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Facebook Live: Geoff Watson, M.D. on Bunions and Hammertoes

Dr. Watson, a lot of people don’t realize that here at Bone and Joint Institute, we deal with foot and ankle conditions – is that correct?


That is very true. Foot and ankle conditions are actually one of the primary things that I treat. I went through medical school, orthopaedic residency, and then did a one-year foot and ankle fellowship. This would be everything from bunions and hammertoes, to Achilles tendons, even ankle arthritis – so a wide variety of foot and ankle issues.


Today specifically we’re going to talk about bunions and hammertoes, so what are those?


A bunion is essentially a crooked big toe. It will create a bump on your big toe, which is where most people typically have pain. That’s why you typically adjust your shoes, or consider surgical options, if necessary. A hammertoe is essentially a toe that will hammer, and flex upward, creating an irritation of the knuckle. 


How do you treat bunions and hammertoes? 


We always try the simple things first. Whether that be toe spacers, shoes that have a wider toe box, or space for the toes – that’s always the first recommended treatment to see if we can get you by without surgery. Sometimes they’re not the cutest shoes, but that’s certainly something that we try. For hammertoe specifically, there’s a few devices that will help to pull your toe down. So, if your toe is pretty flexible that typically helps. There’s something that’s called a boot splint or a toe crest – those can help. There’s also sleeves that can go over the toe. Essentially, there is a wide array of non-surgical treatment. 


Sometimes the simple things don’t always work. Can you tell me what bunion and hammertoe surgery looks like? 


When to do it is primarily driven by pain. Does it affect your lifestyle? Does it affect you wanting to get up and walk around? Are you not doing those things because of this? That is kind of when you start to enter the surgical world. There’s over 150 described procedures for bunions. There are also newer ways of fixing bunions too. Currently, there are bunion procedures where you can walk on it immediately afterwards, but there are also some where you cannot. That is also part of what depends on the goals that we’re trying to accomplish. It can often be a misconception with some of these procedures that you would have to be off your feet for months. For some of the larger bunions, those would usually be about six weeks non weight-bearing, but that’s really the most that you would see. We have a couple of bunion surgeries where we can put you on your feet the same day, so that’s a big deal. Time off of work, time not doing the things that you want to do – time is really important to getting you back to your daily life. A lot of the time we’re doing bunion and hammertoe surgery in conjunction with each other. Usually the bunion is sort of the driver of that. Hammertoe surgery is usually a way of straightening the toe. A lot of the time we’ll have to do some tendon work as well to keep that toe from riding up or elevating. We can stabilize that with pins, or screws, or there’s even hammertoe devices that can help. That is usually something that you can put weight on immediately afterwards as well. 


Here at the Bone and Joint Institute, we try to be on the forefront of technology, and that goes for surgery as well. Is there any kind of advanced technology, whether that’s actual technology or techniques, that we use here? 


A big trend in foot and ankle right now is minimally invasive bunion surgery. Any time that we can look at more ways to correct things with smaller incisions, less scarring, that is ideal. In fact, scarring is the number one complication of bunion surgery. So, to get people moving with less scar tissue issues is one of our goals. One company has developed a burr, which is a thing that cuts bone, but does not cut the soft tissues like tendons or nerves. That is a very nice instrument. By doing this, you can just make a few small puncture holes to correct a bunion. That is also a stable way to fix a bunion that would allow you to walk on it immediately afterwards. There are some very promising results from the first iteration of the study. I’m looking forward to learning more about it, and hopefully implementing it in my practice within the next couple of months. 


We have a great physical therapy and Rehabilitation Services department here at Bone and Joint Institute. Is rehab or physical therapy something that you would encourage to help after foot surgery typically?


It depends. Stiffness is the number one complication, so if we have any hint of stiffness, we’re going to get you into therapy. They do a great job of pushing people along to get their motion back. Especially people who like to do a lot of activity, running, jumping – they really need that flexibility in order to get back to their activities. Therapy can help get you there. 


What tips would you have for someone who thinks that they’re starting to get a bunion or a hammertoe? Is there anything that they can do to prevent or slow the progression of that? 


Prophylaxis is an interesting concept. The biggest thing is going to be shoewear. Shoes with a wedge, narrow shoes, those tend to be the ones that drive the issues. That’s not to say that you can’t wear it before or after surgery. However, that’s one of those things that if you can modify it, that’s great. Sometimes genetics play a big role too. You can go look at mom or dad’s feet, or grandma’s feet, and you can kind of tell where you might be headed. There’s also a question about when to fix the bunion problem. Do you want to fix it when it’s moderate, or when it’s more severe and causing more issues? As you move along, the surgery becomes more time-consuming in terms of recovery, so there’s some element where you might want to get to it before it becomes significant. 


Bone and Joint offers comprehensive care. Can you explain that, and can you help us understand how that helps the patient experience from start to finish? 


It’s really driven by a team effort. We have therapy, we have a relationship with athletic trainers from Williamson Medical Center, and we have individual practices that cater more towards hip and knee, shoulder and elbow, foot and ankle, hand and wrist, or spine – that combination of collegial work effort is the best thing about this practice, and I think very unique to Bone and Joint. 

 

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