On Friday, I had my final post-op visit with Dr. Herbst. He told me everything looked great and that I could return to any activities I chose, including “jogging, cycling, Zumba…” I wrinkled my nose. “I hate Zumba,” I said. He said, “I don’t know anything about it. I just know it’s a big trend right now.”
Not with me, buster. Not with me.
I knew this would be my last chance to ask him all my questions, so I wrote them down in a notebook which I took along and then I accosted him with inquiry.
The first thing I asked was why there are two incisions. He smiled and said, “That’s a really good question, and most people don’t ask.” (See! I’m smart!) He said that the smaller incision, which is kind of between the first and second metatarsal, is to realign the sesamoid bones. Those little bones, which should be under the first metatarsal, get shifted inward as the metatarsal gets shifted outward.
Here’s a photo of my pre-op x-ray:
The sesamoid bones are really hard to see in this picture (they are much more evident in the original x-ray), so I’ve highlighted them below so you know where to look.
Dr. Herbst said that 10 or 12 years ago, doctors didn’t think it was necessary to move the sesamoid bones back into the correct position, but then it was discovered that without moving them, the bunion was much more likely to recur. So he stretched the tendons so that the sesamoids are back under the first metatarsal the way they are meant to be. If a patient does not have severe bunions, then the sesamoids haven’t shifted and don’t need to be moved. But in my case, it needed to be done.
I also wanted to know about the bone bump he had shaved off. When the surgical nurse had showed it to me, she pointed out that it was all bumpy. “Is that normal, and does that cause pain?” Dr. Herbst said it’s totally normal. He said that when the capsule (bone bump) grows, it just grows bumpy. Even in people who don’t have bunions, if that part of the bone has to be cut off, it’s bumpy.
I told him that my second toe on my left foot is still numb. “At this point, that’s not going to come back, is it?” I asked. He said it might. The nerve that goes to that toe gets moved when he works on those sesamoid bones, which confuses the nerve. It can take a while for the feeling to come back, but in a few more months, it might be fine. Even if it remains numb, my body will get used to it and I won’t notice it as much. I said I hoped so, because it was really affecting my quality of life.
When asked the relationship between overpronating and bunions, and whether one causes the other, Dr. Herbst said it’s a chicken and egg kind of thing. If you overpronate, you’re more likely to have bunions, and the bunions may worsen the pronation. He said it’s largely heredity for both. And as far as bunions and heredity go, I was pretty much doomed.
Then I asked him what his opinion is about barefoot running, or running in minimalist shoes. He kind of smiled, thought for a minute, and said, “I think it’s good for my business.” He said that there are probably some people who are thin and have great mechanics and great form and are just light on their feet and built to run, and for them it’s probably fine. But he thinks most people are likely to get hurt. He admitted that the jury is still out regarding long-term effects, and he said he hasn’t read The Book (Born to Run by Christopher McDougall, which seems to have started the trend), and he needs to. Still, he said he prefers the support that a running shoe offers.
So I might try it on some soft, grassy turf sometime. But I’m not going to go all crazy about it. I really like my doctor and all, but I don’t really want to have to go back to see him.
And now the bunion story is coming to completion. I am still working on finding shoes, and I’m still getting back into running. And I haven’t gotten my pedicure yet, so there are still a few more posts to write. But I think in the next six months or so, I’ll really be able to call myself bunionless.
Although since that’s a strange adjective that probably isn’t even a word, I likely won’t actually call myself that.
But I could.