Bunion surgeries fall into two major categories:

• Head procedures that treat the big toe joint. In a head procedure bunionectomy, the bone is cut just behind the joint, moved into its proper position, and fixed in place with a screw or pin. Head procedures are often used for patients who cannot be immobilized for long periods of time.
• Base procedures concentrate on the bone near or behind the big toe joint. Different types of base procedures are conducted depending on the nature of the deformity. These range from cutting a wedge out of the bone and splitting it so that it can be moved into its proper position; making a semi-circular cut and rotating the bone into its correct position; or fusing the joint. Ligaments inside and outside the toe may also be treated during a base procedure.

There are three important factors that impact the success of bunion surgery:

1. Choose a surgeon with extensive experience with bunionectomies. Because a deep understanding of the biomechanics of each patient’s foot as well as the intricacies of each surgical option is needed, surgeons with more experience at doing bunionectomies are better able to help each patient achieve the best outcome.
2. Be realistic in your expectation about what a bunionectomy can accomplish. No physician can guarantee that a bunion won’t recur or that a patient will be absolutely pain free. Additionally, because of the complexity of the foot structures impacted by a bunion, patients may never be able to wear normal or slender shoes. Bunion surgery can reduce or eliminate the bone deformity, improve foot alignment and function, and prevent damage to other toes, but it does have its limitations. Be sure you understand all the possibilities before opting for this surgery.
3. Bunion surgery is not a magic bullet.  Surgery alone may not be all that is needed to achieve your best outcome. After surgery, many patients experience long healing and recovery times and often have to spend time in physical therapy. Additionally, you may need a corrective orthotic device on an ongoing basis.

What To Expect

Most bunions surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.

Prior to the surgery, patients will need to make some preparatory arrangements. These include:

• Seeing your Primary Care Physician (PCP) to make sure any other health conditions are stabilized prior to surgery and to document your complete medical history, which can then be given to the foot surgeon.
• Arranging your schedule to make sure you don’t need to take any long trips for at least two to three weeks following the surgery.
• Lining up another person to drive you home and stay with you for the first 24 hours after the surgery.
• Stopping the use of any anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen, for five to seven days before the surgery.

The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.

Bunion surgery is usually performed with a local anesthetic and is administered by an anesthesiologist. This may be combined with sedation medication to put you into “twilight” so that you are fully relaxed. After the surgery, patients are often given a long-acting anesthetic and pain medication, which is why someone else must drive the patient home.

The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Some patients, particularly those having base procedures, may have to use crutches; others may be sent home wearing a surgical shoe. The foot will be covered in a dressing, which you will need to keep dry for up to two weeks or until the sutures are removed.

During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to reduce swelling. Limited ambulation or walking is required over the first two weeks to promote healing. Most patients also are instructed on some basic exercises that need to be performed daily.

Sutures are generally removed about two weeks after the surgery in the doctor’s office. Once the sutures are removed, you can bathe and shower normally, but will still need to wear a dressing over the wound to keep it clean and prevent infection.

By the third or fourth week post surgery, swelling generally subsides enough for the patient to begin wearing a wide athletic shoe. It is important to continue daily exercises. If recommended, physical therapy may be initiated at this time. Once the wound has completely closed, you can use lotions to soften the skin in the surgical area.

By week five after the surgery, you will be able to walk short distances and do mild fitness activities. Continue following your surgeons instructions for increasing exercise and activities until you are back to normal.

Ankle surgeries emphasize the realignment of the structure either around or after removal of the deformity. Various kinds of internal and external fixation devices—some temporary, others permanent—are often required to maintain the appropriate alignment during, and beyond, the healing process.

Ankle surgeries vary in complexity, length, and severity, yet many of them today are conducted on a same-day, outpatient basis. Patients need to arrange for another person to take them home afterwards and stay with them for the first 24 hours following the surgery. Post-operative instructions, provided by your surgeon, will give you the information needed to care for your recovering ankle following surgery.

