BUNIONS MAY NOT REQUIRE SURGERY
Is it best to have bunions surgically treated before they begin hurting, or do some never cause pain? In the past few months, I've noticed throbbing from the bunion on my left foot, and I'm considering surgery. I have one on my right foot, too, but it doesn't hurt. Will I eventually need the procedure done to both sides?
Not all bunions require surgery, and more conservative means of treatment typically are recommended first, before any surgical intervention is used.
A bunion is a bony bump that forms on the joint at the base of your big toe. It develops due to a shifting or repositioning of some of the bones in the front part of the foot (forefoot). When this happens, the big toe gets pulled toward the smaller toes and the forefoot widens. That's when you start to notice the bump.
Some bunions don't cause any symptoms other than a bulging bump, while others trigger swelling, redness and soreness around the joint. Persistent or intermittent pain may accompany a bunion, and the skin over a bunion may become red and sore.
When a bunion doesn't cause pain or other symptoms, it may not require treatment. If, as in your case, a bunion does become painful — or if it causes other bothersome symptoms — that's the time to make an appointment to have it evaluated. Doctors who specialize in foot and ankle surgery typically are the health care providers best suited to assess a bunion and help you decide on the appropriate treatment.
One of the first steps your doctor may take is to determine the underlying cause of the pain associated with your bunion. In some cases, it may be an internal problem, such as degenerative or inflammatory arthritis. In others, the pain could be from an external source, such as pressure from tight or ill-fitting shoes. Treatment recommendations may be based in part on what's causing the pain.
Nonsurgical treatment options, which usually are the first line of treatment for bunions, often include changing the type of shoes you wear. Roomy, comfortable shoes with plenty of space for your toes will take pressure off a bunion and may help ease pain. Adding padded inserts to your shoes distributes pressure more evenly when you move your foot, and that can help reduce pain, too.
You also can try bunion pads to take pressure off the bunion. They are available without a prescription at most pharmacies and drug stores. Nonprescription pain relievers such as acetaminophen, ibuprofen or naproxen sodium may be useful, as well. In some cases, your doctor might recommend a cortisone shot to help reduce inflammation in the joint that could be triggering bunion pain.
If pain or inability to do your usual activities continues despite these more conservative measures, surgery may be necessary. The purpose of bunion surgery is to correct the foot deformity, increase function and reduce pain. The specific procedure used will depend on your situation.
You should have a discussion with a foot and ankle surgeon to talk about surgery options. He or she can outline the planned procedure and review the expected outcome and healing timeline, along with the potential benefits, risks and complications of the surgery.
A bunion may occur just on one foot or on both feet, and the severity, symptoms and progression can vary greatly from one foot to the other. Therefore, let your symptoms, as well as a discussion with your doctor, guide you when considering bunion surgery.
Martin Ellman, D.P.M., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.
TIPS FOR TREATING A BURN
What's the best way to treat a minor burn? At what point does a burn require medical care?
The level of care needed for a burn depends on how extensive the tissue damage is. Minor burns often can be treated at home without seeing a health care provider. Burns considered "minor" include first-degree burns and second-degree burns that are no larger than 2 inches in diameter. Immediately evaluate in a medical setting any other type of burn that covers a larger area of the skin. A health care provider also should evaluate a burn that shows signs of infection, such as oozing from the wound and increased pain, redness and swelling.
A first-degree burn involves only the top or outer layer of the skin (epidermis). Signs and symptoms of a first-degree burn include red skin that may be mildly swollen and painful to touch. A second-degree burn involves the outside layer of the skin and the next layer of skin (dermis). Signs and symptoms of this type of burn include pain, swelling, intensely reddened skin, blistering and a splotchy appearance.
For these types of minor burns, prompt at-home care is often all that's needed. First, put the burn under cool (but not cold) running water long enough to reduce the pain, which may take about 10 to 15 minutes. If running water isn't available, immerse the burn in cool water, or apply a cool, wet compress. Don't put ice directly on the burn. Doing so can cause further damage to the tissue.
Dry the area with a clean cloth, and apply a sterile, lightly wrapped bandage. Don't apply ointments or butter to a burn, as these can hold heat in the skin, causing further damage, in addition to increasing the risk of infection. If needed, take over-the-counter pain medications for pain relief.
If the burn is caused by a chemical, make sure the chemical, or any clothing or jewelry in contact with the chemical, is removed. If possible, use gloves so that you don't get burned elsewhere or so that someone helping you doesn't get burned.
Don't break blisters if they form. If a blister breaks inadvertently, wash the area with soap and water, apply an antibiotic ointment, and cover the area with a bandage. See your health care provider if large blisters develop, as these blisters may need to be removed.
Monitor the burn daily after each gentle washing and dressing change. Evaluate the burn for spreading of heat, redness or swelling, which may indicate a skin infection. If the wound isn't healing, see your health care provider.
A burn requires immediate medical attention if it covers a large area of the body, or if it involves much of the hands, face, feet, genitals, buttocks, eyes, mouth or a major joint. Second-degree burns larger than 2 inches; an electrical burn; or more severe, third-degree burns, where skin is burned away, charred black or appears dry white, all require emergency medical attention.
Henry Schiller, M.D., Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, Minn. (adapted from Mayo Clinic Health Letter)
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