Our Foot, Ankle, and Lower Leg Surgery FAQs

Will I need surgery for my bunionette?

Bunionettes can be managed with conservative measures at first. Wearing shoes with a wide toe box, using bunionette pads to prevent sores, and resting and icing the foot as necessary will get you by for a while. However, bunionettes do not get better on their own.

If your bunionette continues to give you pain, then surgery may be needed to realign the little toe’s bone so that it does not point outward. Minimally invasive AMI-BUNIONETTE® Bunionette Surgery involves making a very small incision to make this correction.

The surgery is usually an outpatient procedure and results in little if any scar tissue on the outside or swelling on the inside. You should be back on your feet very soon after this surgery.

What kind of treatment do I need for a bunionette?

A bunionette is a bump at the base of your little toe caused by a misalignment of the bones in the foot. The pain and discomfort it causes can be managed with at-home treatments until the misalignment becomes more extreme.

At first, non-surgical treatments like changing to shoes that have a wider toe box will ease the discomfort. The bunionette can also be padded with over-the-counter bunion cushions, which will require a shoe with a wide-enough toe area. If your bunionette becomes inflamed, then you would need to put an icepack on it. A nonsteroidal anti-inflammatory medication such as Advil or Aleve can also help. For short-term relief before an important event like a wedding or a race, Dr. K can inject a corticosteroid into the area to help bring down the inflammation and relieve pain.

How do I know for sure that I have a bunionette?

There are several joint conditions that could be mistaken for a bunionette when they occur at the base of your little toe. Swelling caused by arthritis, a ganglion cyst, gout, and bursitis can look like a bunionette to the untrained eye. In order to know for sure whether the pain and swelling you are experiencing is a bunionette or one of these other common conditions, you should see a podiatrist as soon as possible.

As an experienced foot doctor, Dr. K can examine your foot and take X-rays to see what's going on inside your foot. He will not only tell you what is causing your discomfort but, if it is a bunionette, he can tell you how far advanced the condition is and talk to you about your treatment options.

Do women get bunionettes more than men?

It is commonly believed that bunionettes are caused by tight, pointy-toed shoes like high-heeled pumps and narrow flats. The truth is that this foot deformity is actually caused by genetic factors and often runs in families. Because of this, both men and women can get bunionettes.

However, wearing shoes with small toe boxes that pinch the toes together can make the misaligned bones worse. Because women tend to wear these kinds of shoes more often than men, bunionettes are much more common in women. Also, because women are more likely to want to wear trendy, narrow shoes than men, they are more likely to seek treatment for bunionettes, so they are diagnosed more frequently. 

What causes bunionettes?

A bunionette is not a growth or cyst as some people believe. It is actually a protrusion of the joint that connects the foot to the little toe. The bump is caused by a misalignment of the bone in the foot that forces the joint outward and the pinky toe in towards the other toes. When the bump rubs against the inside of a tight-fitting shoe, a sore spot or callus can develop on the bunionette.

The most common cause of this deformity is a faulty mechanical structure of the foot, which runs in families and can be inherited by both men and women. However, wearing shoes that don't allow enough space for all of the toes to lie flat can make the structural problem worse. High-heel shoes or shoes with narrow pointy toe boxes can rub against the bunionette and cause redness, swelling, and pain.

What is a bunionette?

A bunionette is a small bump on the outside of your foot where your little toe meets your foot. Just like a bunion on your big toe, a bunionette is formed when your little toe turns inward and the joint is forced outward by a misalignment of the bones in the foot. If you wear shoes with a wide toe box or are often in sandals or open-toed shoes, you might not even realize you have bunionette. Most people don't notice the deformity until it becomes painful.

If the bunionette starts to rub against the inside of your shoe, it can become swollen, red, and painful. The more misaligned the bones are, the further out the bunionette will be and the more painful it will become. The only way to permanently correct the deformity is with surgery, but conservative measures can be used to manage the discomfort until it becomes unbearable.

How does a bunion develop?

A bunion is a bony bump at the base of the big toe that gets worse over time. It is not a growth or cyst, however, but rather it is the actual joint between the big toe and the foot bone that is out of alignment. Bunions are believed to be caused by a faulty foot structure that is inherited. A bunion can begin to develop in early adulthood and gets worse with age. Bunions may sometimes develop with arthritis.

