• 0:07
  We're discussing bunions.
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  Our guest is Dr.
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  Stuart Saunders, an orthopedic surgeon.
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  This is Meaningful Medicine, a Novant Health podcast, bringing you
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  access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
• 0:26
  decisions and build a healthier future.
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  Thanks so much for joining us.
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  I'm Joey Wahler.
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  Hi there, Dr.
• 0:31
  Saunders.
• 0:32
  Welcome.
• 0:33
  Stuart Saunders, MD: Hi there.
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  Thank you for having me.
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  Host: Great to have you aboard.
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  Appreciate the time.
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  So first, just about all of us, I think, have heard the word bunion.
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  But for those who may be unfamiliar, in a nutshell, what exactly is one,
• 0:46
  and how does it develop in the foot?
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  What causes it?
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  Stuart Saunders, MD: Sure.
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  So, it's a painful bump or prominence at the base of your big toe that
• 0:56
  slowly develops over time as the soft tissues around that joint
• 1:01
  loosen up and cause that toe to kind of turn towards your second toe.
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  Host: So, it's just the big toe then?
• 1:08
  Stuart Saunders, MD: Yes, sir.
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  Host: I did not know that.
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  All right.
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  I learned something already, and we're just seconds in here.
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  Excellent.
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  So, bunions apparently are far more common in women than men.
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  Do we know why that is?
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  Stuart Saunders, MD: Well, some of the beliefs to it being more common
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  in women is due to shoe wear, in terms of they're more common to wear narrow
• 1:28
  shoes, also higher heels, because the literature has shown that anything more
• 1:34
  than a two-and-a-quarter inch heel puts increased pressure on your foot and can
• 1:38
  increase your rate of causing a bunion.
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  Most men don't wear high heels.
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  Host: Interesting.
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  So, it's a difference in footwear, and you led me beautifully there into my
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  next question, namely, how much does our footwear in general contribute to
• 1:53
  developing bunions or avoiding them?
• 1:56
  Stuart Saunders, MD: So, it contributes a fair amount,
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  especially with tighter shoes, shoes that don't conform to your feet.
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  Anything that puts increased pressure or squeezes that portion
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  of the foot increases your risk of developing those bunions to occur.
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  Also, anything that has a higher heel will put increased pressure on the ball of
• 2:17
  your foot, and that can also contribute.
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  So, that's why we usually recommend that patients wear wider shoes
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  in terms of a wider toe box, more conforming, less of a heel, to try
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  to prevent these from developing.
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  Host: Gotcha.
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  So to be clear, Doc, are high heels and tighter shoes just making the problem
• 2:37
  worse or are they actually helping to cause a bunion in the first place?
• 2:41
  Stuart Saunders, MD: A little bit of both.
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  That's one of the things that we try to educate patients when we start
• 2:47
  to see that bunions have developed, that if they continue to wear tighter
• 2:52
  shoes, narrow shoes, higher heels, it's going to cause the progression of
• 2:56
  the bunion to go faster than if they did not wear those sorts of shoes.
• 3:00
  Bunions aren't just strictly related to shoe wear.
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  There are some of it's hereditary, in terms of someone else in the family
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  may have had them, passed them down.
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  You may have had prior injuries, things like that, that could have
• 3:11
  contributed to the development also.
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  Host: Yeah.
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  And so, to pick up on that point, we've covered footwear, but
• 3:17
  you mentioned genetics there.
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  Just how much of a factor is that if your parents or someone closely
• 3:24
  related has had bunion issues, how much more likely might you be to get it?
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  Stuart Saunders, MD: There's a higher likelihood that it can be
• 3:31
  passed down within your family.
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  You probably have an aunt or a grandmother or mother or something
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  of that nature who's had them.
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  Sometimes fathers, uncles have them.
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  They just usually don't complain about them or worry about them as much.
• 3:46
  Host: So if you're having a big family get-together and you're on the younger
• 3:49
  side, Doc, you may want to look around, especially if it's summer and people
• 3:54
  have their toes exposed, and you might be able to get a look at your future, huh?
• 3:58
  Stuart Saunders, MD: You sure can.
• 3:59
  Yes, sir.
