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Bunions

A bunion is a deformity of the front of the foot and the great toe joint. It is often described as a bump on the side of the big toe. Several different things may cause bunions, such as:

  • Congenital deformities present at birth
  • Inherited structural or biomechanical factors
  • Mechanical factors such as high heeled or ill-fitting shoes
  • Inflammatory conditions or arthritis
  • General laxity (looseness) of ligaments

When the biomechanics of the foot are imbalanced it can worsen over time. They start when the big toe rotates sideways towards the second toe. The bones of the first metatarsal shifts in the opposite direction and gradually changes the angle of the bones. This produces the characteristic bump, which increases prominently over the years.

Causes of bunions

Bunions can occur for several reasons, and it is important to remember there isn’t one specific cause. In general, bunions are a result of:

  • Genetics and a family history of bunions
  • Arthritis (inflammation) in the foot
  • Gout
  • Certain neuromuscular conditions that affect movement and coordination like cerebral palsy
  • Connective tissue disorders
  • Ill-fitting shoes

Signs and symptoms of bunions

Signs and symptoms include

Pain and swelling around the big toe

  • Calloused skin and swelling near the base of the big toe
  • The big toe is pushing the second toe out of place because it is turning inward
  • The base of the big toe includes a large bump
  • Soreness near a big bump
  • Any difficulty or discomfort while walking

Diagnosis

Diagnosis of bunions include physical exam as well as weightbearing xrays. From there, we will be able to assess the extent of the bunion and the best treatment options moving forward.

Bunion treatment options

Treatment options for bunions fall into 2 camps. Surgical and Nonsurgical

Nonsurgical treatment options include:

  • Shoe gear modification: Using wider shoes with larger toe boxes
  • Splinting, strapping, cushioning, and padding of the bunion
  • Custom orthoses to stabilize and slow progression of the deformity
  • Avoidance of activities that aggravate symptoms
  • Anti-inflammatory medication for periodic relief
  • Physical therapy to calm the inflammatory process

Bunion surgery

Bunion surgery is performed as an outpatient procedure, under monitored IV anesthesia. The primary goal of bunion surgery is to relieve the pain associated with the deformity. Bunion surgery consists of removing the pronounced bone, making a cut in the bone to realign the big toe and balancing the foot so the bunion does not return. Screws and staples may be used to hold the bones in place while it heals. The foot surgeons at CMD take pride in performing a more cosmetically pleasing incision performed on the inside of the foot rather than the typical bunion incision placed on top. The advantage of this technique is that you cannot see the incision when looking straight down onto the top of your foot. It also helps to avoid casting or crutches and instead allows you to walk out of the operation in a post-operative boot or shoe.

In cases of more severe bunions a joint fusion also known as “lapidus procedure” is sometimes necessary. This procedure is able to realign even the worst bunions however requires a period of non weight bearing 2-4 weeks depending on a patients bone quality and overall health. After this period patients can progress to protected weight bearing and expect to be back in sneakers at about 6-8 weeks.

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