Bunions and Hammertoes: When Should You Consider Operation?

by | Mar 7, 2018

Many problems go away on their own if you just relax and give them time. A cold, for example, generally passes within a couple of weeks whether you do much about it or not. A nice nap will fix a simple headache most of the time.

On the other hand, some problems will only get worse the longer you ignore them. The garbage isn’t going to take itself out. penalties pile up if you don’t pay your credit card bill. You can add bunions and hammertoes to progressive problems as well.

So, you know you must do something. But what?

Two Ways Forward

When it comes to bunions and hammertoes, there are two basic treatment paths to choose from. Each has their own complexities, of course. But the main fork is this: conservative treatment or surgery.

There are pros and cons to each option.

When it comes to conservative care, the advantage is obvious. No surgery means no downtime, no risk of complication, no risk of scarring. Treatments take effect immediately and won’t force you to skip work or take time away from your hobbies or activities.

The drawback is that conservative treatments are limited to symptom management only. They won’t make your bunion any smaller. They can only make it less painful or limiting, and slow the rate at which it progresses. Over the longer term, a permanent fix via surgery may ultimately be inevitable.

So, which should you choose? Let’s take a closer look at both options, then close with some general advice.

A Closer Look at Conservative Treatment Options

Conservative treatments are all about accommodation. They aren’t going to fix that bulging bunion or downturned digit. But maybe they can help the two of you—you and your bump—live together peacefully and painlessly. A while back we wrote a blog with tips for relieving bunion pain, most of which also apply to hammertoes and are worth repeating here.

Switch to roomier, more comfortable, better cushioned shoes in your day to day life. Tight shoes can create pressure and friction on the bunion, toe tip, or top knuckle. This can create corns, calluses, and blisters. It can also accelerate the rate at which the deformity worsens. Athletic shoes and even contoured sandals (not flip flops!) are usually good choices. Avoid high heels.

On top of this, we may recommend either commercially available or custom-made products used inside the shoe or directly on the feet. They may include:

  • Moleskin pads or cushions—always non-medicated—to defend an exposed bump, toe tip, or knuckle from excess friction.
  • Splints, straps, or tape to hold a misaligned toe in its correct position.
  • Orthotics to cushion, support, and reposition the entire foot. We use prefabricated orthotics as well as custom orthotics, which are fitted for you based on a mold of your feet. Whether you need one or the other depends on the situation.

We will also typically recommend toe exercises that you can perform at home. Although these exercises will not reverse a bunion or hammertoe that has already formed, they can relieve painful symptoms. Furthermore, by strengthening the supporting muscles and connective tissues surrounding your misaligned toe, you may slow down the rate of progression.

A Closer Look at Surgery

Surgical treatments are meant to fix a deformity and realign the structure of the foot, rather than simply accommodating it.

There is no one-size-fits-all surgical procedure to fix a bunion or hammertoe. The size and location of the incision, type of procedure, and techniques used can vary quite a bit based on your specific needs.

For example, one common surgical technique used in both bunion and hammertoe surgery is called an osteotomy. This is when individual bones are precisely cut, and small sections removed, so they can be realigned in the correction position. This is often accompanied by a transfer or reinforcement of surrounding tendons to help keep the realigned digit in place.

However, more serious deformities may require the bones to not only be repositioned, but one or more joints fused to prevent unstable, arthritis-causing motion. This is known as arthrodesis. And even within those categories, there are many different types and approaches.

Recovery time varies depending on the selected procedure. Hammertoe surgery recovery can be as short as a couple of weeks if the initial condition was mild. More extensive surgeries may take several weeks or even months for a full restoration of activity and function. That said, the clear majority of surgeries are successful and the result is typically more than worth the wait.

How to Choose One or the Other

So now that you know a little bit more about what both conservative and surgical treatments entail, we’ll give you our general guidelines for which to choose. This is, of course, no replacement for visiting our office and getting an in-person examination, but it can help you see the thought process.

What it really comes down to is how the bunion or hammertoe is affecting your life. Is the deformity causing daily pain? Is it making it more difficult—or even impossible—to work, play, or pursue your favorite activities? Is it becoming impossible to wear any shoes comfortably? If you answered these questions with a “yes,” surgery is more likely the best way to go.

But even then, we should still see surgery as a last resort. If you haven’t even tried conservative remedies yet, they may still help. Since conservative treatments can not only help with pain but also actually slow the rate at which the bunion or hammertoe worsens, it’s best not to wait until the situation becomes unbearable before you get help!

To summarize (and expand a bit), we’ll typically recommend conservative care if:

  • It’s your first visit, or there are viable conservative treatment options you haven’t tried yet.
  • Your deformity is only causing minor discomfort, rather than everyday pain and activity limitation.
  • Your hammertoe still has a flexible joint, rather than a rigid one.

Surgery is more likely the best way to go if:

  • Pain is a constant, daily problem that keeps you from what you love.
  • You’ve already tried the relevant conservative therapy options with limited success.
  • Your hammertoe is rigid.
  • The problem has recurred after a previous surgical correction.

We hope this clarifies your options for you! Again, if there’s one key takeaway you should remember from this entire blog, it’s that it’s never too early to seek help—even if you aren’t experiencing any pain yet. The sooner you come see us, the more effective options we’ll have to help you. The longer you wait, the greater your odds that surgery becomes inevitable.

To schedule an appointment, please contact Dr. Timothy Dailey at the Freeland Foot & Ankle Clinic at (989) 695-6788.

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