Wearing the wrong kind of shoes, such as high heels with pointed toes and other footwear that is too tight, can also make a bunion worse. Shoes with narrow toe boxes squeeze the toes and gradually push the foot bones further out of alignment. You might be able to slow the development of a bunion by wearing shoes with wide toe boxes and using custom orthotics to cushion the ball of the foot. 

What is a bunion?

A common misconception people have is that a bunion is a growth on the side of the foot, like a corn, callus, or cyst. While a bunion looks like a bump on the base of the big toe, it is actually the joint between the toe and the foot bone that is sticking out because of a misalignment in the foot.

When the metatarsal bone in the foot turns outward, it forces the first phalanges bone of the big toe to turn inward. As a result, the joint between the two bones protrudes out the side. In advanced cases, the big toe can be bent to such a degree that it crosses over the smaller toes and puts them out of alignment as well.

A bunion is much more complex than a simple bump, and the only treatment that can resolve the problem once and for all is surgery. Before surgery becomes necessary, however, a podiatrist can help you with conservative measures to ease pain and discomfort.

What are the best shoes for preventing a bunion?

If bunions run in your family, you probably won't be able to avoid getting one, no matter what kind of shoes you wear. However, you can manage a bunion and slow down its progression by choosing the right kinds of shoes.

The best shoes for bunions are shoes that do not have high heels, small toe boxes, or pointy tips and are not too tight. You want shoes that provide good arch support, sufficient padding, and can stretch and "breathe." When trying on shoes, the big toe should not touch the end of your shoe. Make sure there is a thumb's width of room between the tip of the big toe and the end of the shoe. The shoe should also be wide enough to provide you with room and comfort.

If you are involved in activities that require you to wear constrictive shoes, such as ballet dancing or cycling, you are at a higher risk of developing and irritating bunions. If you are a competitive or recreational athlete, keep in mind that ill-fitting athletic shoes can also make your bunions worse. Seek comfortable, flexible footwear that fits properly to protect against bunions.

Do bunion shields work?

Bunion pads or shields can be an effective way to reduce the pain, irritation, and inflammation of a bunion.

Bunion shields cushion the irritated area of a bunion and help keep a bunion from brushing against the inside of the shoe. A gel-type bunion shield usually provides the most relief, but a silicon-based bunion shield is the most durable and can withstand multiple uses. A bunion shield is placed over the bunion at the base of your big toe. It is also important to wear comfortable shoes with wide toe boxes because you do not want to add more pain and pressure to your bunion in cramped shoes.

However, if the pain and swelling from your bunion continue, then you need to seek medical care from an experienced foot doctor.

How soon after my surgery can I go back to work and participate in sports?

Traditional bunion surgery can keep you off your feet for up to three months. However, minimally invasive AMI-BUNION® bunion surgery developed and perfected by Dr. Ali Khosroabadi significantly reduces recovery time. Every patient is different, but Dr. K's surgery patients are usually back on their feet in two to four weeks.

Once you are back on your feet, it really depends on how you feel as far as engaging in sports, but most patients are able to do normal daily activities, including participating in sports, within a month after surgery.

How can an orthotic help if I have a bunion?

If you have a severe bunion, you may experience pain when you put pressure on the ball of your foot. The misalignment of the bones that causes the bunion can also throw off your balance, making you compensate by walking on the inside or outside of your foot. A custom-made orthotic can resolve some of these common problems.

Custom orthotics are devices made especially for your feet. They are designed to provide the exact support you need by matching the contours of your feet and the way you walk. A podiatrist creates your custom orthotic after examining your foot and taking an impression.

Prescription orthotics are divided into functional orthotics and accommodative orthotics. Functional orthotics are used to control pain caused by abnormal motion and to treat injuries like shin splints or tendinitis. Functional orthotics are often made from a semi-rigid material. Accommodative orthotics are normally softer to provide your feet with additional cushion and support.

If your bunion is causing you pain when you put pressure on your foot, your podiatrist might recommend an accommodative custom orthotic.

Can bunions be corrected?