Bunion surgeries fall into two major categories:

• Head procedures that treat the big toe joint. In a head procedure bunionectomy, the bone is cut just behind the joint, moved into its proper position, and fixed in place with a screw or pin. Head procedures are often used for patients who cannot be immobilized for long periods of time.
• Base procedures concentrate on the bone near or behind the big toe joint. Different types of base procedures are conducted depending on the nature of the deformity. These range from cutting a wedge out of the bone and splitting it so that it can be moved into its proper position; making a semi-circular cut and rotating the bone into its correct position; or fusing the joint. Ligaments inside and outside the toe may also be treated during a base procedure.

There are three important factors that impact the success of bunion surgery:

1. Choose a surgeon with extensive experience with bunionectomies. Because a deep understanding of the biomechanics of each patient’s foot as well as the intricacies of each surgical option is needed, surgeons with more experience at doing bunionectomies are better able to help each patient achieve the best outcome.
2. Be realistic in your expectation about what a bunionectomy can accomplish. No physician can guarantee that a bunion won’t recur or that a patient will be absolutely pain free. Additionally, because of the complexity of the foot structures impacted by a bunion, patients may never be able to wear normal or slender shoes. Bunion surgery can reduce or eliminate the bone deformity, improve foot alignment and function, and prevent damage to other toes, but it does have its limitations. Be sure you understand all the possibilities before opting for this surgery.
3. Bunion surgery is not a magic bullet.  Surgery alone may not be all that is needed to achieve your best outcome. After surgery, many patients experience long healing and recovery times and often have to spend time in physical therapy. Additionally, you may need a corrective orthotic device on an ongoing basis.

What To Expect

Most bunions surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.

Prior to the surgery, patients will need to make some preparatory arrangements. These include:

• Seeing your Primary Care Physician (PCP) to make sure any other health conditions are stabilized prior to surgery and to document your complete medical history, which can then be given to the foot surgeon.
• Arranging your schedule to make sure you don’t need to take any long trips for at least two to three weeks following the surgery.
• Lining up another person to drive you home and stay with you for the first 24 hours after the surgery.
• Stopping the use of any anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen, for five to seven days before the surgery.

The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.

Bunion surgery is usually performed with a local anesthetic and is administered by an anesthesiologist. This may be combined with sedation medication to put you into “twilight” so that you are fully relaxed. After the surgery, patients are often given a long-acting anesthetic and pain medication, which is why someone else must drive the patient home.

The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Some patients, particularly those having base procedures, may have to use crutches; others may be sent home wearing a surgical shoe. The foot will be covered in a dressing, which you will need to keep dry for up to two weeks or until the sutures are removed.

During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to reduce swelling. Limited ambulation or walking is required over the first two weeks to promote healing. Most patients also are instructed on some basic exercises that need to be performed daily.

Sutures are generally removed about two weeks after the surgery in the doctor’s office. Once the sutures are removed, you can bathe and shower normally, but will still need to wear a dressing over the wound to keep it clean and prevent infection.

By the third or fourth week post surgery, swelling generally subsides enough for the patient to begin wearing a wide athletic shoe. It is important to continue daily exercises. If recommended, physical therapy may be initiated at this time. Once the wound has completely closed, you can use lotions to soften the skin in the surgical area.

By week five after the surgery, you will be able to walk short distances and do mild fitness activities. Continue following your surgeons instructions for increasing exercise and activities until you are back to normal.

Nerve Damage
Nerve damage, called Diabetic Neuropathy, can cause lack of feeling (pain, heat, cold) in the feet. This is dangerous because a diabetic may not feel a small cut or blister. The sore may get worse or infected because they are unaware that it is even there.

Poor Blood Flow
Poor blood flow is called Peripheral Vascular Disease (PVD). In a diabetic person the blood flow to legs and feet is reduced, making it harder for a sore to heal or for an infection to clear up. Diabetics who smoke have even more problems with PVD than non-smokers.

