Alameda, CA — Whether or not to consider foot surgery for conditions affecting the joint at the base of the big toe, including bunions and arthritis is a difficult decision. However, according to Dr. Jeffrey J. Niccoli, Board Certified Surgeon, new clinical practice guidelines developed by a panel of leading experts on forefoot conditions from the American College of Foot and Ankle Surgeons offer some help.
“If the big toe joint is painful and interferes with walking, physical activities and regular exercise, non-operative treatments should be considered first,” said Dr. Niccoli.
Dr. Niccoli added that bunions are the joint disorder most frequently treated. Contrary to popular belief, bunions are aggravated, not caused, by shoes. Bunions usually occur from inherited faulty biomechanics that put abnormal stress on the big toe joint. First-line treatment involves educating patients about the condition and evaluating their footwear.
“At first, we recommend that patients wear wider, low-heeled shoes, use bunion pads, apply ice and take analgesic medications. These options are designed to relieve pain and make it easier to walk and engage in physical activities, but they do not address the underlying cause of bunions,” said Dr. Niccoli. “Bunions are progressive so if non-operative treatments bring little or no symptomatic improvement, surgical intervention should be considered.”
“Recovery from bunion surgery is relatively quick and pain free these days due to our advanced techniques,” the doctor continues. “Patients are often amazed at the results and sometimes regret not seeking treatment sooner.”
Surgical options depend on severity and lifestyle
Determining which procedure is most appropriate for specific patients involves consideration of several factors, such as bunion severity, age, possible onset of arthritis and the desired level of physical activity a patient wants to achieve following surgery.
Stage 1 bunions may be painful but not show significant protrusion. Surgery is performed to repair tendons, soft tissue and remove a small amount of bone.
Procedures to correct more severe bunions, such as Stage 2, involve removal of the bump or minor realignment of the big toe joint. Stage 3 bunions usually are very severe and disabling. Surgery in these cases consists of joint realignment, reconstruction, implants or joint replacement.
Dr. Niccoli added that over time, avid tennis players and golfers put continuous stress on the big toe joint that can eventually wear out the cartilage, which could lead to the onset of arthritis.
This condition is known as “Hallux Rigidus,” and causes loss of movement in the joint as well as pain. “Those who experience pain in the joint without evidence of protrusion symptomatic of a bunion should consider it a warning sign that the joint has been traumatized and they are advised to have it evaluated and treated before arthritis sets in,” says Dr. Niccoli.
Lastly, if the initial evaluation and treatment were performed by a primary care physician, the patient should be referred to a board certified podiatric foot and ankle surgeon.
Dr. Jeffrey J. Niccoli is a Board Certified Podiatric Surgeon and Diplomate of the American College of Foot and Ankle Surgeons. His practice is located at 2225 Central Avenue, Alameda, CA. The office can be reached at 510-521-3410 or visit him on the web at www.drniccoli.com
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