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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