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Is surgery always appropriate for bunions?

Dear Dr. Gott: I have had a bunion on my right foot for a long time. It is very painful. My foot doctor has cut the side of my shoe off so the bunion can extend out. This is the only pair of shoes I can wear.

I may have to have surgery, but some of my friends have told me the bunion will probably grow back. Do you know of any ointment that I can put on it? Or what else would you suggest I do?

Reply: A bunion is a bony protrusion on the joint at the base of either big toe. There are a number of reasons for them to form, the most common of which are poorly fitting shoes, congenital deformities, foot injury and arthritis.

Symptoms include the obvious bulge of the bunion, intermittent or constant pain when wearing footwear, swelling and skin thickening at the base of the great toe. The toenails may grow into the sides of the nail bed, and some bones may bend permanently at the joint.

Treatment commonly begins with a conservative approach, such as wearing shoe inserts, using appropriate padding, taking over-the-counter pain relievers and wearing better-fitting shoes. As your physician apparently pointed out and took measures to correct, cutting the shoe at the site of the bunion is yet another means of accommodation; however, if you live in a cold climate, this could certainly present its own set of difficulties during the winter.

When conservative measures fail to be effective, surgery might be appropriate. A podiatrist has several options, depending on the severity of the deformity. In some instances, a patient will be able to walk as soon as the procedure is completed.

In other cases, it may take two months or longer before complete recovery occurs. Recurrence occurs post-surgery if a patient continues to wear ill-fitting shoes. Thus, appropriate footwear is vital. This may be what your friends refer to when they indicate a bunion can grow back.

I recommend you make another appointment with your podiatrist to determine what might be best for you, based on your age and possible medical conditions. Get all your questions answered before making any decision to undergo even the simplest surgical procedure.

If questions still remain, request a referral to another podiatrist for a second opinion. Until a firm decision can be made, consider using bunion pads, icing the area a couple of times each day and using ibuprofen or acetaminophen.

To provide related information, I am sending you a copy of my Health Report 'An Informed Approach to Surgery'. Other readers who would like a copy should send a self-addressed stamped number ten envelope and a $2 cheque or money order to Newsletter, PO Box 167, Wickliffe, Ohio 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Dear Dr. Gott: I am a 70-year-old female who began experiencing restless legs at age 20. I understand you have discussed using hawthorn berries for control and would like to know more about this alternative treatment. Thank you for your help.

Reply: Hawthorn berries contain antioxidant properties and improve blood flow to the heart. Readers have also indicated the supplement has helped with the muscle twitches and tremors associated with restless-legs syndrome, Parkinson's and hypertension.

Check with your primary-care physician before using hawthorn berry, because some herbals can cause unwanted side effects if taken with other drugs. If you choose to continue, be sure to follow the packaging directions for recommended doses.

Dr. Peter H. Gott is a retired physician and the author of several books, including 'Live Longer, Live Better', 'Dr. Gott's No Flour, No Sugar Diet' and 'Dr. Gott's No Flour, No Sugar Cookbook', which are available at most bookstores or online. His website is www.AskDrGottMD.com. Contact him c/o United Media, 200 Madison Avenue, fourth floor, New York, New York 10016.