BUNIONS

A bunion is a bone deformity which occurs at the base of the big toe involving a joint called the metatarsophalangeal joint. The enlargement of bone at the base of the big toe often rubs against shoe wear causing excessive pressure and friction resulting in discomfort. The great toe angles out toward the other toes. This condition is known as Hallux Valgus. Overtime as the bunion enlarges the big toe may overlap or move under the adjacent toe. As the bunion enlarges and the big toe moves toward the other toes, a hammertoe may develop in one or more of the other toes.

Bunions often cause discomfort along the side of the great toe due to the enlargement of rubbing against shoes with everyday walking. Since the great toe joint moves with every step. There may also be pain from within the joint (the metatarsophalangeal joint) and formation of arthritis. The soft tissue along the side of the big toe joint may also enlarge causing a condition called bursitis. The skin on the bottom of the foot or along the side may become thickened with callous formation as a result of friction and excessive pressure from the bunion.

Causes Of Bunions

Often people notice that bunions run in the family however they are not hereditary. Although bunions are not inherited, it is possible to inherit a faulty foot structure which often leads to bunion formation. Although footwear may not be a direct cause of bunions, certain types of shoes such as high heels or very narrow dress shoes promote the formation of bunions. The shape of the shoe forces the front of the foot into an unnatural angle. Maintaining the foot in this position for long periods of time can cause the toes to permanently change position and result in the formation of a bunion. Arthritis can also alter the position of the joint leading to formation of a bunion.

Treatment Of Bunions

Since bunions are a bone deformity, they do not resolve themselves. Conservative or nonsurgical treatment is mainly focused on relieving pressure over the affected area and stopping the progression of the deformity.

Methods commonly used to relieve pain and pressure from bunions include:

  • Change in footwear to more accommodative shoes which do not cause excessive friction or promote the progression of the bunion. Avoid high heel shoes.
  • Have your shoes spot stretched over the bunion
  • Orthotic devices to help realign and maintain correct foot position during standing and walking.
    Removal of corns and calluses which form on the foot.
  • Use of protective padding to help reduce or eliminate friction against the shoe.
  • Splints worn during the night to help align the big toe joint. In younger patients such as adolescents this may be recommended because their bones are more adaptable as they are still developing.
  • A spacer pad may be placed between the big toe and second toe
  • Calf stretches
  • Avoid activities that cause irritation over the bunion

Your podiatrist may:

  1. Consider the use of anti-inflammatory medications to reduce inflammation (provided you do not have any contraindications to the use of such medications)
  2. Prescribe custom made orthotics to address abnormal foot mechanics
  3. Administer cortisone injections if there is bursitis over the bunion

Surgical Treatment

If conservative measures do not adequately relieve symptoms and stop progression of the deformity and related conditions surgical treatment may be advised. Surgery for a bunion, called a bunionectomy involves removal of the enlargement and realignment of the toe.

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Bunion Surgery

If conservative measures do not adequately relieve symptoms and stop progression of the deformity and related conditions surgical treatment may be advised. Surgery for a bunion, called a bunionectomy involves removal of the enlargement and realignment of the toe. Since bunions comein different sizes and shapes, there are different methods used to treat different types and sizes of bunions. Although there have been several different bunion procedures performed and named over the years, they are generally divided into two categories:

  1. Metatarsal head procedures performed close to the big toe joint. This type of procedure is used to treat mild to moderate bunions.
  2. Metatarsal base procedures performed further away from the big toe at the base of the metatarsal bone. This type of procedure is used to treat moderate to large bunions.

In both of the procedures listed above, a specialized bone screw, pin or combination is typically used to maintain the bone in corrected position while it heals.

When selecting the bunion surgery that is best for you the following should be considered:

  1. Overall medical condition
  2. Severity of bunion deformity
  3. Lifestyle
  4. Recuperation time

How long does it take to heal after bunion surgery?

If bone was repositioned and fixated as part of the procedure, healing time is 6 to 8 weeks on average. Once the bone has healed, you are encouraged to gradually return to normal activity as tolerated. Some amount of swelling may last longer than the bone healing time therefore when turning to regular foot wear, it is advised to avoid shoes that are too tight. Over the months following bunion surgery, the swelling will progressively decrease.

 

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