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  Host: So besides genetics and shoes, any other risk factors here
• 4:05
  that people should be aware of?
• 4:07
  Stuart Saunders, MD: Sure.
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  So, there are some other risk factors for developing these bunions.
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  Some of them have to do with your foot shape, your foot mechanics.
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  Not to get super technical, but patients who have flatter feet or lower arches,
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  they put different stresses through their feet and the balls of their
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  feet, which can cause these to happen.
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  People who have more looseness to their joints can also cause this to happen just
• 4:30
  because those tissues aren't as tight.
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  People as well with inflammatory arthritis like rheumatoid or lupus are also at
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  increased risk of developing bunions, as well as people in the sports world
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  who have had prior turf toe injuries or that's where they've damaged ligaments
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  specifically to that big toe joint can also be predisposed to bunions.
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  Host: Gotcha.
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  Let me ask you one more thing about footwear.
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  You touched earlier on the width of a foot.
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  If you have a wider foot, I know I do, and so I can speak from
• 5:03
  experience that sometimes wider shoes, sneakers can be harder to find.
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  Fortunately, I have not had bunions, but am I more prone to getting one perhaps if
• 5:13
  I start wearing a shoe that's too narrow?
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  Stuart Saunders, MD: Potentially on how tight and conforming the material of
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  the shoe is, if you have wider feet, it can be harder to find because you
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  have a narrow heel and a wider foot.
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  And so, you want to find a shoe that fits appropriately, and
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  also conforms to your foot.
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  But yes, if you over time start wearing just more narrow and constrictive
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  shoes, it can potentially develop.
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  And so, that's where you may want to, you know, go to a place that has more
• 5:43
  shoe options, things of that nature to make sure you find the right fit.
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  Host: Gotcha.
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  I'm going to ask you about treatment here in a moment for
• 5:51
  bunions, but one more before that.
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  Are bunions typically purely cosmetic at first, just bumpy looking, et
• 5:59
  cetera, or should people even with mild symptoms consider seeing a specialist?
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  Where's the line when you know it's time to see someone professionally?
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  Stuart Saunders, MD: It really depends on your age and how
• 6:14
  much symptoms you're having.
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  Some patients have very small bunions but they're very
• 6:19
  symptomatic, they're very painful.
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  Some people have very large bunions and they aren't as symptomatic for them.
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  Some people develop bunions in their adolescence or early teenage years.
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  And so, it's just a matter of kind of how bad it's bothering you.
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  And it's never a bad idea to always come in and get checked out so we
• 6:39
  get more information on how to slow down the progression moving forwards.
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  Host: Absolutely.
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  Now, in terms of treatment, there's surgical and non-surgical.
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  Let's start with the latter first.
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  What conservative treatments, if you will, do you recommend
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  before considering surgery?
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  And how effective are they?
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  Stuart Saunders, MD: So in terms of effectiveness, once a
• 7:02
  bunion starts, it will progress.
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  We just can't know how quickly it will progress.
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  So, all these conservative treatments are more preventative to
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  try to slow down the progression.
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  And with that, that is making adjustments to your shoe wear,
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  which we've already touched on.
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  You can wear bunion spacers in your shoes to prevent how much pressure that
• 7:25
  big toe is putting on your second toe.
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  You can do taping or strapping for comfort.
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  I will say the devices that they sell online that say that they can
• 7:36
  realign or put you in a brace for your bunion, those are not effective.
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  They do straighten the toe while they're on.
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  But then, once you take it off, the toe will just drift back over.
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  And so, that's a little bit of an advertising or misadvertisement
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  in terms of bunion correction with that aspect of it.
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  Host: All right.
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  Great warning and advice indeed there.
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  So when surgery is needed, how do you determine if a patient
• 8:03
  qualifies for that, and what kind of a procedure are we talking about?
• 8:07
  Stuart Saunders, MD: Sure.
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  So first off, we determine how much pain they're having and how much it's
• 8:12
  affecting their daily activities.
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  Those are the big points that we look at and talk with the each patient
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  on a patient-by-patient basis.
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  The other things that we look for too is if they're starting to develop
• 8:23
  associated deformities of the adjacent toes, or they're starting to transfer
• 8:27
  their pressure or pain to different areas of their forefoot, that's where
• 8:32
  we'll, you know, talk to them more about potentially doing surgery because we
• 8:35
  know that it's progressing at that point.
