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Alli started running when she was just nine years old. Her dad served in the Air Force, which meant they moved around a lot, and running was a constant that helped her cope with change. She earned a scholarship to run for Indiana State University, but illness and injury interrupted her running career. She lost her scholarship and instead started coaching young athletes in track and cross country.

She tried to keep running, but cartilage damage in her knees forced her to stop. After the birth of her third child, she tried to start running again, but chronic injuries in her knees and hips made it hard to stay consistent. She tried other activities, like swimming and biking, but none of them gave her the same feeling that she got when she was out on a run.

Her history of injuries and rehabilitation inspired her to become a physical therapist. She especially wanted to help girls and young women, who don't often get as much coaching or assistance as their male counterparts. When her three children got older, she went back to school for a physical therapy assistant (PTA) degree.

While she was in school, Alli's feet were starting to get worse. Both her mother and grandmother had bunions, and now she had them too.

"Bunions are more than just a bump that forms on the side of the toe," said Devon Nixon, MD, an Assistant Professor at University of Utah ÐÇ¿Õ´«Ã½, and an orthopedic surgeon with expertise in lower extremity problems of the foot and ankle. "Bunions involve a change in the alignment and rotation of the big toe. You feel a bump on the inside part of the foot, but what you are actually feeling is a change in the position of the big toe in your foot."

Bunions can happen at any age. For some people, the big toe slowly moves into a different alignment and the bump gets progressively more noticeable and painful. The reasons people get bunions are not well known, but it's most likely a combination of several factors that include genetics. Having a family member with bunions can increase your risk. Environmental factors, such as foot injuries, could also contribute.

One common belief is that wearing tight shoes with restrictive toe areas could cause bunions. While poorly fitting shoes could make bunion pain worse, shoes probably don't play as big of a role in causing bunions as previously thought.

Making the Decision to Get Surgery

"I tried everything I could to keep running," said Alli. "I used taping and support, but it kept getting worse." It was bad enough that after her clinical training days—which meant 12 hours on her feet in the clinic—she had to ice her feet. She didn't want to get surgery because she had seen patients in the past with surgeries that went wrong, ending with fractures, infections, and other complications. She was also extremely busy and didn't think she had enough time for a procedure on both feet, plus the recovery times.

Surgery isn't necessarily the only option. "If we can get people to feel better without surgery, we always do," said Dr. Nixon. "We work with plenty of patients who modify their shoes, get shoes with a wider toe box, and/or get inserts to reduce the pain." But for patients like Alli, that unfortunately was not successful.

After looking up orthopedic surgeons at U of U ÐÇ¿Õ´«Ã½, Alli decided to meet with Nixon to discuss treatment options. "After I met with him, and read about his history and experience, something just clicked," she said. They talked extensively about all the options, and she never felt rushed or forced into any decision. Eventually, Alli felt comfortable with Nixon's approach—and impressed by his humility and quiet confidence—and trusted him to perform her bunion surgeries.

"The thing I emphasize to patients is that this is their choice. My job is help them make an educated choice about bunion surgery, or any surgery for that matter," said Nixon. "It's a patient-driven choice, and we look at surgery and recovery based on their lifestyle."

Preparation, Surgery, Recovery, Repeat

Alli's background in physical therapy meant that she already had a very deep knowledge of the bones, muscles, ligaments, and joints in her foot. She had also researched various bunion surgery approaches extensively before even meeting with Nixon. When she decided to move forward, the next step was to work together to figure out what procedure he would perform.

There are two main options for bunion surgery. In the first, the surgeon preserves the joint, removes the bump and makes some small cuts in the bone to straighten the toe. For patients with arthritis, though, that may not relieve the pain. Another option is a fusion, where the surgeon removes the joint and places screws and plates to hold the big toe in place while the bones heal back together.

Alli and Nixon decided on a bunion correction with a scarf and cheilectomy. Nixon removed the areas with arthritis around the joint, then cut a "z" shape into her long metatarsal bone on the inside of the foot. This allowed him to straighten the toe, then he cut a small wedge in Alli's big toe and inserted a staple to keep it aligned.

One of the biggest challenges with bunion surgery is the long recovery process. Most patients cannot put weight on their surgically repaired foot for four to six weeks. Since Alli was still in her PTA degree program, she would have to find a window of opportunity where she could recover properly.

The other problem: her daughter was planning a wedding across the country during the only break she had from school. They had to schedule the surgery before the wedding, and she would still be in active recovery when it happened.

She and Nixon worked together to figure out whether it would be safe for her to fly, and created a special treatment plan to minimize pain on her trip. From her PTA program, Alli had more extensive knowledge and training about rehabilitation than most patients. So she worked with Nixon to create an exercise rehab plan she could do on the trip. Alli also had to promise to rest and stay off her foot as much as she could over the course of the wedding weekend, and keep up with ankle pumps, elevation, and compression the entire time.

"Dr. Nixon really went out of his way to accommodate me and my schedule, and to help me accomplish my goals," said Alli. Everything went as planned, and she was there for her daughter's wedding.

Like many people, Alli had bunions on both feet. They did surgery on her left first because it was the more painful side. But she knew she would need a second surgery. "We encourage patients to do each foot separately so they can recover," said Nixon. Since patients can't drive and can't put weight on the foot for several weeks, a recovery for both at the same time would be very challenging. Most patients wait a few months in between so their first surgery foot is healed and stable.

Alli coordinated her clinical education schedule to work some longer days, then have an extended break when she could get her right bunion removed. This time she had several more days of rest when she could stay off her foot, and she noticed less inflammation compared to her left foot surgery. Now she can tell her PT patients (from experience) how important it is to rest so they can minimize inflammation.