Arthritic Big Toe

The Sklar Bunionectomy | www.footfirst.com

A common condition that we treat here at Foot First is arthritis of the big toe, also called hallux limitus or rigidus.  In our practice we lovingly call this deformity an arthritic bunion.  It is commonly caused by genetics, however it can sometimes be precipitated by an injury to the joint.  These types of patients often have a large lump at the top of their big toe, as opposed to the side like in a traditional bunion.  Depending on how severe the arthritis is, the joint may be stiff or not move at all.  The pain most people experience is over the lump, within the joint, or on other parts of the foot because the joint does not move like it should.  The purpose of this post is to give you a basic understanding of what doctors have to offer in the way of helping a patient.

There are two types of procedures that can be performed for an arthritic big toe joint.  The first is joint salvage.  Joint salvage procedures have the goal of surgically improving the joint without removing it.  These procedures include removing the bone spurs (Cheilectomy), joint decompression, and/or joint realignment.  Removing the bone spurs can offer comfort if a patient is only having pain around the bump over their big toe, however if they are having joint pain then joint decompression and realignment are also necessary to improve the pain.  The advantage to these procedures is that they allow for mobility of the joint so it can keep functioning normally and it is less invasive.  The disadvantage to these procedures is that the joint still remains so it is possible to produce more arthritis in the patient’s lifetime.  The doctor or the patient will know how fast this will happen, if it does, but generally these are successful long lasting procedures for most people.

The second type of procedures are called joint destructive procedures.  These most commonly include joint fusion or joint replacement.  Joint fusion is when the cartilage is removed from the joint so it can heal together where the joint will never move again.  It is hard for most patients to believe, but most people can live very normally without that joint.  Joint replacement procedures remove the cartilage, like in a fusion, but a prosthetic joint is inserted.  The disadvantages to these procedures are that they are more invasive and more permanent.  For instance, if the patient is unhappy with these surgeries, there are much more limited options when it comes to revision as there is no more joint to work with.  The advantage to these surgeries is that since they remove the joint there is no more chance for arthritis to reoccur.  

A patient can also attempt conservative therapy if they aren’t ready for surgery.  Some different types of treatments include ice, NSAIDS, orthotics, physical therapy, change in shoes, PRP injections, and cortisone injections.  At our practice we have a lot of success with change into Hoka brand shoes, and cortisone injections.  Cortisone works to decrease the inflammation around the joint greatly reducing pain and swelling.  This combo can buy some patients months to years before they elect to have surgery.

If a patient elects to have surgery in our practice we almost always turn to our joint salvage Sklar Bunionectomy.  Our procedure is revolutionary in the fact that it both decompresses and realigns the joint without shortening the big toe.  When the big toe is shortened it can be cosmetically displeasing, but also put more pressure on the ball of your foot causing further pain.  With our procedure there are also no visible scars.  Our incision is hidden on the side of the foot which again, provides a functional and cosmetic advantage.  When the scar is on top of the foot it creates scar tissue across the joint.  This can undo the motion that the surgeon is trying to give the stiff big toe joint in the first place.  This works against the goal of surgery.  Lastly, our procedure allows you to step on your foot right away, and return to a gym shoe in 2-3 weeks.  No cast or crutches are necessary.  There is no exercise on the surgical foot for 8 weeks from surgery.  

No matter how bad your arthritic bunion pain is, we are ready to help!  If you would like a consultation regarding this issue please use the contact us form on our website or give the office a call at 847-352-9221.  

Can you Shorten the Big Toe?

When we talk about toe shortening in our practice, we almost always are referring to the smaller toes.  Patients more often develop corns, pain, and hammertoes on the lesser toes from them being too long in their shoes.  Occasionally, however, sometimes patients ask if they can shorten the big toe.

Of course we can!  

The big toe is too long usually due to genetics.  Patients can get the same symptoms to the big toe as they do the smaller toes when they are too long.  By shortening the big toe we can reduce pain in shoes, corns, or keep them from hammering.  

Toe shortening recovery for the big toe is similar to when we do toe shortening to the smaller toes.  Surgery is done under twilight anesthesia, where we remove a section of bone through an incision of the side of the foot.  If you have a bunion, we also can correct this at the same time.  After we remove the section of bone we use pins to hold it in place.  These pins are buried underneath the skin, and do not stick out of your foot.  After your toe is done healing, we remove the pins under local anesthesia usually in between 8 and 12 weeks after surgery.  During that time you may not run, jump, or walk for exercise.  You are able to stand and walk for limited amounts of time, and you do not necessarily need crutches.  Patients are usually able to get into a gym shoe after three weeks.  

Cosmetically, when we shorten any toe, a full cosmetic result takes 6 months to 1 year.  Our best photos in our gallery are all taken at about that time after surgery.  

If toe shortening or bunion surgery is something you are interested in, please reach out for a consultation by visiting the “contact us” link on our website at footfirst.com.

What are Corns?

What are corns, and how do those ugly things get on our toes?  Can’t you just cut them out?