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  Host: In that case, what kind of a procedure are we talking about?
• 8:42
  Stuart Saunders, MD: Sure.
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  And then, we're looking at doing procedures to correct the bunion,
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  either through soft tissue balancing or rebalancing, as well
• 8:51
  as bony work called osteotomies.
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  You can do those either through open procedures where we make a large open
• 8:59
  incision, or there are also newer procedures called minimally invasive or
• 9:04
  MIS surgery, where you're able to correct the surgery through smaller incisions.
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  Host: I'm going to ask you more about that in just a sec.
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  But first, to go back to something you mentioned a moment ago, you said if you
• 9:14
  have a bunion and it gets progressively worse, it can affect the adjacent toes.
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  So, how important is it because of that alone to get it
• 9:25
  addressed in a timely fashion?
• 9:27
  Stuart Saunders, MD: We take it a case-by-case basis.
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  Some patients we try to get to the surgery beforehand so that those hammer
• 9:34
  toes and things like that don't develop.
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  It also depends on what age and stage you are at life.
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  Some patients come in and, you know, they don't want to have surgery, so they talk
• 9:44
  to us about things that they can do to, you know, prevent their progression or
• 9:49
  things that they can do with shoe wear to, you know, decrease their pain or live with
• 9:54
  other deformities that have developed.
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  Host: And then, you mentioned a moment ago minimally invasive bunion surgery.
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  And so, what are the basic advantages there over the
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  more traditional open surgery?
• 10:07
  Stuart Saunders, MD: Sure.
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  So with the minimally invasive surgery, it's through smaller incisions.
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  Usually, it's three to four little poke hole incisions, which theoretically
• 10:17
  should reduce your pain as well as swelling and potentially increase
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  your recovery time and greatly reduce how much restricted weight
• 10:28
  bearing you have to be after surgery.
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  Host: And what kind of a recovery are we looking at in terms of time and
• 10:35
  physically what people can expect?
• 10:38
  Stuart Saunders, MD: So with any bunion surgery, we say it's going to
• 10:40
  take you three to six months to fully become comfortable on your foot again.
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  In terms of with open surgery, you usually are more limited in terms of
• 10:49
  your weight bearing at first, usually for a minimum of six weeks, versus the
• 10:54
  MIS surgery where, usually, you may be able to walk right away afterwards.
• 10:59
  On more average, we're seeing that patients are limited weight bearing
• 11:02
  for closer to anywhere from two to four weeks, and then allowed to start kind of
• 11:06
  ramping up their recovery at that point
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  Host: And then, in summary here, Doctor, what's your overall message, generally
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  speaking, to those joining us about the prospect of successfully addressing
• 11:19
  their bunion issue if they have one?
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  Naturally, every case is different, but in general.
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  Stuart Saunders, MD: The biggest thing would just be if you have
• 11:28
  questions, seek a provider that you feel comfortable with to be able to
• 11:32
  answer those questions about how to best manage your bunion moving forwards.
• 11:38
  Host: And then, you would say there's a pretty good chance that in some
• 11:41
  form or fashion their bunion can be addressed in a positive manner, yes?
• 11:46
  Stuart Saunders, MD: Yes, sir.
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  Either with or without surgery.
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  You know, of course, no surgery is 100% guarantee.
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  But the goal of surgery is to be able to get you back pain-free to
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  be able to do the things you want to do and not have to worry about the
• 11:59
  bunion still being painful for you.
• 12:02
  Host: Absolutely.
• 12:03
  Well, folks, we trust you are now more familiar with bunions.
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  Dr.
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  Saunders, keep up all your great work.
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  Thanks so much again.
• 12:10
  Stuart Saunders, MD: Thank you.
• 12:11
  Host: And to find a physician, please visit novanthealth.org.
• 12:15
  For more health and wellness information from our experts,
• 12:18
  please visit healthyheadlines.org.
• 12:21
  If you found this podcast helpful, please do share it on your social media.
• 12:25
  I'm Joey Wahler.
• 12:26
  Thanks again for being part of Meaningful Medicine, a Novant Health podcast.