We recently sat down with Geoff Watson, M.D. of The Bone and Joint Institute of Tennessee to discuss the problem of bunions, a very common foot disorder characterized by painful bone and joint pain where the big toe meets the foot. Dr. Watson is a board certified orthopaedic surgeon specializing in treatment of the foot and ankle.
How common are bunions?
Dr. Watson: It’s a fairly common problem. Bunions are something we see every day in clinic, but the good news is they do not always need surgery. In fact, we typically try to avoid surgery until it significantly affects your quality of life.
What can a person do to avoid or prevent getting bunions?
Dr. Watson: The two most common causes of bunions are genetics and shoe wear, especially high heels and shoes with narrow toe boxes. Shoes with a wedge more than a couple inches high may present a risk. While there’s nothing to be done about genetics, you can reduce risk by wearing shoes with soft soles, low heels, and broad toe boxes.
Where did your interest in treating bunions begin?
Dr. Watson: My interest sparked in residency and then furthered in a fellowship at the Hospital for Special Surgery in New York City. While training there, I learned multiple bunion correction techniques. We would have people fly into that hospital from all over the world for their bunion surgeries.
How are bunions treated?
Dr. Watson: First, I think there are several misconceptions about bunions – one being that orthopaedic doctors don’t treat bunions. That’s not the case. I completed a foot and ankle fellowship, and the treatment of bunions is certainly within the scope of our practice.
Secondly, there’s a lot of internet chatter about bunion surgery. Considering that there are over 150 prescribed procedures for correcting bunions, comparing various surgical techniques can be like comparing apples to oranges. For example, you can almost never shave the bump off; this technique is almost never enough to correct the bunion and it has an extremely high recurrence rate. You usually have to cut the bone to correct the bunion; this approach is often a much more manageable option than usually described on the internet.
Thirdly, although there are surgical options that require patients to be off their feet for a few weeks, there are many procedures that aren’t as limiting. The bottom line is, if you get to the problem earlier, the surgery is not as invasive.
When should a patient seek care for a painful big toe joint?
Dr. Watson: Pain is really the driver. If they have pain at all – pain in their big toe or even pain in their second toe, which is sometimes caused by the bunion, they should come see us. There are even instances where correcting the bunion can help the rest of the foot, too. Patients can often come straight to us, no referral needed. (Please check your individual insurance plan to see if a referral is needed for orthopaedics.)
Have there been any recent technological advancements in your field changing how patients receive care for bunions?
Dr. Watson: There’s been a big trend over the past 10-20 years of correcting bunions and allowing people to bear weight the day of surgery. This is certainly evident in my practice. Right now, the biggest advancement is minimally invasive bunion correction. There’s a big push that started in Europe of correcting bunions by making a total of two to three small incisions less than a centimeter in length. This is made possible by the development of a surgical tool that utilizes a certain frequency to cut only bone while sparing soft tissues like nerves or tendons. It’s a technology I’m currently learning and planning to begin using at Bone and Joint Institute of Tennessee in the next couple of months.
What do you enjoy most about your work?
Dr. Watson: There’s nothing better than seeing a happy patient. That’s a very rewarding experience, and it’s one that really drew me to medicine in the first place – especially orthopaedics.
Bunion Treatment at The Bone and Joint Institute
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