Bunions can present a problem for diabetics in several different ways. These problems sometimes make the option of surgically correcting the bunion more attractive than simply leaving it alone.
A bunion is a complicated deformity in which the 1st metatarsal bone at the base of the big toe joint is gradually moved outward towards the skin, making a large prominence on the side of the foot and pushing the big toe towards the second toe. A comprehensive guide to bunions can be found by following the highlighted link.
The simple issue with bunions for a diabetic is the prominence of the bone against the skin, which can lead to abnormal shoe pressure and a skin wound. Because the skin is generally stretched thin over this prominence, wounds can quickly deepen to bone, exposing it to bacteria and infection. A somewhat less obvious issue with bunions for diabetics is the second part of the bunion deformity, namely a subtle inward rotation of the big toe that exposes more of the side of the toe to the ground pressure. Since the skin on the side is not as thick as the skin on the bottom, a thick callus will result from this pressure. This callus on the side of the big toe often becomes ulcerated after persistent pressure, leading to chronic wound problems that are difficult to treat due to the rotation acting on the toe.
By correcting the bunion deformity somewhat earlier in this process, these wounds can be avoided, and the risk of amputation is lowered. Not all diabetics can or should have this elective intervention, as bone and skin must heal after the surgery. For those in relatively good general healthy and stable blood sugars, this option can be attractive as a means to prevent future problems.
Scott R. Kilberg DPM 