Bunions

What is it?

A bunion is a common foot deformity that develops over the first metatarsal phalangeal joint of the foot. The first metatarsal phalangeal (MTP) joint is the joint that joins the big toe to the foot. When this joint becomes prominent and the big toe becomes crooked, a bunion develops. The term referring to big toe as it becomes crooked is called Hallux Valgus, while the bump on the joint itself is known as the bunion. When the bunion becomes red and swollen, it is usually due to inflamed soft tissue over the underlying bone.

Causes

The most common cause of bunions is prolonged use of poorly designed shoes such as narrow high heels. This is one of the reasons why bunions are much more common in women than in men. There is also a hereditary component to bunions, where many times we will see a grandmother, mother and daughter all with various stages of bunions. 38% of women in the United States wear shoes that are too small and 55% of women have some degree of bunion formation. Bunions are 9 times more common in women than they are in men.

History

Left untreated, bunions will gradually become worse, especially if you continue to wear narrow pointed shoes. Not all bunions progress, as good footwear and timely intervention can help stop bunion development. Once developed, most bunions will not get better no matter how they are treated. Surgical treatment is usually reserved for bunions that are painful. If they are not painful, they should simply be observed and footwear should be modified. Occasionally, the patient will want the bunion corrected for cosmetic reasons.

Footwear

There are a few basic pointers to remember when buying shoes. Do not buy shoes by simply buying the size that you think you should fit into. The shoe must be tried on and worn in the store for several minutes until you make sure that it is not compressing your foot. The shoe itself should look as close as possible to the normal shape of a foot. You should realize that the size and shape of your feet will change as you get older. With age your arch generally flattens out slightly and your foot will become slightly longer. As well the left foot will not always be the same size as the right foot. Shoes should be fitted at the end of the day when your feet are at their largest due to gravity and natural occurrence. You should stand during the fitting process and make sure that you measure width as well as for length of the shoe. Do not expect your shoes to stretch to fit you.

Indications for Surgery

Pain is the most common indication for bunion surgery. You may also notice redness and inflammation, which usually means that the bunion has progressed to a point that will not respond to simple prevention methods. Eventually, the joint of the big toe will become stiff, making it difficult for athletic & everyday activities.

Types of Bunion Surgery

There are many different procedures described to correct bunions. You should be aware that usually just shaving the bunion off, although it is attractive and minimally invasive, is usually not enough. Initially the foot will look much better, but with time the bunion will reoccur.

Arthrodesis refers to surgery performed on the big toe joint where the joint is fused. This is usually reserved for people with very severe deformities when other surgical options are impossible.

Bunionectomy refers to the simple removal of the bunion itself. This is seldom used because it doesn’t correct the underlying bone problems.

Osteometry is the most common surgical procedure. The bones are cut, realigned, and pinned in place until they heal, so that the underlying bone deformity is corrected and the bunion will not reoccur.

Resection arthroplasty refers to the removal of the toe joint, which creates a flexible scar that functions as the joint instead. In the past there has been some interest in implanting artificial joints, but this has fallen out of favor due to the fact that they usually do not hold up with the normal every day stress that people put their feet through.

Surgical Results

All patients should understand pre-operatively what they can expect from the surgery. The majority of patients who have bunion surgery are very pleased with their results and see a significant improvement in both their cosmetic appearance as well as the pain. Surgery does not, however, make it possible to fit into smaller shoes for the purpose of cosmetic reasons. If this is done, the bunion generally will reoccur. Utilizing good footwear is crucial after surgery.

You should be aware of the risks and complications of surgery, such as infections, nerve injuries, reoccurrence of the bunion, and failure of the hardware. Other medical risks such as blood clots in the legs and risks related to the anesthetic must also be considered. Generally speaking, bunion surgery is safe and effective. Surgery is performed same-day on an outpatient basis, unless there are underlying complications.

Post Operative Care

Crutches will need to be utilized for the first few days. After that, a special boot is placed on the bandage and the patient can bear weight, but will have to wear a special post-op shoe for approximately 4-6 weeks. The dressing has to be kept clean and dry, but usually the patient can move around for everyday activities quite well after just 2-3 days. However, activity will have to be modified during the 4-6 week healing period.