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GETTING BETTER

One step back, and two forward

When bunions become unbearable, surgery that requires months of recovery is often considered. For one woman, the demanding procedure was worth it.

November 25, 2002|Benedict Carey | Times Staff Writer

Vanity alone didn't deform Yong-Yong Tam's feet. As a young woman, she had danced ballet, leaping high and landing on tender toes. Over the years she'd spent entire days stuffed into ski boots or swim fins. Then there was the 25-year hospital career, working 10 to 12 hours a day, sometime without more than a minute to sit down.

But a woman who owns 100 pairs of pumps, boots, sling-backs and other shoes knows the wages of fashion. "I happen to love high-heel shoes, and I didn't want to give them up," said Tam, 52, an emergency room doctor living in Oakland, "so I admit that vanity did play a part in my problem with bunions."

At a time in her life when she'd earned the right to some indulgence and leisure, Tam found herself considering bunion surgery -- a last resort that doesn't always repair the problem, and requires a lengthy, difficult recuperation that deters many sufferers.

The most common chronic foot complaint, bunions are bony lumps that form at the base of the big toe when the toe tilts toward its neighbor, pushing the joint outward. Some people are born with their big toes leaning over; but usually the deformity develops over years, and mostly in women. Often it's narrow shoes that cause the problem. "With some fashionable shoes, the heels are so high and the fronts so narrow, it's like the ancient Chinese practice of foot-binding," said Tam's physician, Glenn Pfeffer, an orthopedic surgeon in San Francisco. "The foot is rectangular, and the shoe is triangular. You're stuffing a square peg into a triangular hole."

Tam was well aware of the consequences. She also knew that once the big toe angle got beyond a certain point -- between 15 and 30 degrees off center, doctors estimate -- it won't bear much weight. Without the help of its strongest member, the foot's other toes have to take up the slack, and people begin walking on the outsides of their feet. In Tam's case, this duck-walk caused sore knees, hips and lower back; she was moving like a 90-year-old, and in constant pain. "The feet are unique in that if they swell up and hurt, they can affect your entire body," Tam said. "If your feet hurt, you're transferring weight around and trying to compensate and your whole body gets fatigued, it affects your overall sense of well-being."

She tried padded socks, bigger shoes; she bought clogs for work, which helped a little. She spent thousands of dollars on special prosthetic shoes built to protect her toes. But nothing stopped the pain or reversed the slope of her toe. Meanwhile, her work never let up: She was on her feet for 10 to 12 hours at a time. And when she went out, she went straight to her shoe closet. "They're the only thing that goes with a nice, long, svelte gown, with off-the-shoulder straps," she said of her high heels. "I'm not going to wear clogs with something like that."

By late last year, after she'd exhausted all other options, Tam decided it was time for surgery. Her feet had acquired a more pronounced shape, they hurt constantly, and she couldn't get them into ski boots or fins. Finesse wasn't the answer: Brute force was. In bunion surgery, the big toe is fractured, the deformed joint surfaces are shaved off, and screws are inserted to hold the newly straightened bones together. It's not cheap: With doctor's expenses, anesthesia and follow-up, the bill can range from $5,000 to $15,000 per toe. Tam's insurance brought her cost down to about $1,500 for each foot. After meeting with Pfeffer, Tam elected to do one foot at a time. "You need to be able to get around," she said, "so doing both at once was out of the question."

After a few hours in Pfeffer's office, Tam was back home, with a bottle of prescription painkillers.

She could not put weight on the foot for the first month and half, however; and having to wear a clunky plastic shoe to protect her toe, she couldn't return to anything near regular activity for three months. "I read a lot of books," she said.

Only now -- after the second surgery, done four months after the first -- has Tam been able to work, part time.

"If you're dependent on your wages, like most of us, then you really need to be somewhere that has a disability policy," Tam said. "I've had to take a lot of time off."

Sandra Pope, 44, a dancer living in Huntington Beach who had bunion surgery on one foot a month ago, has set aside about six months for full recovery.

"I may be able to do some limited moves after a couple of months," she said, "but it's going to be much longer before I can get back to what I was doing before."

Foot surgery often gets a bad rap because of expectations, Pfeffer said: "People think they're going to get this done during lunch break and be back at work in a week. This is not minor surgery; the bone usually needs about six to eight weeks to heal."

Foot doctors say the best way to avoid bunions is to choose shoes for comfort as well as style. Surveys have found that many American women wear shoes that are more than a size too small. High heels are particularly harmful. According to Pfeffer, a three-inch heel puts seven times more pressure on the toes than a one-inch heel. Shoes that stretch; shoes with heels no more than 2 1/2 inches high; shoes with wider fronts -- all will help prevent bunions. "It used to be comfortable meant ugly when it came to women's shoes," Pfeffer said, "but that has changed."

For Tam, the surgery has paid off: She has more energy at work, she's no longer in pain, and she can soon step out in her favorite shoes, if sparingly. "I really want to stress this: It was worth it," she said. "I had emotionally given up on all my precious shoes, but recently I tried on a pair of bright red sling-backs -- and they fit. I literally cried out for joy."

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