Bunions

A bunion is a very common cause of foot pain, and is a common deformity seen in all ages and activity levels.  It is a complex foot deformity involving both bone and soft tissue (ligaments, tendons). Usually inherited from one’s family genetics, bunions have several underlying causes. The most common cause is due to having flatter feet. Over time, muscular changes needed to adapt to walking with flat feet will push the great toe towards the second toe, and make prominent the 1st metatarsal head ( the bone one sees sticking out ) . This can make for pain in the bunion when it is rubbed against tight shoes. Joint pain in the big toe joint can develop over time due to its abnormal position and the eventual development of arthritis in that joint. This can allow for pain even while barefoot without the pressure of shoes against the side of the toe.  The great toe can also crowd into the lesser toes, and even cross over or under one or more toes, causing pain and toe crowding in shoes.

Bunions gradually worsen over time due to instability that causes them to form in the first place.  This process may actually take decades, but most people notice the changes rather suddenly.

Treatment can include conservative measures that attempt to pad the bump or separate the great toe from the second toe. This can include gel toe separators or a bunion shield.  Wider shoes may also help relieve bump pain, and should be the first measure tried. Orthotics (prescription shoe inserts) may help to lessen the progression of the bunion by controlling it’s underlying cause, but cannot reverse the joint changes already in place.   In most cases, surgical correction with an alteration of the bone position and soft tissue tightness is necessary to permanently treat this condition.

Bunion surgery is one of the most common types of foot surgery performed.  In many cases, the bone involved in the deformity must be cut and moved over towards the central part of the foot.  A simple procedure of shaving the bone ‘bump’ will not actually correct the deformity, and some patients can have a return of their symptoms in as little as a few months.  The bone that is cut (1st metatarsal) is angled too far away from the 2nd metatarsal bone next to it, owing to the gradual deformity process.  The bone position must be moved back over so it is in proper angle alignment with the 2nd metatarsal (essentially parallel to it, not angled outwards).  Where this bone is cut is dependent on how big of an angle the bone creates.  If the angle is generally under 14-15 degrees, a cut in the area near the head of the bone can correct the bunion.  This is generally easier to heal, as it is more stable.  If the angle is more than 15 degrees, a cut must be made at the base of the bone in order to fully correct the abnormal angle.  This area is not as stable as the head of the bone, and recovery usually demands non-weight bearing until the bone heals.

The cut bone needs to be secured together to help it heal.  This is typically accomplished with internal screws or an external wire.  This process takes 6 weeks typically, but sometimes up to 8-12 weeks depending on the location of the healing bone and one‘s bone density and general health.  Any excessive motion or pressure at the bone cut site while it is trying to heal can result in a delayed healing, or healing with the bone in an undesired position.  Most people heal well, and without any significant issues or discomfort.