Seattle Bunion Treatment: Surgical and Non-surgical

Bunions are a very common condition seen in our office.  A bunion is not a corn or a callus.  It is a bump on the base of the big toe, actually a bone that is protruding.  The bone is called the first metatarsal, located behind the big toe bone.  When there is an increase between the angle between the first and second metatarsal, the bone behind the 2nd toe, the bunion is seen.  The bump, as well as the big toe joint, can become painful.

Diagram indicating location of bunion on a foot

Many people who come into the office state that they have a family history of bunions, that is, they know a parent, grandparent or other family member with the same condition.  They also say that the family member may have had a painful surgery in Seattle with a long, difficult recovery time.

Dr. John Hoy has been in practice since 2000.  He is a native of Seattle, and is a Teaching Associate of the University of Washington School of Medicine, Department of Family Medicine, instructing medical doctors on foot and ankle conditions during their residency.  He completed his foot and ankle medical education and residency in the University of California San Francisco/Stanford University Medical Center system.  He utilizes a diversity of non-surgical and surgical approaches to the treatment of bunions.

In Seattle, often one technique, the most invasive surgical approach, is utilized for all bunion cases.  This may be the reason many testify to a long, difficult and painful post-operative period.

At Seattle Foot and Ankle Center, we utilize a comprehensive examination and treatment approach instead of going immediately to the most invasive surgical approach, which according to the textbooks is usually reserved for the most severe of cases.

A complete foot and ankle examination is performed of all the systems including circulation, nervous, skin and musculoskeletal.  Circulation has to be checked to ensure healing of surgery.  Skin calluses can give clues into weight distribution and biomechanics.  X-rays are taken to ensure there are no fractures.  Many people who complain of bunions may actually have a broken bone, or an acute inflammation such as gout.  These must be addressed first.

Once a diagnosis is established, appropriate treatment starts.  Often this is with non-surgical treatments, including suggestions for shoes and inserts to ensure proper weight distribution and biomechanics.  The cause of the bunion and the treatments are thoroughly discussed.  Treatments will take into consideration the goals of the patient, whether that is to prevent progression, reduce pain and/or to fix the deformity.

If surgery is indicated, and other non-surgical approaches have been tried and failed, we customize the treatment plan.  X-rays give clues to the severity of the bunion.  In our practice, there is not a one-procedure-fits-all approach.  The age, medical condition, lifestyle of the patient, as well as severity of the bunion all come into play with the selection of a surgical procedure.  The recovery time will depend on which procedure is selected.  Dr. Hoy will only offer procedures which will be appropriate, in the context of a treatment plan that offers long-term success.

There are over 100 different types of bunion procedures.  These are documented in the podiatric medical profession’s textbooks and taught in school and residency.  A foot and ankle surgeon must have performed a diversity of bunion procedures to be certified with the only Board that certifies foot and ankle surgeons.  This is the American Board of Foot and Ankle Surgery.  Dr. Hoy is Certified with this Board.  He is also a Fellow of the American College of Foot and Ankle Surgeons.

Biomechanics and weight distribution is an important element of bunion treatment.  Improper biomechanics will cause a bunion to worsen as well as return even after the most advanced of surgical techniques.  For this reason, custom functional foot orthotics is a part of treatment protocol.  Dr. Hoy is also Board Certified with the American Board of Podiatric Medicine, which certifies medical and biomechanical expertise.

The Seattle Foot and Ankle Center approach involves properly addressing foot and ankle biomechanics and choosing the most appropriate surgical procedure for the bunion condition.  It also involves proper diagnosis and proper non-surgical care.