In The News
Sutter Medical Center, Sacramento
Bunions can be a nasty bump in the walk of life
By Sam McManis
smcmanis@sacbee.com
Published: Sunday, Mar. 22, 2009 - 12:00 am | Page 5L
Bunions, my friends: They just get no respect.
Maybe it has something to do with the toes themselves, seemingly frivolous appendages that actually are vital to our ambulatory ability. Or maybe it's just that those other digits, the fingers, get to do all the glamorous things, such as grasping the TV remote and eating popcorn.
That could be why the humble bunion, a calcified enlargement on the big-toe joint, gets dismissed as merely a minor medical condition. Oh, got a wee bump on the little piggy who went to market? Poor baby.
In truth, though, bunions are a literal pain. They can make even the most prosaic of activities – putting on a shoe, walking to the mailbox – an exercise in torture.
Ask Kathleen Spruitenburg, 41, of El Dorado Hills, whose left foot throbbed for months with a bony protuberance and who used a wheelchair and then crutches for six weeks after surgery.
"You've got to think of all those tiny bones in the toe and all that abuse we put on it," she says. "It's not something that goes away until they cut it out. I've had a lot of surgeries, like on my knees, but this was the worst ever."
Or ask Abel Martinez-Centano, a 38-year-old Carmichael man whose passion for playing soccer was derailed by a bunion.
"After every game, it was really painful," Martinez-Centano says. "Some of the shoes I wore for everyday business were killing me, too. This was 30 years of destroying my feet."
Martinez-Centano, who a month ago underwent surgery to shave off calcified bone and restructure the toe, is one of the exceptions among the millions who see podiatrists each year for bunions and its kid brother, the "bunionette" on the outside of the fifth metatarsal (the little piggy who went wee- wee-wee all the way home).
He originally injured the cartilage in the toe joint as a teenage soccer player. Most people, however, cannot pinpoint exactly how, when or why the lump develops.
For Spruitenburg, it was partly hereditary, partly from wearing high-heel shoes.
"It's often multifactorial," says Dr. Masoud Ghalambor, a foot and ankle specialist at Sacramento Knee & Sports Medicine. "In general, there's a hereditary component. And one of the underlying problems is laxity of the tissues. The more lax the ligaments are, the more susceptible you are to creating a deformity at the level of the joint. It's also more associated with flat feet, which puts more pressure on the inner part of the foot. And that causes the toe to move to the other side."
And yet one of the baffling things about bunions is that some people live for years with the condition with nary a painful moment, whereas others are plagued with chronic pain.
Often, Ghalambor says, taking care of one's feet by wearing proper footwear and not putting stress on it from being overweight can slow the progress. Not always, though.
"There's a wide spectrum," Ghalambor says. "If you could prevent the progression of the bunion, you may live your life without ever having to do surgery. There's still a lot we don't know.
"Bunions are not simple. There are chapters in books devoted to this problem. Every time we have an (orthopedic) conference, there are always lectures devoted to this topic, because you can screw it up easily. And because the condition is so common."
This much orthopedists and podiatrists do know about the bunion: It often is exacerbated by structural flaws in the foot.
"A pronated (foot) that flattens out and rolls to the inside is one type to watch," says Sacramento podiatrist Dr. Spencer Lockson. "A smaller percentage of bunions are caused by arthritic conditions like rheumatoid arthritis. But it's that foot structure that causes undue forces on the joint."
Treatment ranges from the conservative (choosing shoes with a wider toe box, wearing a prefabricated arch support or custom orthotic) to the invasive: surgery.
Both Ghalambor and Lockson try to put off surgery if possible, opting to prescribe lifestyle changes for patients for at least a few months.
"The more you wear appropriate shoes, the less the chance a bunion progresses," Ghalambor says. "I'm not saying a woman whose mother had bunions should never wear Jimmy Choo (high heel) shoes. But during the eight to 10 hours a day they're walking, running errands standing and bearing weight, they should try to do that in comfortable shoes.
"And when you go out at night, it's OK to wear (heels) for a couple of hours, then come home and kick them off. That way, you're not constantly exposing it to this constrictive pressure that forces all your toes together."
The criteria for surgery, say orthopedists and podiatrists: high levels of pain over a prolonged period after conservative measures fail.
"My rule is, no pain, no surgery," Ghalambor says. "But there are surgeons, especially in and around Hollywood, who'll do (cosmetic) bunion and foot surgery for women who want to get in those Jimmy Choo shoes. I won't do that."
For Spruitenburg, another bunion surgery beckons. Her right big toe has the same large bump. She knows what awaits her.
"I'm going to get it done, eventually," she says. "But I want to get the other one healed first. It's not something you look forward to."
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