BUNIONS
By: Corinne Gehegan, DPM
 A bunion appears as an enlargement of bone at the great toe joint. The
deformity is most often caused by inherited poor mechanics of the foot.
The 1st metatarsal (the bone that precedes the great toe) gradually
drifts outward while the great toe leans inward toward the second toe.
At the end stage, the great toe may actually position itself underneath
the second toe causing a hammer toe deformity of the 2nd toe. Additional
problems that may develop along with bunions are painful corns between
the toes, calluses at the ball of the foot, and ingrown toenails.
A bunion is a progressive condition that gradually worsens over time.
Some bunions progress more rapidly than others. Wearing shoes that crowd
the toes may accelerate the progression of the bunion or may aggravate
it. Symptoms may, therefore, arise sooner. Shoes that are not supportive
may also accelerate the condition as the faulty foot mechanics that lead
to the condition are not well controlled. Orthotics (custom inserts for
shoes/sneakers) may be used to provide support for the feet and improve
the mechanics of the feet. They can be utilized to slow the advancement
of the deformity. Other non-surgical modalities used to treat bunions
are anti-inflammatory medications, topical analgesics, ice, injection
therapy, toe splints, and padding. (Be aware that padding may decrease
the amount of room inside of a shoe and further crowd the toes).
Non-surgical modalities will not reverse the deformity, but may slow the
progression and ease the symptoms.
Surgical management should not be pursued for cosmetic purposes. It
should be considered if the discomfort is interfering with daily
activities and/or athletic activities. The goal of the surgery is
elimination of pain. There are over twenty types of bunion procedures
performed today. The key is to select the procedure most appropriate for
the individual. Factors involved in this decision are the findings on
physical exam, medical history, medications, history of smoking, age,
quality of the bone, quality of the joint, patient lifestyle, patient
expectations, ability to comply with the required post-operative
instructions, and x-ray findings. The length of the recovery and the
ability to bear weight post-operatively varies depending on the
procedure selected. Most procedures involve some type of osteotomy (a
break made within the bone utilizing a bone saw). Once this has been
performed the bone can be re-aligned into a more appropriate position.
Hardware (pins/wires/screws/plates) is implanted to secure and stabilize
the osteotomy. The majority of bunionectomies are performed with IV
sedation and local anesthesia in a same day surgery setting.
There is a high success rate in treating bunions; however, patients
should be aware of all possible complications. Patients should fully
understand the peri-operative course and be able to fully commit to the
required post-operative instructions.
Article written by Dr. Corinne Gehegan
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