Foot Care
When a person has diabetes it is essential to have their feet checked by a health care provider at least once a year. (The feet should be checked more often if the person is experiencing foot problems.) A health care provider should be contacted if a diabetic notices cuts or breaks in the skin, ingrown nails, or noticeable changes in their feet. The health care provider should be the one to trim any corns or calluses.

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Most people are concerned about the health and appearance of their feet during the summer months, but by the time winter rolls around, feet are all but forgotten, shoved back into boots and heavy sneakers. We should be vigilant about foot care during the colder months, when falling temperatures, drier air, ice and snow and closed-toe shoes can contribute to foot problems. Here are some tips to keep you on your feet this winter:

1. Invest in some good shoes. Trying to put thick socks into thin summer sneakers isn’t the way to go. Good winter shoe should be waterproof, have enough room to fit two pairs of socks to insulate feet and prevent moisture buildup, and have a gripping sole to prevent slips and falls. For men and women who wear shoes that can easily get ruined in the wet, slushy streets of NYC, buy overshoes that can be slipped on over dress shoes as a way of keeping feet dry and warm and improving traction.
2. When purchasing socks, one pair should be a light synthetic ‘wick’ sock, to transfer moisture to a thicker wool outer sock, where it is absorbed and evaporated to the outside. Cotton socks absorb moisture and make for a soggy environment, which ultimately makes the feet cold and wet and sets them up for frostbite and athletes foot. Cotton socks are a great alternative to change into once in a warm, dry environment.
3. Lets try to keep our feet looking great, even though they are covered up most of the time in the colder months. Keeping toenails trimmed to avoid ingrown toenails, and to keep slathering on the lotion to avoid painful superficial and/or deep skin fissuring. Feet tend to dry out in the winter, which can cause cracks and peeling, so use a hypoallergenic lotion at least once a day to prevent irritation or infection from dry skin.
4. Watch your step when walking and keep an eye out on the streets, because cold weather leads to slippery surfaces and cracks in the sidewalk. Clear pavement can be covered in ice which you may not be able to see, so you need to pay attention, because a good shoe alone won’t be able to protect you.
5. Don’t make quick, sudden moves on slippery surfaces. Even if you don’t fall, you could pull or tear something, which may cause a foot or ankle sprain or strain. This can take weeks, or even months to heal, which makes for a not so happy winter.
6. Even we don’t see dramatically cold weather in NYC like some of our neighboring northern states, try not to stay out in the cold for too long. This can lead to numbness and pain in the toes and feet, which could mean the beginnings of frostbite. If this occurs, start by applying a warm towel and water to the affected area at the first sign of numbness, then seek a doctor’s care immediately to be sure to prevent any irreversible tissue damage.

If you are suffering from a bunion, the doctors of Hamilton Podiatry, with offices on the upper east side of Manhattan and Bay Ridge, Brooklyn want you to know the facts before you decide whether to have bunion surgery or treat it with other methods.  If you have questions after reading this helpful article, please call us at (212) 570-9300.

What is a Bunion?

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Valgus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoe.

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain.

Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.

Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

• Protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems.
• Removal of corns and calluses on the foot.
• Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth.
• Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.
• Exercises to maintain joint mobility and prevent stiffness or arthritis.
• Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.

Bunion Surgery

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

This valuable resource consists of the following top-level categories that then drill down to more detailed sections: What is a Podiatrist?, When To Call a Doctor, Foot Anatomy, Foot and Ankle Problems, Basic Foot Care Guidelines, EPAT: Extracorporeal Pulse Activated Technology, Foot Problems, Medical Care, Fitness and Your Feet, Shoes, and Links.

Hamilton Podiatry’s doctors, Dr. William Spielfogel, and Dr. Josephine Kleyner are very excited to offer this service to their patients.

Dr. William Spielfogel is a published author of several scientific papers and chapters in medical textbooks. He co-chairs the New York State Podiatric Medical Association’s clinical conference in New York City, which provides continuing medical education in foot and ankle surgery and medicine to over 1,000 podiatrists annually. Dr. Spielfogel has also been a lecturer at several national scientific meetings.

