Bunions
Hallux Abductovalgus

A bunion deformity is a structural deformity caused by abnormal biomechanics in which the first metatarsal drifts away from the second metatarsal.  This causes the big toe (hallux) to drift towards the second toe.  The result is a bump or prominence of the inside aspect of the foot and the big toe hitting up against the second toe.  

With a course of conservative treatment consisting of anti-inflammatory medications and orthotics, the pain associated with the bunion can be alleviated and surgery can be delayed.  Surgical correction if indicated is aimed at realigning the first metatarsal with the second.

Most patients will be able to wear comfortably fitting shoes within four weeks, but a return to full activity might take up to three months.

Examples of bunions of different severity

For additional information on bunions visit:
www.apma.org/topics/bunions.htm

Hammertoes

Hammertoe deformity is a structural deformity in which abnormal biomechanics cause the toe(s) to contract at one, two or all three of the joints within that toe.  When in its early stages, the deformity is flexible.  Normally hammertoes by themselves are not painful, but with foot wear the prominent knuckle of the toe rubs the shoe, producing an area of irritation which eventually forms a corn.

Orthotics and anti-inflammatory medications can work well to alleviate symptoms.  When the contracture becomes rigid and nonflexible and increased swelling and pain persist, then surgical correction might become necessary to alleviate symptoms.

Corns and Calluses

Corns and calluses are NOT soft tissue problems and there is no "root" to be removed.  No matter how much they are cut down or debrided, they will return.  Painful corns and calluses are the result of abnormal position of the underlying bone.  Often hammertoes become painful because a bursal sac will develop between the bone and corn or callus.  The bursal sac can be treated with injection and anti-inflammatory medications.  If this relieves the symptoms than surgery can be delayed.  If these treatments fail, then structural correction of the hammertoe is recommended by Dr. Marchese.