 What is it?
A bunion is a very common foot deformity
that develops over the first metatarsal phalageal joint of
the big toe of the foot (see diagram). The joint that joins
the big toe to the foot is called the first MTP joint. When
it becomes prominent and the big toe starts to become crooked
this is known as a bunion. The term referring to deformity
of the big toe as it becomes crooked is called Hallux Valgus.
It is the bump itself that is known as the bunion. When it
gets red and swollen over the bunion because it gets sore this
is usually due to an inflamed soft tissue over the underlying
bone.
Causes
The commonest cause of bunions is prolonged
wearing of poorly designed shoes such as the narrow high heels
that women wear. This is one of the reasons why bunions are
much more common in women than in men. There is also a hereditary
component to bunions in that many times we will see a grandmother,
mother and daughter all with various stages of bunions. 38%
of women in the United States wear shoes that are too small
and 55% of women have some degree of bunion formation. Bunions
are 9 times more common in women than they are in men.
History
Left untreated bunions will gradually become
worse especially if women continue to wear the narrow pointed
shoes. Not all bunions progress because if the patient starts
wearing good shoewear and they are caught early enough they
may not get any worse. In general however, they will certainly
not get any better no matter how they are treated. We generally
reserve surgical treatment for bunions that are painful. If
they are not painful they should simply be observed and shoewear
modified. Occasionally the patient will want the bunion corrected
for cosmetic reasons.
Shoewear
There are a few basic pointers to remember
when buying shoes. Do not buy shoes by simply buying the size
that you think you should fit into. The shoe must be tried
on and worn in the store for several minutes until you make
sure that it is not compressing your foot. The shoe itself
should look as close as possible to the normal shape of a foot.
You should realize that the size and shape of your feet will
change as you get older. With age your arch generally flattens
out slightly and your foot will become slightly longer. As
well the left foot will not always be the same size as the
right foot. Shoes should be fitted at the end of the day when
your feet are at their largest due to gravity and natural occurrence.
You should stand during the fitting process and make sure that
you measure width as well as for length of the shoe. Do not
expect your shoes to stretch to fit you.
Indications for Surgery
Pain is the commonest indication for bunion
surgery. You may also notice redness and inflammation and usually
this means that the bunion has progressed to a point that it
will not respond to simple modification in shoe wear. Eventually
that major joint of the big toe will become stiff and this
makes it difficult for activities such as climbing stairs and
sports.
Types of Bunion Surgery
There are many different procedures described
to correct bunions. You should be aware that usually just shaving
the bunion off, although it is attractive and minimally invasive,
is usually not enough. Initially the foot will look much better
but with time the bunion will recur.
Arthrodesis refers to surgery performed
on the great toe joint where the joint is fused. This is usually
reserved for people with very severe deformities when other
surgical options are impossible.
Bunionectomy refers to the simple removal
of the bunion itself. This is seldom used because it doesn’t
correct the underlying bone problems.
Osteomety is the commonest surgical procedure.
The bone is cut and the bones realigned and pinned in place
until they heal so that the underlying bone deformity is corrected
and the bunion will not recur.
The resection arstplasty refers to the
removal of the toe joint and this creates a flexible scar that
functions as the joint instead. In the past there has been
some interest in implanting artificial joints but this has
fallen out of favor due to the fact that they usually do not
hold up with the normal every day stress that people put their
feet through.
Surgical Results
All patients should understand pre-operatively
what they can expect from the surgery. The majority of patients
who have bunion surgery are very pleased with their results
and have a significant improvement in both their cosmetic appearance
as well as the pain. Surgery does not however make it possible
to fit into smaller shoes for the purpose of cosmetic reasons.
If this is done the bunion generally will recur. You have to
wear good shoe wear after surgery.
You should also be aware of the risks and
complications and alternatives such as infections, nerve injury
and recurrence of the bunion and failure of the hardware. Other
medical risks such as blood clots in the legs and risks related
to the anesthetic must also be considered. Unfortunately no
surgery can be formed that is actually risk free no matter
what kind of surgery is performed. Generally speaking bunion
surgery is safe and effective. Surgery is performed on an outpatient
basis unless there is underlying medical problems. The patient
will enter and leave the hospital on the same day and the patient
will have a choice of different anesthetics such as spinal,
general anesthetic and various nerve blocks. The anesthesiologist
will discuss this with the patient in detail.
Post Operative Care
Crutches will need to be worn for the first
few days. After that a special boot is placed on the bandage
and the patient can weight bear but will have to wear that
special post-op shoe for approximately 4-6 weeks to ensure
proper healing. This dressing has to be kept clean and dry
but usually the patient can get around for day to day activities
quite well after just 2-3 days. But they will have to modify
their activities during the 4-6 week healing period.
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