Many times bunions can be managed, but not cured, with non-surgical treatments, including the following

• Wearing footwear in the correct size with good padding and arch support
• Placing bunion shields over the area of the bunion
• Avoiding activity that causes bunion pain
• Taking anti-inflammatory drugs such as ibuprofen
• Applying ice packs
• Injections of corticosteroids by a doctor to reduce inflammation

However, if a bunion gets progressively worse, then surgery is likely to be the only option. Traditional bunion surgery leaves scars on the outside of the foot and scar tissue inside the foot, which results in more pain and swelling. There may also be a loss of range of motion for the big toe, which requires physical therapy.

Fortunately, Dr. K's AMI-BUNION® bunion surgery uses a much smaller incision than traditional bunion surgery. This means no scarring on the outside of the foot and very little, if any, scar tissue inside the foot. Dr. K's patients normally experience far less swelling and pain than people who have traditional bunion surgery.

Are there different kinds of bunions?

There are two main types of big toe deformities that are often referred to as bunions, although they are different conditions. They are:

• Hallux valgus. This is what most people mean when they talk about a bunion. It appears as a "bump" on the side of the big toe. This bump reflects changes inside the framework of the foot. The big toe leans toward the second toe instead of pointing straight ahead.
• Hallux rigidus. This term refers to a form of degenerative arthritis in the big toe that causes pain and stiffness in the joint. Over time, it gets increasingly harder to bend the toe. In some cases, a bone spur forms on the big toe that resembles a bunion, but is not. People with bunions also sometimes develop this type of arthritis, but it can also occur with no deformity whatsoever.

If you have pain and stiffness in your big toe, it's important to get an accurate diagnosis. Bunions and arthritis are treated in different ways.

What causes bunions?

Doctors don't know exactly what causes bunions, but it appears to be related to the genetic foot structure that you inherit from your parents. Certain types of foot structures are more prone to developing bunions than others. A bunion is a progressive disorder, which means it will get worse over time. It doesn't fix itself.

However, a bunion will get worse faster if the wrong types of footwear are worn. Shoes with narrow, pointed, toe boxes that squeeze the toes into an unnatural position (i.e. high heels) can contribute to worsening bunions. According to the American Orthopedic Foot and Ankle Society, 88 percent of women in the U.S. wear shoes that are too tight and 55 percent of women have bunions. Also, women get bunions nine times more often than men.

I have seen ads from a different doctor doing silicon implants and getting toe-lengthening results immediately. Is that a good treatment?

If something looks too good to be true, it probably is. That definitely holds up when we look at silicon implants as an immediate fix for brachymetatarsia or short toes. Despite what you may have seen another doctor claim in TV ads, toe implants are the worst surgery being advertised for brachymetatarsia. The immediate results might look o.k., but the procedure is very temporary.

In the procedure, the surgeon puts a silicon implant in the joint to try to achieve a cosmetically acceptable result. However, there is no explanation of how the toe joint will function later. The implant could very likely dislodge and destroy the joint sooner or later. Don't risk the functionality of your toes for a quick fix that won't last.

I have more than one toe that needs to be lengthened on each foot. Can the same surgery be performed?

Brachymetatarsia is a genetic condition that causes one or more bones in—usually—the fourth toe to stop growing while the other toes keep growing. In children with this condition, growth of the affected toe usually tops when they are around 7 or 8 years old. Brachymetatarsia can happen on one foot or both feet, but it is unusual for it to affect more than one toe on the same foot. Even though this is not common, Dr. K has operated on feet that have had up to three toes affected by this condition, so, yes, he can perform the same surgery on more than one toe on each foot.

Will Dr. K do my toe-lengthening surgery himself?

Yes, absolutely! This surgery is very complicated and needs an experienced hand. Dr. K is one of the most experienced toe-lengthening surgeons in the country.

Dr. K will explain exactly what he will do during your procedure, but generally speaking, he will surgically place a small device on the toe bone. By turning a screw on the device at home, your toe bone will be gradually lengthened over time. These adjustments are usually painless. Alternatively, Dr. K might cut the toe bone in half and insert a graft between the two halves of the toe bone to lengthen the toe. After a few weeks, the bone graft heals and becomes part of the original toe bone.

How long after toe-lengthening surgery will I be able to wear high heels or participate in sports?

Brachymetatarsia is a condition in which one of the five long bones of the foot (the metatarsals) is abnormally short, resulting in a shortened toe. It is also referred to as short toe, short metatarsal, small toe, stubby toe, short fourth toe, and short toe syndrome. 

