A bunion is a bony protrusion on the side of the big toe or in some less common cases on the outside of the small toe. The protrusion at the joint of the base of the toe can become irritated, swollen and painful. As the protrusion becomes larger the toe bends toward the second toe causing further sources of irritation. There appears to be multiple causes of a bunion. Genetically the foot may be shaped such that normal activity puts excessive pressure on the big toe eventually causing a bunion. Some suggest footwear that does not fit properly may also put excessive pressure and cause a bunion. The protrusion may be excessive bone structure or a fluid sac called the bursa that becomes inflamed. In any case the deformity of the toe makes it difficult to find proper fitting footwear, is not a pleasant sight, and can be very painful.
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won?t actually cause bunions, it sometimes makes the deformity get progressively worse. Symptoms may therefore appear sooner.
SymptomsCorns and calluses may occur on the soles of the feet, in between toes and on the bunion joint. Stiffness can occur at the big toe due to secondary arthritis, this is known as Hallux Rigidus. Other foot conditions can occur such as in growing toenails and in severe cases the bunion joint may have a fluid filled sack called a bursitis. This can be very painful and can become infected.
Bunions are readily apparent, you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the Podiatrist may arrange for x-rays to be taken to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike, some bunions progress more rapidly than others. There is no clear-cut way to predict how fast a bunion will get worse. The severity of the bunion and the symptoms you have will help determine what treatment is recommended for you.
Non Surgical Treatment
In the early stages of the formation of a bunion, soaking feet in warm water can provide temporary relief. The best way to alleviate the pain associated with bunions is to wear properly fitting shoes. Shoes designed with a high, wide toe box (toe area) are recommended for people suffering from forefoot disorders, such as bunions. Shoes with rocker soles will unload pressure to the bunion area. Orthotics are also recommended for this condition to provide extra comfort, support, and protection. Other conservative treatments include using forefoot products designed to accommodate and relieve bunions such as bunion shields, bunion night splints, and bunion bandages. These conservative treatments can limit the progression of the bunion formation, relieve pain and provide a healthy environment for the foot.
Bunion surgery can be performed under local or general anaesthetic. The operation usually takes between half an hour to an hour. There are several types of bunionectomies. Some involve removal and realignment of the bones in your foot. Mild bunion problems can sometimes be resolved using soft tissue release or tightening. For some very severe cases bones of the big toe are fused or the bunion is cut out along with some of the bone at the base of the toe. Be sure and discuss which type of operation you will have with your surgeon. With any type of bunionectomy your surgeon will make one or more incisions (cuts) near your big toe. They will use instruments to trim the bones and remove the bunion. Wire, screws or plates may also be used to hold the new joint in place.
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Most of the time, hallux valgus deformity is accompanied by soft tissue enlargement consisting of a fluid-filled sac (called a bursa) under the skin. You may also have heard the Latin term hallux rigidus,” which is a completely different foot condition, that of having a big toe that is stiff with a very limited range of motion. If you notice that your big toe isn’t straight and that it is bending toward the toe next to it, this is something that you must not ignore or assume that your big toe will straighten out on its own.
I must caution you that the use of the TightRope for bunion correction is a relatively new concept but is very promising. The most common complication from this type of procedure has been fracturing of the second metatarsal bone which in all cases required further surgery to correct the fracture. The study mentions other possible causes for failure such as the fact that the drill holes through the second metatarsal bone will naturally weaken the bone. The next video demonstrates implant surgery for correction of a bunion. This procedure is sometimes performed in conjunction with an osteotomy procedure to realign the metatarsal and toe bones. Many patients ask me if you can have laser surgery on bunions. More importantly, lasers cannot remove bone, all they do is burn bone, so a laser could not be used to remove the large bump of a bunion deformity.
Associated deformities may include second digit hammertoes and flexible or rigid flat foot. Instability of the second digit may allow a more rapid progression of hallux valgus, as it is unable to act as an adequate lateral buttress. If surgery it to be contemplated it is imperative that peripheral blood flow be adequate for healing. Understand that bunions are progressive and that non-surgical treatments alleviate symptoms but do not limit progression. The most important indication for surgery is pain, not deformity, although there will often be concern about the appearance of the deformed joint. It is usually a combination of bone and soft tissue surgery.
Contributing factors, if present, include gastrocnemius or gastrocsoleus equinus, flexible or rigid pes plano valgus, rigid or flexible forefoot varus, dorsiflexed first ray, hypermobility, or short first metatarsal. During normal propulsion, Flat Feet approximately 65° of dorsiflexion is necessary at the first metatarsophalangeal joint, yet only 20-30° is available from hallux dorsiflexion. Note the greater deformity of the right foot (image left) versus the left foot (image right).