bunions, morton's neuromas in both feet

My podiatrist has recommended lapidus bunionectomy, neurectomy and tailor bunionectomy to correct the major issues i have with my feet. One foot at a time, of course. I also have lost the cartilage at the joint of the big toe. I function normally now and the worst of the pain is when i am on my feet for long periods or walking (sight-seeing). My question is about timing the surgery ~ should I wait until the pain is unbearable and i basically cannot walk without pain or should i go in now while I still have good mobility and the second foot is still OK? Also, in doing research on this, i have read many horror stories of the post-op pain and patients being disappointed with the results of their surgeries. How common is this? Thank you.

RESPONSE

Hi,

Your concern is a dilemma that many people face when contemplating elective surgery and this is not limited to foot issues.
There are two schools of thought here. One, as you pointed out, is to have the surgery now, while you are healthy and can undergo the surgery and probably limit your downtime, as opposed to waiting until the pain is unbearable at which point you will probably be older, the healing process will take longer and perhaps even more procedures will be required to correct your problem, because the situation has deteriorated.
I like to refer to the risk reward ratio when deciding on surgery.
Every surgery has risks involved. One of those risks is surgical failure, whereby you are no better off, or even worse, after surgery than you were before surgery. This can happen even without complications such as infection, etc.
As marvelous as your surgeon may present the procedures he or she wants to do, the surgeon cannot do one thing and that is guarantee a good result. Sometimes what looks good on the "drawing board" does not translate well on the operating room table.
So, for you to take on the risk of surgery, you really need to be in a lot of pain, so that the risk reward ratio works in your favor. In other words you would not undergo all this surgery if you were only having marginal pain.
My criteria becomes one where when your feet hurt so bad that they adversely affect your life style, then perhaps it is time to consider surgery. When you start avoiding certain activities because you know your feet will hurt, then your feet are adversely affecting your life style. I would not consider surgery, however, until you at least tried some conservative therapy. Based on your problems I would suggest trying a wider, boxier shoe to accommodate the bunion and tailors bunion as well as an orthotic to deal with the neuroma issue.
I do not know if you are male or female but am guessing female, so then the issue of how conservative a shoe you are willing to wear comes into play. Only you can answer that.
The good news here is that fortunately you do not have life threatening or even limb threatening medical problems, so you can take some time if you chose, to think all this through. Good luck!

Marc Mitnick DPM
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