Whatever you call it, you are anxious to get it fixed and get back to your normal life. The good news is that after completion of the toe-lengthening process, most patients usually only need a few months to fully recover. Every patient is different and, depending on how well your new bone develops, Dr. K will let you know when you are cleared to resume normal activities, including wearing high heels and participating in sports.

Are there going to be big scars after my toe-lengthening surgery?

During brachymetatarsia surgery, small incisions are made along the affected metatarsal bone, and pins are inserted into the bone. The pins feed into the device that you will turn to gradually lengthen the short bone.

After your surgery, the incisions will heal completely. Usually, after about a year, there is no or very minimal visible scarring. Keep in mind that some people may scar more than others. Please let us know if you are prone to keloids, as this condition could leave a scar after any type of surgery.

What are possible complications following toe-lengthening surgery?

Dr. K has unmatched experience in performing toe-lengthening surgery. Because of his skill and experience, it is a low-risk procedure.

However, every kind of surgery carries some amount of risk. Before you consent to the surgery, Dr. K will give you a list of the most common complications that can arise after the toe-lengthening procedure. Rest assured that he will treat any complications that may arise.

Is it possible to get an infection from the external fixation device?

Because an incision is made in order to place the external fixation device during your toe-lengthening surgery, there is a slight risk of infection. You could develop a superficial infection, causing tenderness and redness around the pins of the external fixation device.

If you do show signs of infection, Dr. K will prescribe antibiotics that will quickly take care of it. Be sure to report any pain, swelling, or redness around the pins to Dr. K. as soon as possible.

When will the external fixation device be removed from my toe?

The method Dr. K uses to lengthen a short toe is a gradual process. The bone is cut and pins are placed in it and attached to an external device that is turned a little bit each day to stretch out the bone. Because you are generating new bone throughout the process, this takes time. How long it takes for you will depend on several factors. However, for most people, the external fixation device is removed after anywhere from eight to 16 weeks.

Do I always turn the external fixation the same amount during the lengthening phase?

The amount you turn the external fixation device depends on the rate at which you are growing new bone. Dr. K will see you in his office every two weeks to take X-rays and chart your progress. Based on his X-ray findings, Dr. K may change the external fixation turn rate. If your toe is not growing enough new bone, Dr. K will slow down the rate of turning so new bone can develop. If Dr. K finds the bone is getting solid at a faster rate, he might speed up the turn rate.

You will get very clear instructions about what to do, so you will not have to worry about doing the wrong thing. Keep in mind that if you are from outside of California, you will need to go to a doctor who will take and send the X-rays to Dr. K every two weeks.

When will I get instructions on adjusting the external fixation?

Before coming in for your toe-lengthening surgery, you will have a good idea of the entire process. After surgery, you will be sent home so that the incisions can heal and the external fixation device can settle in. Within a week after the surgery, Dr. K will see you in his office to give you instructions on how to adjust the external fixation at home. Generally speaking, the bone will be lengthened approximately .5 mm per day, but that can vary. Dr. K will give you instructions based on your specific situation.

How long does Dr. K’s minimally invasive brachymetatarsia procedure take?

During the brachymetatarsia procedure, Dr. K cuts the bone and inserts pins that will attach to an external device. Your toe is not lengthened during the surgery itself, but over time by turning the device. Because every patient is different, each procedure is slightly different, but the surgery usually takes anywhere from one to three hours.

What method does Dr. K prefer to fix brachymetatarsia?

Dr. K has performed hundreds of toe-lengthening surgeries and uses several different methods, depending on the exact cause of the shortened toe. This is where Dr. K’s experience is so valuable. He will examine the patient and choose the method that best addresses the patient’s specific condition.

How does casting work to correct clubfoot in babies?

Dr. K is trained in the Ponseti Method for correcting clubfoot and has performed this protocol on hundreds of patients. Placing the baby's feet in casts is an essential part of the treatment. During the casting process, Dr. K gently moves the baby’s clubfoot toward the correct position of a normal foot and then places the clubfoot in a tiny plaster cast to hold it. Every five to seven days after that, the baby’s clubfoot is gradually moved by about 10-15 degrees and placed in a new cast.

Usually, five to six casts are used in the Ponseti Method. However, very stiff feet may need eight or nine casts over two months. After the casting is over, the baby will need to wear a foot brace for three months, 23 hours a day, to hold the foot in the correct position.