Corns are small calluses that form on top of toes or in between toes.  They are hard, and can be painful when they rub against each other or in shoes.  The calluses can be trimmed down or padded so they don’t hurt as much, but why do they keep coming back?  The cause of these little nuisances is usually deeper than the corn itself.  Corns occur and keep coming back, because there is an underlying deformity to the toe that it is on.  

A hammertoe is the number one cause of how a corn can form.  A hammertoe is when the toe becomes permanently bent over time.  This can happen with genetics, aging, or because a bunion is pushing the toe.  Where the toe bends down, it rubs on the tops of shoes.  This constant rubbing produces a callus, and eventually a deep corn.  

Another very common cause for corns is the toe is too long.  Similar to hammertoes, when a toe is too long it buckles when it goes into a shoe.  Where it buckles, or bends, the shoe rubs and creates the corn.  

Sometimes a corn is caused, because a person has a lump on the bone.  When a patient has a lump on the side of their toe, that causes corns in between the toes.  

To fix a corn, the underlying problem with the toe must be corrected, or it will just keep coming back.  

If a patient has a hammertoe we correct the underlying issue by straightening the toe.  If the toe is too long, we shorten the toe.  This prevents the toe from rubbing on the top of the patient’s shoe and the corn can eventually heal on its own.  If the patient has a bony prominence, we will file the bone down so it stops rubbing.  

We try never to cut a corn off of the toe, because it can leave a scar.  We want the corns to subside on their own so when the patient is done healing there are no visible scars, and no one can tell that surgery was even done!

Some corns are difficult to cure.  Corns are more stubborn if a patient smokes cigarettes.  Smoking cigarettes has a negative effect on the tiny vessels that keep skin soft and healthy.  We often see that cigarette smokers have a harder time healing corns even if surgery is done.  Another cause of stubborn corns is genetics.  Some patients are genetically predisposed to making calluses, and that will also make it harder for them to heal.  Lastly, if the corn has been present for many many years, then it will make it harder for the surgery to be as successful. 

If you would like to schedule a consultation because you have ugly corns, please reach out through our website at www.footfirst.com, on Instagram at footfirstpod or call 847-352-9221.

The Sklar Bunionectomy® vs Lapidus Type Procedures

A common question we get here at Foot First Podiatry is what is the difference between the Sklar Bunionectomy® and Lapidus type bunion procedures? 

There are three major differences between these two procedures: the cut in the bone, the cosmetic appearance, and the recovery.

Bone Cut

Lapidus type bunion surgeries typically are performed at the first metatarsal-cuneiform joint, and involves fusing this joint so it no longer moves ever again.  This is done at the base of the first metatarsal closer to the top of the arch of your foot, not near the area of the bunion.  The cut in the bone is usually fixated with screws and plates.  The screws and plates used can be very expensive depending on the system the doctor chooses.  Because this type of procedure fuses a joint it typically requires removal of bone, which in turn shortens the big toe in comparison to the lesser toes.  There are also certain risks that a Lapidus type procedure exposes a patient to, such as higher risk of delayed or nonunion (the bones may not heal together), or elevated positioning of the 1st metatarsal.

The Sklar Bunionectomy®  is a minimally invasive surgery performed at the first metatarsal-phalangeal joint where the bunion deformity takes place.  We use two to three screws to fixate this procedure.  Typically there is much less metal placed in a patients’ body than that is used with Lapidus type procedure.  The cuts in the bone are placed in areas that heal consistently and predictably.

Recovery

The biggest difference between the two procedures is recovery time.  With a Lapidus type bunion surgery most patients are required to be bandaged and in a boot for 4-8 weeks after surgery.  In addition to that, there is a high possibility of not walking and using crutches during this time.  If surgery is performed on the right foot driving is prohibited.  

With our Sklar Bunionectomy® the recovery is much more manageable.  Our patients are able to step on their feet immediately after surgery.  In fact, our patients walk out of surgery safely to their respective rides to take them home.  They are to be bandaged in a surgical shoe for approximately two weeks, then they are able to get into a tennis shoe.  We do limit our patient’s walking, however most are able to return to a desk job within about three days.  We also do not restrict driving even if surgery is performed on the right foot.   

Cosmetic Appearance

Fixing Feet Beautifully™ is our motto at Foot First Podiatry because we pride ourselves with not only how our Sklar Bunionectomy® functions, but also how beautiful it leaves a foot.  There is a remarkable difference with how a foot that has healed from a Lapidus type bunionectomy has healed than with the Sklar Bunionectomy®.  This is mostly due to the scarring that is left after surgery.

With the Sklar Bunionectomy® our small scars are hidden to the side of the foot where they cannot be seen.  There is also minimal to no shortening of the big toe to make it look disproportionate to the other digits.  This means that after a patient has recovered from surgery their foot appears as if it had never needed surgery in the first place: naturally beautiful.  

With Lapidus type procedures there are typically one very long scar or multiple scars on top of the foot.  Scars on top of the foot are not only unsightly, but can also create problematic scar tissue that can affect the end functional result of surgery as well.  And also as stated above, there can be remarkable shortening of the big toe, causing an awkward looking appearance after surgery.