Dr. Josephine Kleyner is an experienced foot doctor and skilled surgeon, who has extensive training in all facets of podiatric surgery and medicine. She completed an intensive three-year Podiatric Medicine and Surgery residency program at both New York Methodist Hospital in Brooklyn NY, and New York Downtown Hospital in lower Manhattan, where she served as Chief Resident. Dr. Kleyner attended the New York College of Podiatric Medicine where she earned her Doctorate in Podiatric Medicine and received her Bachelor of Science degree from Stonybrook University. Only daughter to immigrant parents from Ukraine, she is fluent in Russian.

Hamilton Podiatry, with offices of Podiatric Medicine and Surgery located on the Upper East Side of Manhattan, New York City and in Bay Ridge, Brooklyn, are dedicated to using the most advanced technology to deliver expert foot care. Their goal is to educate each patient and begin a treatment program with the highest quality of care. Whatever the foot and ankle problem, our podiatrists and staff will work together with patients to find the answer that will provide comfort and bring relief.

Contact:
Dr. William Spielfogel
Hamilton Podiatry
wspielfogel@aol.com
(718) 680-6276

Hamilton Podiatry’s doctors, Dr. William Spielfogel, and Dr. Josephine Kleyner are very excited to offer this advice.

Dr. William Spielfogel is a published author of several scientific papers and chapters in medical textbooks. He co-chairs the New York State Podiatric Medical Association’s clinical conference in New York City, which provides continuing medical education in foot and ankle surgery and medicine to over 1,000 podiatrists annually. Dr. Spielfogel has also been a lecturer at several national scientific meetings.

Dr. Josephine Kleyner is an experienced foot doctor and skilled surgeon, who has extensive training in all facets of podiatric surgery and medicine. She completed an intensive three-year Podiatric Medicine and Surgery residency program at both New York Methodist Hospital in Brooklyn NY, and New York Downtown Hospital in lower Manhattan, where she served as Chief Resident. Dr. Kleyner attended the New York College of Podiatric Medicine where she earned her Doctorate in Podiatric Medicine and received her Bachelor of Science degree from Stonybrook University. Only daughter to immigrant parents from Ukraine, she is fluent in Russian.

Hamilton Podiatry, with offices of Podiatric Medicine and Surgery located on the Upper East Side of Manhattan, New York City and in Bay Ridge, Brooklyn, are dedicated to using the most advanced technology to deliver expert foot care. Their goal is to educate each patient and begin a treatment program with the highest quality of care. Whatever the foot and ankle problem, our podiatrists and staff will work together with patients to find the answer that will provide comfort and bring relief.

Contact:
Dr. William Spielfogel
Hamilton Podiatry
wspielfogel@aol.com
(718) 680-6276

Dr. William Spielfogel, of Hamilton Podiatry, is a published author of several scientific papers and chapters in medical textbooks. He co-chairs the New York State Podiatric Medical Association’s clinical conference in New York City, which provides continuing medical education in foot and ankle surgery and medicine to over 1,000 podiatrists annually. Dr. Spielfogel has also been a lecturer at several national scientific meetings.

Present Appointments:

• Columbia Presbyterian Medical Center
• Beth Israel Medical Center
• Maimonides Medical Center
• Lutheran Medical Center

Credentials:

• Board Certified- American Board of Podiatric Surgery
• Board Certified- Foot Surgery
• Certified in Extra Corporeal Shock Wave Therapy
• Trustee- New York State Podiatric Medical Association
• Past President- NY Division of The American College of Foot and Ankle Surgeons

Teaching Qualifications:

• Lecturer- Columbia University Medical Center, Department of Orthopedics
• Assistant Clinical Professor- New York College of Podiatric Medicine 1990-1996
• Clinical Instructor- Mount Sinai School of Medicine, Department of Orthopedics 1999-2006

Education:

• Medical School- New York College of Podiatric Medicine- DPM
• Residency- New York College of Podiatric Medicine Affiliated Hospitals

Memberships:

• American Podiatric Medical Association
• American College of Foot and Ankle Surgeons
• New York State Podiatric Medical Association