One foot under: blitzing bunions

I had co-existed happily with my bunions for years - until last summer, when I noticed that both my big toes had started to drift alarmingly across their neighbours. My feet looked far too ugly to wear sandals, but my concerns were not merely cosmetic. My bulbous big toe joints, rubbing painfully against my shoes, had become red and inflamed. I had to wear trainers for any walk that took longer than 10 minutes.

Still, when the orthopaedic consultant I'd been referred to by my GP recommended surgery - starting with my worst-affected, right foot - I hesitated. Most bunion surgery is brutal (the bone joining the ankle to the toe is usually broken and re-set), painful (comparable to childbirth, according to comments on one website) and entails a long recovery period - usually several weeks on crutches, followed by months of stepping gingerly; no dancing, no parties, and certainly no aerobics.

Was this drastic measure really necessary? It wasn't as if I was in constant pain or couldn't walk. Then there were the possible risks I'd read about - among them, damage to the big toe and permanent numbness, swelling and failure of the bone to heal properly. An off-hand comment from a hospital registrar that the operation "will turn your life upside down" didn't help matters.

On the other hand, I was (relatively) fit for surgery and could temporarily work from home. The consultant had said my bunions would only get worse; did I really want to face old age hobbling round in misshapen, oversized shoes? My partner's aunty Patsy, 86, said she regretted not having had hers done years ago. And my friend Maxine, who'd had the operation, had been delighted with the result.

The night before the operation, I loaded the freezer with ready-made meals, stuck a list of household instructions on the fridge door and scrubbed myself all over with the hospital's special anti-MRSA soap.

I had never been an inpatient before. Shortly after arriving, I sat on a narrow bed in one of those hospital gowns that humiliatingly fall open at the back, while my right shin was marked with a downward pointing arrow and an identity band snapped on my wrist. There was no going back but, still full of trepidation, I burst into tears in the anaesthetic room.

A bunion isn't just a superficial bump; it is caused by an underlying deformity (both genes and bad footwear could be responsible for this, but it is far more common in women, affecting up to half of them) in which the main bones of the big toe joint develop at an angle to each other rather than being in line. There are over 100 different ways to correct this, depending on the type of deformity you have. I had the most common type of surgery - a metatarsal osteotomy, in which the first metatarsal (the bone in the foot which links to the big toe), is broken, re-aligned and fixed in place with metal screws, and the bunion bump on the bone is shaved off.

I had opted for a spinal rather than a general anaesthetic, so I was awake during the operation, but numb from the pelvis down and euphoric from the sedation I had been given. Staring up at the theatre lights, listening to the opera Carmen bizarrely blaring out of a CD player while surgeons attended to my foot behind a discreet paper screen, I didn't feel, see or hear any of it. Afterwards, my foot bandaged, I was fitted with an oversized black nylon slipper with a stiff sole to be worn for six weeks at least.

I was in hospital for three nights. The low point: having to use a bedpan for the first time in my life. The high point: finally managing to get to the bathroom on crutches on day three.

Back home, enforced leisure posed its own challenges. Keeping my foot elevated for most of the time to reduce pain and swelling was uncomfortable and boring; wobbling up and downstairs on crutches was terrifying. I was dependent on my partner and teenage kids, who coped heroically, but grew increasingly irritated by my constant demands for cups of tea, clean sheets and anything else that could make prolonged periods of rest more bearable.

After a few days, my foot was no longer painful, but I worried about what was happening underneath the increasingly grubby bandages. Was it healing? Could it be infected? Why did it turn so alarmingly purple if I hobbled around for more than a few minutes? My palms started to ache from using the crutches and the skin on my elbows cracked from constantly pushing myself up on them. During the second week I learned to negotiate the stairs better, and even ventured out for coffee. But life was still difficult.

It has now been over three weeks since my surgery. All dressings and stitches have been removed to reveal a foot that bears little resemblance to how it was. It is still slightly swollen, with a large scar down the side; but the ugly bump has gone and, to me, my new foot is surprisingly nice looking. However, my big toe is stiff and still pointing slightly inwards. On the advice of a doctor, I have stuck a wad of dressing between it and the second toe, to encourage it to straighten.

The registrar was right: this surgery does turn life on its head. Looking at the results, though, I think it will be worth it in the end.

I am considering having the left one done - but not just yet.

The podiatrist's guide to perfect feet

• High heels and tight shoes are the main cause of bunions. They put pressure on the outside of the feet, forcing the big toe towards the little toe. Toe spreaders (made from silicon gel) help re-align the toe. Avoid bunions by wearing fitted, well-cushioned shoes.

Corns appear when a tight shoe puts pressure on the top of the toe. The toe keeps producing skin but it doesn't flake off as normal, so a layer of hard skin forms. Corn separators will relieve any pressure and friction. Avoid over-the-counter corn knives - you can cut yourself with them and they breed bacteria.

Calluses are caused by pressure on the foot from ill-fitting shoes. Similar to corns, they form in larger areas across the feet. Use foot cream - with 10% to 15% Urea - daily, until the skin softens.

• A verruca is a viral infection, which produces a fleshy growth. A podiatrist or GP will freeze it to stop the virus from spreading or use a bio-gun, which kills the virus with electricity. Avoid over-the-counter remedies because they aren't strong enough. The best defence is to keep your immune system healthy, so you are not prone to infection.

Inflammation of the heel bone is caused by walking on hard surfaces in high heels or flip-flops. A podiatrist will use ultrasound or laser anti-inflammatory treatment.

• Stubbing your toe can lead to a fungal infection. The nail separates and the infection gets underneath the nail. It won't hurt at first so people often just apply nail varnish and ignore the discolouration. Over-the-counter remedies do not penetrate the nail, so see a podiatrist as soon as possible.

Athlete's foot is a fungal infection caused by not drying your feet properly. Use a liquid or cream such as Canesten until the symptoms disappear, and up to 10 days afterwards, to prevent further infection.

• Tight shoes and badly-cut toenails cause ingrown toenails which break through the skin. Do not touch it, because it is an open wound and prone to infection. Seek professional help from a podiatrist.

Common feet problems can be avoided by wearing shoes that should fit three-dimensionally (length, width and depth) and have a strap mid-foot.

• Your GP can refer you to a podiatrist. If you contact one yourself, ensure they are registered with the Health Professionals Council (HPC) and are an accredited member of one of the following: The British Chiropody and Podiatry Association (, The Society of Chiropodists and Podiatrists (, or The Institute of Chiropodists and Podiatrists (

Charles Goldman was talking to Carlene Thomas-Bailey

Thanks to who have provided this article. View the original here.


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