Choose Your Podiatrist Wisely!
odiatrists Dr. Mark Reed and Dr. Melanie Reed have performed thousands of bunion corrections over 25 years in being in practice. The Foot Doctors specialized in Cosmetic Bunion Surgery with the emphasis of crating beautiful feet while minimizing the pain associated with these procedures from 25 plus years of innovations and advanced techniques that come with being a meticulous surgeon. Both Podiatrists are board certified by the American Board of Foot and Ankle Surgery. The Podiatrists also trained at USC Medical Center and completed a combined residency UCSF and San Francisco VA Medical Center -- considered the top podiatry residency in the United States. As a patient considering bunion surgery, you will not find more compassionate, personal, credentialed, or experienced Podiatrists in the area period.
Dr. Mark Reed and Dr. Melanie Reed have seen many complications from young new Podiatrists who have moved into the area with many fake five star reviews who are aggressively pushing surgery with little experience and are not board certified by the American Board of Foot and Ankle Surgery. Patients need to understand each bunion surgery must be tailored to your unique anatomical requirements that comes with 25 years of experience.
In selecting a Podiatrist to do your bunion surgery, experience and being Board Certified by the American Board of Foot and Ankle Surgery should be a major consideration. Over the last 25 years, the Podiatrists continue to see many gimmicks on the internet including later bunion surgery, painless bunion surgery, minimal incision bunion surgery, and other attempts to create false expectations to sell surgery. In complete contrast, Dr. Mark Reed and Dr. Melanie Reed emphasize a conservative approach to bunion treatment by assessing the severity of the bunion on an annual basis with X-ray evaluation and working on trying to slow the progression of the bunion deformity using toe spacers, custom molded foot orthotics and motion control running shoes to name a few interventions. Bunion surgery is scheduled when there is pain, arthritic degeneration forming in the joint or the patient has a strong preference to correct the unsightly deformity with the timing based on what would be optimal for the patient's work and family priorities. There are many patients who have bunions that are the patients of both Podiatrists that have not seen their bunions increase in many years with conservative intervention. Other patients, based on their annual X-rays are not so fortunate and these patients are encouraged to consider surgery based a six month to year window to find the most optimal time for recovery and the least impact on their schedules. Rarely is there ever a reason to rush into bunion surgery considering most patients have lived with the condition for many years.
Bunion Deformity - A Complex Deformity
The history of bunions has been discussed in the medical podiatry literature for more than 100 years. The term "bunion" is derived from the Latin word for turnip. Bunions usually occur on both feet with one foot usually worse than the other. In western countries, bunions occur more in women due to the type of shoes women wear. In countries where men and women do not wear shoes, the incidence of bunions in men and women has been found to be the same. However, the person's inherited or developed tendency to walk flat- footed has been shown to be the primary cause of bunion deformities. In rare circumstances, neurological disorders, rheumatoid arthritis, and developmental deformities can also cause a bunion deformity.
Evaluation of a bunion
deformity begins with obtaining a complete history and physical
as well as obtaining X-rays of both feet. Typically, as a bunion
deformity progresses, calluses form under the ball of the foot,
a reddened area appears over the prominent first metatarsal head,
lesser toe deformities appear, shoes no longer fit properly,
degenerative arthritic joint changes occur and the cosmetic appearance
of the foot deteriorates.
Treatment of a bunion
deformity primarily involves two issues, correcting the underlying
cause of the bunion deformity, and when required, surgically
realigning the bunion deformity. In cases where the bunion
deformity is mild to moderate and the patient is not in pain,
custom molded foot orthotics are prescribed to help correct the
weight bearing forces which usually cause the bunion deformity.
realignment of a bunion deformity consists of a realignment of
the great toe and first metatarsal. In some cases where
arthritic joint degeneration has occurred, besides realigning
the joint deformity, the joint must also be fused or artificially
replaced. A bunion deformity actually involves two unique
deformities. The first is the widening of the knuckle joint of
the great toe from the knuckle joint of the second toe and is
called Metatarsus Premus Adductus. Metatarsus Premus Adductus
is measured by measuring the angle created by drawing a bisection
of the first and second metatarsal bones on a weight-bearing
AP X-ray. The angle of the first metatarsal to the second
metatarsal is called the 1-2 Inter-metatarsal Angle and usually
is normal if under 10 degrees. The second deformity is
the rotation of the great toe towards the second toe that is
called the Hallux Abductovalgus Deformity.
In evaluating a patient
for surgical correction of their bunion deformity, ultimately,
the different causes of the patient's Metatarsus Premus Adductus
and Abductovalgus Deformity must be determined by the surgeon.
Usually, the cause of the bunion deformity is solely due
to widening of the first metatarsal away from other metatarsals.
However, there are many anatomical reasons that a bunion
deformity can be in existence and this is why a foot specialist
should evaluate a bunion deformity prior to surgery. In
correcting a bunion deformity, some doctors still cut off a portion
of the knuckle joint of the great toe to narrow the appearance
of the foot but do not realign the knuckle joint of the great
toe. This type of narrowing procedure typically severely
narrows the knuckle joint of the great toe and has been associated
with numerous complications such as early degenerative joint
arthritis. Typically, these narrowing procedures are temporary
in giving any relief to the patient and other surgical procedures
must be performed subsequently to realign the knuckle joint of
the great toe. A second opinion should be obtained from
a foot specialist if a doctor recommends a narrowing procedure
that intends to narrow the knuckle joint of the great toe without
realignment of the joint.
In discussing recovery
expectations, in the hands of a good foot surgeon, for the patient
with a mild to moderate bunion deformity that involves only the
widening of the first metatarsal compared to the second metatarsal,
the patient will have usually a two to four week recovery period
before returning to shoes and can walk on the foot during recovery.
For the patient with a severe bunion deformity that involves
only the widening of the first metatarsal from the second metatarsal,
surgery usually involves an eight to ten week period in which
no weight bearing can occur.
In making a pre-operative
evaluation of the patient, weight bearing X-rays must be evaluated
to determine he appropriate procedures that need to be performed.
The amount of angle between the first and second metatarsal
is one of the main factors in determining which type of procedure
is indicated and how much recovery time will be experienced by
the patient. The angle between the first and second metatarsals
is important because there is a point that the first metatarsal
head can not be sided back gains the second metatarsal. When
the first metatarsal is too wide to slide it over against the
second metatarsal, a wedge procedure must be performed to swing
the metatarsal over far enough to move the first metatarsal head
against the second metatarsal head. In evaluating X-rays, there
are actually 11 other X-ray measurements that are typically evaluated
in deciding what is the correct procedure for correcting a bunion
Early medical intervention
using custom molded functional foot orthotics, silicone toe spacers, and motion control running shoes can in many cases
prevent bunion surgery or slow the progression of the deformity for a lifetime.
The use of foot orthotics after bunion surgery is important in
preventing the return of the bunion deformity because the surgery only realigns the joint back next to the second metatarsal and does not actually correct the underlying cause of the bunion in how your naturally walk. Please review
the foot orthotic article for information on foot orthotics. The use of a silicon toe spacer reduces stress to the ligaments
of the joint and in many cases can return the patient to a pain free joint unless there is significant arthritic degeneration in the joint.
The best approach in
deciding what to do about a developing bunion is to get an X-ray
early in the progression of the deformity to gain an understanding
of what is the best intervention to either prevent the deformity
from increasing in severity. When there is pain, arthritic degenerative changes or a deformity that is progressing in severity, surgery should be considered but only after conservative interventions have been utilized.