Surgery vs. Conservative Care (for Bunions, Hammertoe, and Flatfoot)

Eugene Pascarella
Dr. Eugene Pascarella, with a desire to help people, began Foot & Ankle Associates of Florida in July 1984.

At first glance, it might not seem like there’s a lot in common amongst bunions, hammertoe, and flatfoot conditions, but there’s actually a couple of things they do share.

To start, all three develop in the body’s lowest appendages. Another commonality—one that is certainly related—is the fact each of them can cause pain and difficulty walking. Given how important your feet are for mobility, independence, and simply giving you options in life, this also means they can keep you from your favorite activities.

One more shared feature is the fact each of them can be treated either with conservative measures or surgical intervention – but this isn’t as cut-and-dry as it appears.

When you come to Foot & Ankle Associates of Florida, we will carefully assess your unique situation, and then determine an appropriate course of treatment. When we do, you can trust that our recommendations are always provided with your best interests in mind.

Surgery Vs. Conservative Care

Understanding Bunions and Conservative Bunion Treatment

A bunion is a foot deformity that develops when the big toe starts to turn inward and point towards the second toe. This condition happens at the metatarsophalangeal (MTP) joint—where the toe and foot connect—and results in the bone or tissue around the joint becoming enlarged, swollen, and tender.

Common symptoms include pain at the MTP joint, toe deformity, redness, swelling, inflammation, and difficulty finding comfortable shoes. The pain experienced can often be attributed to irritation due to rubbing against the inside edge of footwear.

It is easy to observe the toe deformity when you look at your foot and see a protruding bump where the big toe meets the foot. In addition to the bony bump, there is often redness and noticeable swelling of soft tissue in the affected area.

Your treatment options will vary in accordance with the severity of your condition. It is important to note that dealing with a bunion in its earlier stages may help in slowing or stopping its progression.

Conservative bunion treatment options include:

  • Splinting or padding and taping your foot into a natural position to alleviate pain and reduce stress on the bunion.
  • Applying ice to a bunion after time spent on your feet can relieve inflammation, soreness, and decrease pain.
  • Padded shoe inserts may be helpful in reducing symptoms, preventing the condition from worsening, and distributing pressure more evenly to reduce irritation.
  • Changing footwear to comfortable, roomy models that offer ample space for your toes.
  • Anti-inflammatory Medications.
  • Cortisone injections.

Bunion symptoms might be treated without needing surgical intervention. Depending on your particular situation—and especially if symptoms are mild and the deformity is not particularly severe—this might be all the treatment you need. That said, the condition itself can only be truly corrected with surgery.

Bunion Surgery (and Bunion Surgery Myths)

Not all bunion surgical procedures are exactly the same. There are several different ones our foot doctors may elect to use, depending on your specific circumstances. These include:

  • Arthrodesis – Inserting plates, wires, or screws to hold surfaces together after damaged joint surfaces have been removed.
  • Exostectomy – Rarely used, this procedure removes the bump on the MTP joint.
  • Resection Arthroplasty – Mainly selected for older patients, this surgery removes damaged portions of the joint.
  • Osteotomy – This type of procedure entails cutting and realigning the joint.
  • Joint Implant- Either partial or total joint replacement.
  • Cartilage Replacement- This procedure replaces damaged cartilage in the MTP joint.
  • Repair of Tendons and Ligaments – Often used in conjunction with osteotomy, we may need to shorten loose tissue and lengthen tight ones to correct an imbalance that can result in the big toe drifting inward.

Here are some common myths about bunion surgery:

Myth #1 – Bunions Just Return Anyhow. Whereas it is possible that a bunion will return, this is not a particularly likely scenario. Most patients are satisfied with the outcome from the procedure and go forward without recurrence. When bunions do return, it is often on account of a biomechanical function that we can help to correct with the use of orthotics.

Myth #2 – There is Intense Pain. The fact of the matter is this – bunion surgery is simply not “more” painful than surgeries for other ailments. There will be a certain degree of discomfort or even pain with any invasive medical procedure, but we create a plan that, if followed, will help to keep any discomfort to a minimum.

Myth #3 – The Surgery Causes Unsightly Scars. Some people believe this procedure leads to unsightly scars that will mar the foot. We will discuss the surgery in advance and you can learn more about where the location of the incisions and what size you can expect. Incisions are kept at a minimum and this means surgical scars will be, too.

Myth #4 – You Need Casts and Crutches for Months. Depending on the nature of your bunion, recovery from the surgery may simply entail wearing a surgical shoe for up to six weeks. The nature of some modern procedures can allow for protected walking at only two weeks postoperatively.

