2008-11-06 / Health & Wellness

Hope for teens suffering from bunions

By Michael A. Zapf, DPM

In the past I've written about bunion correction for children and bunion correction for adults but I seem to have left teenagers out of the discussion.

For children with bunions, you may recall, we offer orthotic support to resist the forces that want to increase the size of a bunion and, if their growth plates are still open, growth plates stapling procedures to reduce the bunion as they mature.

For adults with bunions we offer several well-defined and successful surgical procedures because conservative therapy rarely works for an adult bunion. But what about teenagers?

I'll use Cameron as an example. Cameron is a local high school freshman who plays on the basketball team and has a bunion that hurts. By the time Cameron saw me, he had already tried more comfortable shoes, padding of his foot to protect the bunion and even taken antiinflammatory medications to reduce his post-game pain and discomfort.

The advice he had been given from his pediatrician, and another surgeon, was to simply live with the pain until he became physiologically mature enough, perhaps at age 18, to have an adult type bunionectomy. This advice was not working for Cameron who came to our office in desperation.

My examination found Cameron to be in excellent health and could easily undergo a bunion surgery. I sympathized with the previous doctors who wanted to see the shape Cameron's foot would be in before planning surgery. But for Cameron this would be four more years of cruel and unusual punishment.

I proposed to Cameron, his parents and his pediatrician that a bunion surgery could be done safely, with a reasonably quick recovery and he would be back on the court in less than three months.

I do not believe that teenagers need to be left in pain just because they are not physiologically mature. Every child with a painful bunion deserves to be examined and evaluated as an individual.

There is a lucky medical happenstance that makes Cameron's surgery possible. All long bones of children have a growth plate that allows for the bone to lengthen. This holds true for the little long bones of the foot called metatarsals. You do not want to do any surgery around the growth plate.

Fortunately, the growth plate of the first metatarsal, the one involved with bunions, is at the base of the bone and not the head where the surgery is usually done. This allows for a bunion surgery to be performed on most adolescents safely.

I had a nice discussion about this with Cameron's pediatrician who, fortunately for Cameron, saw the merits of my point of view.

With his pediatrician's consent, bunion surgery was performed on Cameron a week after his basketball season ended. The outpatient surgery was done under local anesthesia with a little sedation. For one month after surgery Cameron walked in a postoperative shoe followed by a second month of walking in an athletic shoe. Physical therapy was begun three weeks after surgery and by three months after surgery he was back on the court.

I am the father of a teenage athlete and I know how anxious these kids are to remain active and avoid surgery. Sometimes this is not possible. Sometimes the choice is between surgery to remain active and inactivity until they get "old enough" for surgery. I believe that neither inactivity nor playing with pain is usually the best answer if there is a reasonable alternative.

Zapf is a podiatrist in private practice at the AgouraLos Robles Podiatry Centers. He will be giving his lecture "Bunions, Bump and Beautiful Feet" at the Thousand Oaks Surgical Hospital on Oct. 29. Call (805) 4181255 for details and reservations.

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