A bunion is a common condition that involves an abnormal, bony bump at the base of the big toe, causing the joint to swell outward and become painful. The big toe may also turn inward toward the second toe as a result of the enlarged joint, which can then lead to difficulty walking, ingrown toenails and corns and calluses.
Bunions can form when there is an improper balance of forces exerted on the joints of the foot, causing instability in the joint of the big toe. This often occurs as a result of shoes that do not fit properly, abnormal walking habits or an inherited foot type. Bunions can also be caused by injury, birth defects, arthritis or certain neuromuscular disorders. Most common is a alignment of the first metatarsal from your genetic makeup.
Bunions can be painful and can cause problems with adjacent toes. If left untreated, they will usually grow larger and more painful over time. It is important to seek medical attention and discuss treatment options with Dr. Deland.
The decision to correct the bunion depends on symptoms or if a second toe needs correction and the great toe is already rubbing against it. Progressive bunions also often need to be corrected. The surgical treatment depends on the type and severity of the bunion. A smaller bunion can be treated with a smaller surgery with early weightbearing. To get adequate correction a larger bunion can require a larger surgery to minimize the chance of recurrence. What is particularly important is to do a surgery that will correct the bunion adequately for the long term. Surgical treatment can improve pain, inflammation, and deformities.
Conservative Treatment
What can be effective is choice of shoe wear, soft leather and possibly wider width at level of the bunion. Fortunately, there are many choices in shoes. If second toe is being rubbed on by great toe, a toe spacer in between the toes can help.
Surgery
Surgery to treat bunions most often used for symptomatic cases. There are several different surgical options available, depending on the type and severity of the bunion.
The most common surgical procedure for bunions is a bunionectomy, which includes:
- Shaving the bunion
- Realigning the first metatarsal after releasing the tight capsule on the second toe side of the bunion
- Repairing the capsule on the non second toe side of the bunion
- Possible further straightening the toe at the toe bone level (proximal phalanx) with an Akin procedure
There are different versions if this depending on type and severity of the deformity. In general the more severe deformities must have bony correction further up the metatarsal bone for adequate correction, but there are exceptions to this
Dr. Deland with many years of experience will help you decide which procedure will be most effective for your individual condition after evaluating your bunion and X-ray images.
Most bunion procedures are performed on an outpatient with adequate, sedation and a block, not general anesthesia.
Recovery
Recovery from bunion surgery depends on the procedure chosen which in turn depends on the severity and type of bunion. Particularly important is to choose a procedure with minimal risk of recurrence. Too often patients will go for the earliest recovery or more “minor” procedure and that procedure can have significant chance of recurrence or inadequate correction. Nevertheless, there are certain bunion deformities which allow for early weight bearing in two or four weeks. The longest is usually six weeks. Even if it is the longest, remember what is most important it is what your bunion correction is like at six months or years later. Dr Deland will let you know which is the right procedure for you for the best result. After your surgery you will need to elevate your foot well for 10-14 days. Going into a boot or sandal soon after surgery is an option.
Other Conditions