Myth #5 – Bunion Surgery Isn’t Necessary. Some people may think surgery for a bunion is unnecessary, but when this deformity causes pain and affects your ability perform daily tasks, it might be what you need. We will first attempt to treat the condition conservatively. When those effort are not enough, then we look to surgery as the answer to your problem.

Doctor Checking Feet

Hammertoe Treatment – Conservative and Surgical

Of course, we will always attempt to treat a hammertoe (or any condition, really) with conservative (nonsurgical) methods first.

With regards to toe deformities like this one—and related conditions claw and mallet toes—some of the conservative treatment options include using custom orthotics, switching to shoes that have more room in the toe box area, and using medication to relieve any pain you experience from the condition and use of hammertoe pads.

It is worth noting at this point that, much like with a bunion, conservative care can address the symptoms, but is not able to reverse the condition. To actually correct a toe that is abnormally bent, surgery needs to be used. That being said, the best chance for nonsurgical treatment to be effective is when the condition is in its earliest stages.

If the deformity is severe and prevents you from performing normal activity and causes pain, we may need to discuss a surgical procedure.

The root cause of a hammertoe (and related conditions) is an imbalance in strength between the muscles and tendons on the top of your toes versus the ones found in the bottom. Now, when opposing sets work together in the intended manner, everything runs smoothly. With an imbalance, though, that simply doesn’t happen.

In this case, we may be able to correct the problem by either cutting supporting tissue or even moving tendons.

Other potential surgical options for hammertoe correction include arthroplasty and arthrodesis. Arthroplasty is a matter of removing part of the affected toe bone; whereas arthrodesis is removal of part of the affected joint(s) (and then allowing the toe bones to fuse together).

In some cases, we may even need to straighten the toe or replace a bent joint with an implant. This is extremely rare, but amputation may need to be considered in especially severe cases. (If that sounds concerning, we’d like to emphasize the “extremely rare” part!)

Conservative Flatfoot Treatment (When Even Necessary)

As we look at the possible treatment options for flat foot, it is best to start out by noting that feet with low arches simply do not require care if there are no painful symptoms. In cases like these, it is wise to monitor the condition, especially when beginning new activities and exercises or ramping up the intensity of existing ones. If issues arise, we can provide the care you need.

You may be relieved to find that when treatment is needed for flat foot, conservative care is often quite successful and surgery is only needed in rare cases. Some of the nonsurgical treatment options we may prescribe or recommend include:

  • Orthotic devices or arch supports. Depending on the severity of the condition and symptoms, it is possible that over-the-counter arch supports may provide relief, but we may also recommend custom orthotic devices that work better with your unique feet.
  • Supportive shoes. If your choices in footwear is leading to issues, we will likely recommend switching out your footwear for models that are structured to provide greater arch support and restrict excessive motion. This can be particularly beneficial for runners.
  • Stretching exercises. It is common that individuals who have flat feet also have shortened Achilles tendons, which are greater risk of developing tendonitis. This can also lead to heel pain if the Achilles pulls on the calcaneus (heel bone). Stretches can help keep the tendon limber and reduce injury risk.

There are instances where flat foot issues are not resolved through conservative methods, but these tend to be rare. If this is the case, though, you can take comfort knowing that our office has experienced, skilled professionals ready to help you.


Reconstructive Surgery for Flatfoot

In those rare cases when surgery is recommended, we start by completely evaluating your feet. This is used, in part, to determine if the fallen arches are stiff or flexible. We then utilize diagnostic imaging (typically X-rays) to create our surgical plan. The work we perform on the front end enables us to conduct a successful procedure for you.

Depending on variables that are specific to you, we may elect to either use regional or general anesthesia. No matter which we use, the intent is to ensure a painless procedure. Your comfort and safety are always primary concerns for us!

The specific surgical procedures used will depend, again, on variables specific to you and your condition. Whereas the actual procedures can vary, all flatfoot surgeries we perform have the ultimate goals of improving your walking ability and taking away your pain.

Flatfoot surgery does not entail a lengthy hospital stay. At most, you might need to stay overnight, although many patients go home the day of the procedure.

Comprehensive Foot Care Services—Conservative and Surgical—in Central Florida

Conditions like bunions, hammertoe, and flatfoot are fairly common – but they don’t have to cause pain and disrupt your life!

In fact, these problems will only become worse over time if you leave them unaddressed. Fortunately, this doesn’t have to be the case. Instead, you can contact our team at Foot & Ankle Associates of Florida and receive effective, professional care.

If possible, we will treat your condition with conservative, nonsurgical methods. At the same time, if you would best benefit from surgery—or it’s simply a necessary course of action—our team is highly-skilled and has extensive experience helping patients just like you find the relief they need.

For more information simply call 407-339-7759 or 352-589-9550 (if calling from Lake County) or feel to request an appointment with any of our five Central Florida offices online right now.

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