Bunion Deformity

bunion

Introduction

A bunion is a bump on the inside of the foot.  The bump is located just behind the big toe and is a result of the foot changing shape over time.  If you have a bunion, you know the pain that is experienced while walking and using closed toed shoes.  Sharp shooting pain can be experienced around the bump and often going into the big toe.  Most patients have some amount of swelling at the boney prominence because the body produces a bursa (fluid filled sac) to protect the bump.  This protective and natural cushion unfortunately can add pressure to the bump and can result in increased pain and symptoms.  Both conservative and surgical methods can be used to help decrease symptoms of the bunion.  This educational article will discuss both methods. 

 

Conservative Methods to Treat a Bunion

A custom orthotic is the primary conservative measure that is utilized by podiatrists all around the world.  The job of the custom orthotic is to support the arch of the foot to allow evenly distributed pressure across the entire foot.  The orthotic will also prevent abnormal motion of the foot thereby helping stop or slow down the forces that caused the bunion.  No foot is the same and therefore customization of the orthotic to each individual foot is crucial for relief of bunion symptoms.  The podiatrist will examine the orthotic up against the foot to ensure a proper fit.  The doctor will also examine the patient while standing and walking with the orthotics in the shoe.  This is to ensure proper alignment of the body with the orthotic so that the patient can achieve the maximum benefit from the device.   

 

Wider shoes and padding are two simple conservative options to help alleviate the pain of a bunion.  The wider shoes allow for increased space at the front of the foot thereby reducing the amount of pressure placed on the bunion.  Wider shoes can be purchased at any local retailer and your podiatrist can help you choose the right style and brand of shoe.  Padding is also a simple and effective way to help reduce symptoms.  We at Advanced Podiatry have a variety of different pads for all sorts of lumps and bumps of the foot.  Our bunion pad has a comfortable gel insert that decreases friction and pressure to the bunion very effectively. 

 

Injections of steroids or alternative medicines (sarapin, ozone, prolotherapy) are also options in relieving pain.  The injection will decrease inflammation to the area of the bunion and will also help to shrink the bursa (fluid filled sac).  Sometimes nerve pain can develop over the bump and the injection can help to decrease inflammation of the nerve at the bunion site. The injection can last several months and is minimally painful.

 

Surgical Methods to Correct a Bunion

There are several different ways to correct a bunion surgically and these methods have been used for decades.  The principle goals of bunion surgery are to reduce the bump on the inside of the foot and to place the bone back into its normal position.  This is accomplished by shaving the bump down.  In addition the abnormally aligned first metatarsal bone must be moved back into normal alignment for long-term correction. This is accomplished by making a complete cut in the metatarsal bone allowing for it to move freely.  After proper positioning of the bone is achieved, a single screw, staple, or wire can be used to hold the cut bones together.  This fixation of the bone cut allows for faster healing and also helps to preserve the alignment of the toe. 

 

The ultimate goal of the surgery is to make the toe straight. The surgical procedures vary by the location and type of bone cut utilized by the surgeon.  The surgeon will assess the bunion before surgery and determine what kind of technique is needed to get the best correction of the bunion.  This is done by examining the bunion and also analyzing X-rays of the foot.  Once the necessary information is gathered, the type of procedure will be chosen.  The surgeon may decide to choose a straight cut, V cut, or a wedge cut.  Once the cut is type is determined, the surgeon then decides at what location the bone cut will occur.  If the bunion is severe then the bone cut will be at the base of the bone.  If it is a small bunion then the bone cut will be performed closer to the tip of the bone near the toe.  Either way stabilization with a screw or other device will be necessary to hold everything together.  

 

The incision for this procedure can be 2mm to 7cm.  The size of the incision is determined by the surgeon to allow for visualization of the anatomic structures and also to create enough space to correct the bunion.  The larger incision also makes it easy to release any tendons that are causing strain on the bunion.  By releasing these tendons the bunion deformity will be reduced because the abnormal pull of the tendon will no longer exist.  The incision leaves a minimal scar since the surgeon will repair the area with a specialized stitching technique.  This simply means he/she will stitch the soft tissue back together properly to ensure optimum healing and minimal scarring. 

 

The use of minimally invasive techniques to correct bunions are an excellent option and this is discussed in a separate article.  This method of correction is not for everyone but will be utilized if the patient is a candidate.   

 

At Advanced Podiatry surgery is typically performed on a Friday so that the patient will have Friday, Saturday, and Sunday to relax their foot before returning to work.  The more the patient stays off their foot the better they feel.  Pain medication, anti-inflammatories, icing, and elevating also will help to keep the pain to a minimum. 

The patient will not be allowed to get the foot wet until the stitches are removed which is typically ten to fourteen days after the surgery.  A shower cover is is used to help prevent the surgical site from getting wet during bathing.  The patient will also be given a walking compression boot which is used to keep swelling down and also to protect the surgical site and keep the area stable.  The patient will use the boot for three to five weeks depending on symptoms and evidence of bone healing on x-rays.  Once the bones are healed, the patient will be transitioned to a regular shoe.  Physical therapy may be used in order to help with range of motion of the big toe. 

 

Conclusion

Bunion pain can be very debilitating and is something no person should endure.  At Advanced Podiatry we will exhaust conservative measures before considering any type of surgery.  If the conservative therapy does not improve the symptoms then surgical methods will be considered.  At Advanced Podiatry the patient is the most important part of healing process so their opinion is highly regarded.  We make our treatment decisions based on a balance of effective treatment and respect for personal lifestyles.  We will always strive to get you back to your active lifestyle as quick as possible.  Please call 813-875-0555 and make an appointment today if you or a loved one has questions regarding bunion pain. 


Content written by the doctors at Advanced Podiatry.