When Should I Have My Bunion Operated On?


Bunions, for those who suffer with them, can be very painful, or may never cause a moment of discomfort.  This foot deformity, in which the base of the big toe is prominent on the inner side of the foot and the big toe itself is angled toward the second toe, has been covered by me in a previous post.  For an in-depth review on bunions and bunion treatment, see my other article explaining bunions.

The big question on many patient’s minds is when should a bunion be corrected.  Fixing a bunion is a fairly straightforward process: it involves a surgery that cuts the bone, moves it back over into a corrected position, secures the bone with a metal screw or pin, and tightens up the supporting tissues.  Healing is generally complete in 6-8 weeks in most cases.  The question that must be answered is ‘what is the optimal time to do the surgery?’  Unfortunately, there is no simple answer.  A number of different factors go into figuring out if a bunion needs correction.  The most important factor is whether or not the bunion is even painful at all.  If the bunion hurts enough to limit shoe use and activity, then yes, the time is probably right to fix it.  If it does not hurt, then surgery may not be necessary.  However, depending on one’s age, other factors may need to be considered.  For example, if one is middle aged, there is a reasonable expectation that surgery in the future when and if the bunion eventually becomes painful may not be possible due to future health problems.  Increasing arthritis in the joint may also force a different kind of surgery that is more involved or has to accomplish a completely different goal like replacing the eroded joint surface.  Younger patients may have to consider job restrictions or family life with young children that may make the recovery period difficult, if not impossible.  Other factors to consider is the reason behind the desire for fixing the bunion.  Bunion surgery will reduce pain and improve the function of the big toe joint and the side of the foot in general.  It will not grant the recipient a free pass to wear exceptional high heeled shoes, restrictive fashion shoes, or other such inappropriate footwear without the consequence of pain or discomfort.

Essentially, there is no opportune time a bunion should be fixed due to the complexity of life.  A good guideline is that if there is pain enough to affect your life in some way, or if the deformity is visible and bothersome enough that you are anticipating and worried about pain or limitation in the near future, then surgery is right for you.  It is a six to eight week inconvenience, but restoration of a more normally functioning foot will reap great future rewards for a lifetime.

What causes the bump on top of my big toe joint?

hallux limitus

In this post I will discuss the ‘bump’ some people have on top of their big toe joint.  Many people are aware of the bump some people have along side of the big toe joint, as it goes by the name of a ‘bunion’. What is less known is the cause and treatment of a bump on top of the big toe joint, which is something somewhat different than a bunion.

Firstly, I would like to apologize for taking so long in between posts this past month.  In between very long days in the office, as well as more recently a number of hours spent helping coach my son’s football team, my spare time to post has been limited.  Now that I have more time, I can continue to post articles I hope everyone finds informative.

Back to the topic at hand.  As I wrote above, the cause and treatment of a bump on top of the big toe joint is different than what is traditionally known as a bunion.  Not to confuse things further, but this condition is commonly called a dorsal bunion by physicians, and can actually be seen with a traditional bunion at the same time. However, it’s cause really is from a somewhat different process than the traditional bunion (see the other bunion article on my site for a more detailed explanation of a bunion).

The bump commonly felt on top of the big toe joint is usually due to jamming of that joint from an arthritic process. Arthritis of the big toe joint develops over time due to a number of reasons. Usually, there is some structural abnormality in the base of that joint that allows excessive and premature wear and tear of the joint cartilage. This can include a bone that is too long, too short, angled too high, or angled too low. The motion of the big toe joint becomes reduced over time due to this wear. The reduction in motion of the joint and excessive compression force on top of the joint from it trying to force lost motion causes bone spurring to form. This usually occurs on top of the head of the 1st metatarsal, which is the long bone that forms the base of the big toe joint. The spurs become painful as inflammation develops in the joint below, and also in the tissue that covers the spurs above. What is felt externally is the painful enlargement of the spur below, which is also irritated by pressure from shoes.

Treatment of this condition usually involves surgery, although a steroid injection or anti-inflammatory medication can provide temporary relief. The surgery can be as simple as shaving the spurs down. Unfortunately, this does not correct the underlying structural problem and over time the spurs can reform. What is often needed is a procedure that alters the abnormal bone position, decompresses the joint, and repairs the joint arthritis. There are numerous procedures that accomplish this. Some severe cases of arthritis need a procedure that replaces the joint with an artificial one, or fuses it all together.