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    Bunion Surgery Puts the Best Foot Forward


    In their study, the 209 patients with bunion and hallux valgus were assigned to receive either surgery, orthoses, or watchful waiting. They were evaluated for pain intensity during walking, cosmetic problems, footwear problems, and function. Study participants were also asked to give their own assessment of their condition and satisfaction with their form of treatment -- at both six and 12 months into the study.

    At the six-month interval, patients who had undergone surgery experienced the largest degree of pain relief, followed by those who received orthoses. At one-year followup, the surgical patients scored highest in all categories, followed by the patients who received orthoses, with the watchful waiting group bringing up the rear.

    In all, 83% of those who underwent surgery said they had improved since the beginning of the study, compared with 46% of those who received corrective device, and 24% of those who received no therapy. When it came to overall satisfaction, however, the race tightened a bit, with 80%, 70% and 61% satisfaction rates in the surgery, orthoses, and watchful waiting groups, respectively.

    Overall, though, surgery is the only treatment option that can correct a serious deformity, agree two foot surgeons who commented on the findings for WebMD.

    "There's very little midrange therapy for symptomatic bunions which are operated on for either pain and/or deformity," says Robert J Scardina, DPM, in the department of orthopaedic surgery at Massachusetts General Hospital in Boston, and a clinical instructor in orthopaedic surgery (podiatry) at Harvard Medical School. "The surgery is done if there's pain and/or deformity that's clearly unresponsive to traditional conservative care, and conservative care is very, very limited. You're talking usually a major significant change in shoe gear, maybe also a change in activity, and orthoses."

    "[Corrective] devices, for the most mild forms of bunion sometimes can be effective -- they sometimes slow the progression of the bunion, but in general over time bunions do tend to get a little worse and more symptomatic. And it also depends on the patient's symptoms. If somebody's having a problem with most shoes on a daily basis, those things rarely just improve with watchful waiting or even orthoses," says John M. Giurini DPM, chief of podiatry at Beth Israel-Deaconess Medical Center and associate clinical professor of surgery at Harvard.

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