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Bunion Surgery Puts the Best Foot Forward

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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.

"I generally never do watchful waiting," Scardina tells WebMD. "I always make at least limited conservative treatment suggestions, like wider toe-box shoes for women, lower heels, maybe switch to a different kind of weight-bearing activity or go to a non-weight-bearing activity like swimming or life-cycle vs. running. But at any age, there's almost always some type of conservative recommendation that can be made."

"It really depends on the severity of the bunion," Giurini adds. "The natural history of bunions is that they do tend to get more symptomatic over time. We'll see somebody today with a bunion that doesn't look too bad and they're having minimal symptoms, and they may come back a year or two later and their symptoms have increased. That's the usual natural history of a problem like this."

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