When should clubfoot treatment begin?

Babies born with clubfoot should begin treatment with casting within seven to 10 days of birth while the baby’s bones are still soft. In most cases, you can prepare for this well before the baby is born. Most cases of clubfoot are diagnosed before birth during a routine ultrasound. About 80% of clubfoot cases can be discovered at 24 weeks. After the baby is born, there may be an X-ray or a CT scan done to show the baby’s foot bones, ligaments, and tendons, and then treatment can begin.

Does the Ponseti Method hurt the baby?

The Ponseti Method does not hurt the baby because the castings and adjustments are done very slowly and gradually. The baby’s muscles, ligaments, and bones are still soft and can be easily manipulated to the correct position. The difference it will make in the child's ability to walk normally in the future is invaluable.

Who created the Ponseti Method to fix clubfoot?

Dr. Ignacio Ponseti, a faculty member and practicing physician at the University of Iowa, noticed that traditional clubfoot surgery did not fully correct clubfoot and often created problems later. In the 1950s, Dr. Ponseti developed the non-surgical method of slowly moving the clubfoot to the correct position with a series of castings. Many podiatrists have since been trained in this method, including Dr. K, who has successfully performed the protocol hundreds of times.

What causes babies to have clubfoot?

While no one knows the specific cause, clubfoot is believed to be both genetic and environmental. Clubfoot may have something to do with the position of the baby in the uterus. It has been noted that there is a decreased amount of amniotic fluid in the uterus during pregnancy. Sometimes babies with clubfoot also have cerebral palsy or spina bifida. The good news is that it is correctable when treatment starts early.

How often does clubfoot happen?

Parents often struggle when their baby is born with an abnormality. They worry that the child will have a difficult road ahead and might be limited in what they can achieve. However, if your baby was born with clubfoot, there is no need to worry. Effective treatment is available, and most patients achieve a total correction of the deformity.

The good news for expectant parents is that clubfoot is very rare, only occurring in one out of every 1,000 births. Males are twice as likely to get clubfoot as females, so if you are having a girl, the chances are even less.

Will I need surgery for hammer toes?

If you have severe hammer toes, you made need to have surgery to fix the tendons and straighten the toes. Surgery helps get rid of the pain and enables you to resume regular activity. The good news is hammer toe surgery is an outpatient procedure, and requires minimal healing time.

What can I do if I have hammer toes?

If you have a mild form of hammer toes, there are conservative measures you can take to reduce pain and continue being active. You should get new shoes that are wide enough and long enough to accommodate your foot. You may need a small splint, padding, or tape to hold the toe in the right position and change the muscle imbalance. Custom shoe inserts (orthotics) can also be helpful. The pain can be treated with anti-inflammatory drugs such as Advil and Aleve, or with cortisone injections in Dr. K's office.

Are there different types of hammer toes?

There are two types of hammer toes, flexible and rigid.

You can straighten a flexible hammer toe with your fingers and it may not cause pain. If left untreated, a flexible hammer toe’s tendons can tighten, the joint may become misaligned, and the toe can turn rigid. You cannot move a rigid hammer toe. It is often painful and can interfere with walking.

What causes hammer toes?

Hammer toes happen because of a muscle imbalance, tight tendons, or tight ligaments that normally hold the toe straight. Hammer toes can occur when toe muscles become weak, which puts pressure on the toe’s tendons and joints.

Narrow, ill-fitting shoes, your genetic predisposition, or an underlying medical condition can all contribute to hammer toe development.

How do I know if I have a hammer toe?

Hammer toes happen when one or more of the small toes develops a bend and curls under. The toes look like a hammer or claw. Hammer toes may become sore and difficult to move. As a foot doctor, Dr. K can examine your toes and take an X-ray to see what’s going on inside your foot.

What is a hammer toe?

A hammer toe is a toe other than the big toe that unnaturally bends or curls downward. The bend in the toe looks like the head of a hammer, which is where it gets its name.  

There are two kinds of hammer toes, flexible and rigid. Flexible toe joints can usually be moved back and forth. Rigid toe joints cannot be straightened and may be painful. When hammer toes interfere with walking and cause pain, it's time to see Dr. K for a diagnosis and treatment plan.