ACORN Article
By: Michael Zapf, D.P.M.
January 2003
Hat trick, Triple Crown, and triple-double are three examples of names given
to accomplishment in threes. On the last Thursday in December I accomplished a
triple accomplishment of sorts: the triple no pain. My surgery day is Thursday
and I usually perform two or three foot surgeries. On that special Thursday I
did three relatively routine bunionectomies. What made them special was what
they told me the following week when they returned. None of the three needed to
take even one pain pill. I am not telling you this to brag but to dispel one of
the myths of foot surgery – that it is always painful.
I did my foot surgery residency in the mid 1980s. Patients at that time
routinely spent 3 days in the hospital for a bunion surgery. The first day after
surgery was spent just "dangling" their feet but without walking. Physical
therapists would help them walk on the second day and they would be ready to go
home on the third. During their stay in the hospital they started with
intravenous Demerol for pain and we would wean them to oral medications by the
time of discharge.
Insurance companies were the first to see the needless coddling these
patients were receiving. While the doctors complained, the "heartless" insurance
companies stopped paying for overnight stays for bunion surgeries. And to tell
the truth, they were right. By 1987 nearly all bunion surgeries were performed
on an out-patient basis and they rarely needed more than a prescription of pain
pills, and sometimes less.
Since that time we foot surgeons have refined our techniques to what they are
today: highly predictable and usually nearly painless. Most bunion surgeries are
done at a surgery center or the outpatient department of a hospital. Patients
return home only a few hours after the procedure and usually walk the same day
in a post-operative surgical shoe.
Among the techniques that make this procedure, and most foot surgery for that
matter, less painful is the delicate handling of the tissues of the foot during
surgery. When an instrument is used that might create heat, a cool irrigation is
used. When a bone is cut it is done in such a way as to minimize any movement of
the pieces. If that can’t be done, screws are used to eliminate movement that
would otherwise result in pain. During the procedure a long acting Novocain-like
anesthetic is used so that there is no pain on waking up. I like to have my
patients take an anti-inflammatory medication starting two days before surgery.
This is called preemptive analgesia. After surgery the use of ice packs reduces
painful inflammation even more.
Maybe there are reasons not to have a bunion repaired, perhaps other medical
conditions or the timing is inconvenient, but pain should not be one of them. So
if the fear of pain is keeping you from calling your foot doctor, I have three
reasons that might change your mind.
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Dr. Michael Zapf is a podiatrist in private practice in Agoura Hills and
Thousand Oaks. For more information on bunions and foot care see the web site:
www.conejofeet.com or call his office at (818) 707-3668
