Acorn Article
August 2000
When Is A Bunion Not A Bunion
By: Michael Zapf, DPM, MPH, FACFAS
I finally had a real Deli Pastrami. As I write this I can still taste the pastrami from
Katz Deli in New York’s Lower East Side. My family and I stopped there for lunch just
before winging our way back to the Conejo from the Big Apple. (Look for our vacation photo
in an upcoming Acorn). For fifteen years I have been listening to the lament of my New
York patients that you "just can’t get good deli out here" so I went and
tried it for myself. Katz is one of New York’s finest and oldest delis. They have
been hand-slicing their pastrami and corned beef since 1888. The sandwich was wonderful,
piled high with the thickest and leanest pastrami I have ever had and served by a waiter
who worked there for 35 years. I even got "yelled at" for loosing my punch
ticket they use to keep track of the food. Going to Katz was a wonderful experience, but I
have a secret for all you who are not from New York: some our local Delis are good too.
Don’t tell the New Yorkers, though. Now to the bunions.
A bunion is the enlarged bone just behind the big toe. With a bunion the big toe
usually leans over and crowds the lesser toes. For many people bunions hurt so much that
bigger shoes and decreasing activities are not an option and surgery is the only choice.
Because of the active and young population of our community I do a lot of bunion
surgeries.
With that said, I didn’t do three bunions this week. Now that may not seem like
such an odd statement but these were three patients who actually had a bunion but or one
reason or another we decided not to do anything about it. Let me tell you about them.
Marvin was easy. He is an 88-year-old retired teacher with huge bunions. He has lived
with them for at least 50 years and is in no hurry to have them operated on. But the right
one is now hurting. Fortunately for Marvin his pain was made worse by an attack of gout. I
say fortunately because with a short course of an anti-inflammatory medication he can
quiet down his gout and live, again, long and happy with his bunions. Marvin, by the way,
is from New York and loves Katz.
Ariel is 13 and has a bunion that hurts when she plays basketball. It is not surprising
to see a teenager with bunions. Sometimes they start as early as 5 or 6 when there are
strong forces that lead to their formation. She is a candidate for bunion surgery and will
get one eventually but not right now. I suggested that she wait until her foot matures and
the growth plates in her feet close. Then we can get a better assessment of the amount of
correction she needs for a perfect correction. In the meantime I will make her a pair of
custom orthotics that can counter at lest some of the forces causing her bunions.
Finally there was Kathy, a 32-year-old real estate professional. She has bunions and
wanted advice on getting them fixed. Both of her sisters were happy with their recent
bunion surgeries. I told her my three criteria for not fixing a bunion: First, if they do
not hurt wearing the shoes you need to wear when doing the things you need to do. A
realtor needs to wear much different shoes than a fitness trainer. Kathy’s bunion did
not hurt even in the highest of heels. The next two criteria need an x-ray. Second, if the
x-rays indicate that the size of the bunion gets close to the point of no return I
suggest a bunion surgery. When a bunion goes from medium to large it suddenly gets hard to
fix and has a reduced likelihood of long-term success. Kathy’s was safely in the
small to medium size. Third, I suggest a surgery if there is visible damage to the bunion joint
or neighboring joints due to the position of the bunion. Kathy’s x-rays did not show
any of the tell tale signs of the damage a bunion can cause. Her cartilage was undamaged
and there were no changes to the neighboring toe joints. I cautioned Kathy to return in a
year or so for follow-up examination but just because she noted a bunion was no reason to
have a bunion surgery.
So this is a strange thing to say, but if you don’t want your bunions fixed, go
see your local podiatrist. You might be surprised at what we don’t do. And if you
want a good pastrami, stay local. But remember, don’t tell the New Yorkers I said
that.
Dr. Michael Zapf is a board certified podiatrist in private practice in Agoura and
Thousand Oaks since 1985. For more information or a copy of his 20+ page Bunion Brochure,
please call his office at 818-707-3668.
