Dr. Jacoby discusses the diagnosis and treatment of bunions.
Bunions are diagnosed primarily by X-ray. Obviously, a clinical diagnosis is going to bring you to that conclusion, but you need an X-ray to see what the alignment is of the bones inside the foot. The great toe is bent in a certain angle to the metatarsal, and that’s really what we call a bunion.
The medical term in the United States is called hallux valgus, and that describes the condition that is seen, and that’s really another way of describing in Latin what we see–a toe that is bent that causes a big lump on the side of the foot.
So an X-ray is important. Once the X-ray has established what the deformity is, then we get into treatment protocols. First thing is for a mild bunion is change your shoes; wear a low heeled shoe that has plenty of room in the toe box. If it’s an early, mild sensation of pain, and it hasn’t been going on for a long period of time, I think a cortisone injection is a treatment of choice.
Physical therapy, exercises, Pilates exercises are great for foot problems, strengthening the muscles. But if the condition goes on for any length of time and changes from what we call a positional deformity, in other words it’s easily reduced to a structural deformity which is not easily reduced, then it’s surgery.
The last time I looked to see in the literature how many surgical procedures were used for bunion deformities it was over 175 different procedures, which means there is no one procedure that works best, but you can divide the procedures into soft-tissue procedures, boney procedures that require plates and screws, or joint replacement procedures. They are the three ways we divide them up. Early—soft tissue; middle-stage—boney procedures; late stage—implants replacing the joints.
About Dr. Jacoby, D.P.M.:
Dr. Richard Jacoby, D.P.M., graduated from the Pennsylvania College of Podiatric Medicine. He completed his residency at Parkview Hospital, Philadelphia, specializing in foot and ankle surgery. Board certified by the American Board of Podiatric Foot and Ankle Surgeons, he is currently president of Valley Foot Surgeons in Scottsdale, Arizona. In addition, Dr. Jacoby is chairman of the board of Healthcare Networks of America.
Dr. Jacoby has been named the 2010 President of The Association of Extremity Nerve Surgeons.