Bunions:

One of the most common procedures that I perform in my practice is bunion corrective surgery. A bunion occurs when the long bone behind the great toe (called a metatarsal bone) starts to shift out of place and move away from the rest of the metatarsal bones. As this occurs, the great toe starts to shift towards the second toe and a visible bump develops. As the bunion gets bigger, so does the bump. This can cause pain with shoes and can also cause pain in the joint between the toe and the metatarsal bone. 

Bunions are a structural deformity meaning that they can only be repaired via surgical repositioning of the metatarsal bone back to its proper alignment . In some cases, surgery may involve cutting the metatarsal bone, shifting it back into place and then holding the bone cut with some type of fixation device such as a screw or a staple. In other cases, the correction may require fusing a joint.  

In either instance, it takes approximately 6-8 weeks for the bone to heal or the joint to fuse sufficiently to allow return to regular shoes. Depending on the procedure, weight bearing on the surgical limb may or may not be allowed during this time. And once the bone is healed, there may still be some amount of swelling that will take additional time to go down. 

Generally, I recommend that patients allow 8-12 weeks recovery before resuming more high impact or aggressive exercise activities.  

Hammertoes:

Hammertoes occur when one or more of the toes starts to contract (deform) causing the toe to rub inside of a shoe and cause pain. Commonly, calluses will develop on the toe joints or under the ball of the foot and these can increase the amount of discomfort the patient experiences.   

Like bunions, hammertoes are a structural deformity meaning that the only way to correct them is through outpatient surgery. This may involve removing a small piece of a phalanx bone (one of the small bones in the toe) to allow the bone to sit in front of one another rather than piling on top of each other. In some instances, it may involve fusing two of the phalanx bones together in a straightened position with either an implanted device or with a wire that sticks out of the end of the toe while the bones are fusing together. Additionally, the metatarsal bone (the long bone that sits behind the toe) may need to be cut and shortened, necessitating additional fixation, usually in the form of a screw to hold the bone together while it heals. 

Recovery is generally 4-6 weeks for bone healing, and I generally will allow patients to be weight bearing in a special boot that protects the foot and keeps pressure away from the bones that are healing. Once the patient is healed enough to go back into regular shoes, they may do so, though swelling in the toes may persist for several weeks (sometimes several months) after surgery. However, this does not mean that regular activities are prohibited. Generally, I do recommend that patients allow at least 8 weeks recovery before resuming higher impact activities, especially if metatarsal work is involved. 

Posterior Heel Spurs/Achilles Tendinitis:

The Achilles tendon is the very large and strong tendon in the back of the leg that inserts into the heel bone. It lifts the heel off the ground when we walk and is made up of the tendons from the calf muscles. If the Achilles tendon is very tight, it can exert a constant pulling on the back of the heel bone where it inserts, and this can cause a spur to form and can also cause the tendon to become inflamed and painful. The spur itself lives inside of the tendon which can irritate the tendon and even cause damage to it. It also can become a physical prominence that can make walking or wearing shoes painful and can even cause pain just by resting the back of the heel on something (think footrest of a recliner).

When necessary, I will remove the spur. To do this, the Achilles is at least partially removed from the heel bone, the spur is shaved down, the Achilles tendon is repaired as needed and then reattached to the heel bone with strong anchors. Usually, I will also perform a procedure in the back of the leg to help relax the Achilles tendon so that a new spur does not form later.  

Following surgery, patients are non-weight bearing in a special boot for three weeks then weight bearing is increased over an additional three weeks in the boot to full weight bearing after which the patient is allowed to return to shoes. While the return to weight bearing and shoes is a short time, getting back to normal strength and gait can take a year. So, patients need to be well-prepared for this.

Midfoot Spurring:

This is something that I see frequently in my high-arched patients and is a more common complaint in the fall when we trade in sandals for regular shoes. This is when a bone protrusion develops on the top of the foot where the arch is highest and most pronounced. Lace up shoes cause pain as they press down on not only the spur but also on a nerve that runs across the spur, resulting in sharp, aching, burning pain and even numbness which can radiate down to the toes. 

Because it is a physical abnormality of the bone, I will often remove it. This is an outpatient procedure and involves shaving the spur down, smoothing out the surrounding bone and decompressing the nerve to prevent further irritation or damage. 

The recovery is not long, with patients allowed full weight bearing in a post operative shoe. After approximately 2 weeks, sutures come out and the patient is returned to regular shoes as tolerated. There may be some residual tingling or even numbness in the top of the foot but this resolves on its own. 

Tailor’s Bunions (Bunionettes):

A tailor’s bunion is a bunion that occurs on the pinky-toe side of the foot . Like a traditional bunion, the metatarsal bone behind the little toe starts to move away from the rest of the metatarsals and oftentimes also moves downward toward the ground more. As it moves outwards, the fifth toe will rotate inwards towards the fourth toe. It is not uncommon for a mass to form under the bone which usually turns out to be an inflamed nerve. 

Surgery to fix this problem may involve cutting and shifting the bone back to where it is almost parallel with the fourth metatarsal bone. If there is a mass that is readily identifiable under the metatarsal, this will be removed as well. The fifth toe is also properly realigned in front of the metatarsal bone.

Patients are allowed to be weight bearing in a post operative boot that keeps pressure back onto the heel. Recovery is usually about 6 weeks for the bone to heal and for the patient to be allowed back into regular shoes. Swelling will take additional time to resolve.

I generally recommend at least 8 weeks recovery before returning to more high impact or aggressive exercise activities. 

Ankle stabilization:

We have all sprained our ankles at one time or another. Usually, it is a mild injury, and we recover from it quickly and with little long-term disability. However, when an ankle injury is more severe and the stabilizing ligaments no longer work properly, chronic pain, instability and recurrent injury occurs. Although physical therapy can help significantly with restoring function, sometimes surgical intervention in the form of stabilizing the ankle is needed. This is essentially where the ankle joint capsule (the dense tissue that surrounds the joint and helps maintain its function) is tightened so that the ankle will no longer roll easily, improving function, preventing recurrent injury and resolving pain. If there is damage to one or more of the surrounding tendons, those are repaired as well.

Generally, I will have patients non-weight bearing for 2-3 weeks after surgery in a post operative boot, followed by 3 weeks of gradual protected weightbearing and then back into regular shoes in 5-6 weeks. Return to full pre-injury activity level can be as early as 12 weeks but is patient dependent.