ANKLE & FOOT
We hear the word bunion thrown around all the time, and there is a ton of misinformation out there regarding where they come from, how they are treated, and what its like to have one repaired….and I say repaired and not removed, because when it comes to fixing a bunion, its not like having a bad appendix removed, its about straightening an angled bone and mal-aligned joint.
So lets start at the beginning…what is a bunion. Basically, a bunion is defined as a prominence or bump that emanates from the base of the big toe. They can be of the arthritic variety where the bump is actually just very large bone spurs below the skin surface that cause the bump, or they can be from mal-alignment where the big toe deviates towards the lesser toes and causes the metatarsal head to protrude and form a bump. Many people think that bunions are the curse of women wearing 5 inch stiletto heels, where the tight cramped toe box squeeze the toes together and cause a bunion. Well there is some truth to ill fitting shoes, but this doesn’t explain all bunions. Many men and women that wear reasonable shoes still get bunions, and even in non-shoe-wear communities, such as in some villages in Africa, bunions still exist. People often think they are genetic, but again this isn’t entirely true. There is no bunion gene, however there often is a tendency for “bad feet” to run in families. The reality of the formation of bunions is that it is multifactorial. Poor fitting shoes, injuries, hyperlaxity of the joints, and perhaps a touch of genetics all play a role in the development of a bunion. But no matter what the reason, the treatments all start the same way
Most bunions can be treated non surgically. Treatment is often focused around alleviating pressure in the toe box so that the bunion does rub excessively on shoe gear. External pads, silicone sleeves and simple lightweight bunion splints can be worn to offload the pressure of the bunion. A simple google search for a bunion splint will yield thousands of devices on the market which treat bunions. I always tell patients that the more options there are for treatment of a problem, the less likely any one them is superior. Often trying a few different types to see what works is best. Ultimately however, none of the external treatments actually fix the problem, they just alleviate the symptoms. When these treatments fail, surgery then becomes an option.
I always counsel patients that you need to meet only 1 of 3 criteria to make you a candidate for surgery. First is that the painful is bunion. Second, the bunion is causing difficulty with reasonable shoes…not four inch Louis Vuitton heels. And finally the deformity is rapidly progressing and starting to cause issues with the lesser toes which leads to instability of the lesser metatarsophalangeal joints, and pain in the ball of the foot. The most common reason in my practice to fix a bunion is that the bunion is progressing and now causing pain and issues with the lesser toes, particularly under the second metatarsal head. Bunion surgery is focused on correcting the underlying deformity, and restoring the anatomy of the first metatarsophalangeal joint to normal alignment. There are several procedures that exist to get this done, and recovery time is dictated by which procedure is chosen. Often there is a period of non weight bearing from 2-4 weeks, followed by progressive weight bearing in a walking boot. With newer techniques and advances in regional anesthesia blocks, bunion surgery isn’t as painful as most people think, and when done by specialists with the right training and experience, the likelihood of recurrence is very low.