Foot & Ankle Surgery

Bunions

 

Definition:

Bunions are a very common, often painful, condition of the forefoot also known as Hallux Valgus. The word bunion describes a bony enlargement or bump on the side of the great toe. The deformity is the result of misalignment of the joint at the base of the great toe. As the deformity progresses, the big toe gradually moves toward the adjacent toes, creating apparent enlargement of the bump and crowding of the other toes. Bunions affect women more often than men because of their frequent use of tight-fitting, pointed/confining, or high heeled shoes. Bunions are typically caused by faulty mechanics or abnormal function of the foot. People with flat feet (low arches) are especially prone to develop bunions. Injuries such as fractures or joint sprains, as well as various forms of arthritis, can also lead to the development of bunions.

Common Symptoms:

Pain is the most common symptom associated with the bunion deformity. However for many individuals the deformity also a cosmetic problem. Pressure from shoes over the bunion leads to irritation of the soft tissues and underlying bone resulting in swelling, inflammation, and pain. Patients frequently report difficulty in finding comfortable, appropriate shoewear that doesn't aggravate their symptoms.

As the big toe continues to drift toward the other toes, the bunion deformity increases in size so that even small amounts of pressure can be extremely painful and disabling. In addition, with increasing deformity of the great toe, the second toe begins to displace upward creating a painful Hammertoe deformity. This alters the function of the second toe often leading to a condition known as Metatarsalgia (pain over the metatarsal head).

Misalignment of the great toe joint can also lead to premature wearing out of the articular cartilage (joint surfaces) and the development of early arthritis. Other symptoms associated with bunions include toenail problems and the formation of corns and calluses.Increasing deformity and symptoms tend to progress more rapidly in younger patients.

Diagnosis:

Initial evaluation includes a history and physical examination. X-rays of the feet, usually in the standing position, are also taken. This allows your doctor to measure certain angles which are important in assessing the deformity and determining the best treatment plan.

 

Treatment Options:

Treatment for bunions varies with the age of the patient,the nature and severity of symptoms, and the degree of deformity. Coexisting medical conditions are also carefully considered in determining the most appropriate treatment. Initially, efforts should be directed at relieving pressure over the bunion which is most easily accomplished by obtaining a proper fitting shoe with a broader toebox to accommodate the deformity. Stiff leather shoes can be stretched or altered. Various splints or padding may also aid in reducing symptoms. Shoes with tight or constrictive toeboxes and high heels should be avoided. Orthotic devices also play an important role in improving faulty mechanics which may slow progression of the deformity. Antiinflammatory medication is sometimes used to decrease acute symptoms. While these treatments may relieve pain in some patients, they do not address the structural deformity or functional defecit and therefore their beneficial effects are frequently only temporary.

In more severe cases or in those individuals for whom conservative measures fail, surgery may be necessary. There are over 100 different surgical procedures available today for the correction of bunion deformities. As these disorders are often complex, a combination of several procedures may be required to address all components of a particular deformity. The procedures your surgeon selects will depend on the type and severity of your bunion as well as any associated secondary changes such as arthritis. The goals of surgery are to remove the painful enlargement and to reestablish correct alignment of the joint so that normal function can be restored. Surgery is usually performed on an outpatient basis under either local anesthesia with sedation (foot block),spinal or general anesthesia.