Below are two examples of Lapidus type surgical results: 

Lapidus Type Scarring

Following that image of the two examples of Lapidus Type surgical results are comparisons of patients who have had the Sklar Bunionectomy® on one foot, and a Lapidus type procedure on the other:

The Sklar Bunionectomy vs Lapidus Type Surgical Results

The Sklar Bunionectomy vs Lapidus Type Surgical Results

Both the Sklar Bunionectomy® and Lapidus type procedures can offer good results when correcting a bunion, however the journey to the end result is drastically different, as well as the appearance.  We at Foot First always recommend patients to read reviews, and ask for before and after pictures when choosing their surgeon and procedure.  To us the obvious choice is always the Sklar Bunionectomy®.

Both procedures:

• Involve cutting the bone and using hardware

• Can offer correction of bunions of many shapes and sizes

• May need removal of hardware 

Lapidus type procedures:

• More scarring/visible scarring 

• Shortening of the big toe

• More internal hardware used

• Longer and more involved recovery

• Fuses a joint

Sklar Bunionectomy®:

• No visible scars 

• Minimal shortening of the big toe

• Manageable recovery
  

If you are thinking about having foot surgery, please explore our website at www.footfirst.com or connect with us on our Instagram handle @footfirstpod. You have choices when it comes to the type of surgical procedures you can have, so why not choose the one that makes recovery easy and your foot looking beautiful.

Long, short, curled or even just plain ugly toes? At Foot First we can fix that!

Before & After results with the Sklar Bunionectomy & Toe Shortening Procedure

Long toes can be troublesome for a patient for many reasons.  Toe shortening is a unique procedure that we perform alone, or along with our bunion surgery, the Sklar Bunionectomy™.   

Toe shortening has a similar recovery to our bunion surgery where you are able to weight bear immediately, and get back into a gym shoe in a short amount of time.

You may wonder why some people request to have their toes shortened.  Long toes can be problematic not only cosmetically, but also functionally.  A long toe extends past the other shorter toes so it may hit the end of the shoe first, causing the toe to curl and jam.  This can cause a hammertoe over time, or a painful corn on top of the toe as it rubs on the shoe. The constant jamming at the end of the shoe can also cause the toe to dislocate over the metatarsal bone.  This causes a painful callus on the ball of the foot. This also occurs when the metatarsal bone behind the toe is too long as well, and would require an additional procedure to the toe shortening to fix.

If you have a bunion along with long toes, we always correct the bunion with the toe shortening procedure.  This is because if we do not correct the bunion deformity, the big toe pushes against the smaller toes as they heal.  This eventually causes them to heal crooked, or become crooked over time. This is why we always address the bunion deformity as well.  The image to the right is a patient who had her toes shortened by another doctor without fixing her bunion. We then had to correct her bunion along with her crooked toes.

During our initial consultation we determine which toe shortening procedures you need by where you are feeling pain, and with X-rays of your feet.  We also determine how much you want your toe shortened. You tell us approximately where you envision your shortened toe to be in comparison to the other toes.  For instance, some patients still want their second toe to be in line with the big toe, or some patients want their second toe to be shorter than the big toe. This is where the surgery becomes more of an art than a science, because everyone has a different opinion of what they consider beautiful.

Surgery for toe shortening is done under local anesthesia (awake with numbing of the toes) or twilight anesthesia (asleep) through a small incision on the side of the toe.  We remove a section of bone that we determine before surgery. How much bone we remove will depend on how much your toe needs to be shortened. We then insert a wire to hold the toe while it heals.  The wire will be underneath the skin and will NOT stick out the ends of your toe. The wire is not meant to be permanent and will need to be removed at a later date. We then close the incision usually with only one stitch, and allow you to recover.

After toe shortening surgery patients usually experience pain for three days.  They are able to weight bear immediately and are wearing a surgical shoe. Patients wear the surgical shoe for three weeks, and also have to keep the foot clean and dry during that time.  At three weeks the sutures will be removed and patients will be allowed to wear a gym shoe. At 8-12 weeks, depending on how the bones are healing, we will numb the toes to remove the pin inside of the toe.  Then patients are allowed to return to exercise like running, jumping, and wear different shoes.

Toe shortening surgery is very successful, although it will never be perfect.  Healing is determined by the success of the surgery, genetics, and compliance with instructions all combined.  With all the surgeries we tell our patients that toes will cosmetically look ugly for 4-6 months before they start to see their true result.  This is how long it takes for most patients’ swelling to come down. Some more serious complications of toe surgery are, but not limited to, floating toe, crooked healing, creases/scarring to the skin, a swollen toe, numbness, or a toe that is painful.  Usually if we work together by us performing good surgery, and the patient follows instructions and genetically heals well, we all end up with a beautiful result.

Our unique toe shortening procedure offers patients the chance to lessen their pain, and have a beautiful looking foot.  Our before and after pictures showcase our most beautiful results. As stated before, toes take 4-6 months on average to become beautiful.  All after photos posted are usually taken at 6 months to 1 year after having toe shortening surgery.

For more information about our unique Toe Shortening procedure or to view additional before and after results, visit www.footfirst.com.