Bunions Treatment Nashville

Bunions Treatment Nashville

Bunion Overview

A bunion, often referred to as “hallux valgus,” is a common foot condition characterized by a bump on the side of the foot, adjacent to the first digit. As this bump grows larger, the shift in the skeletal structures results in displacement of the big toe, which can often lead to pain and difficulty with shoes or walking.

What Causes Bunions?

The definitive cause of bunions has yet to be identified. However, most leading theories indicate that bunions develop secondary to subtle structural abnormalities such as high arches, excessively flat feet, and hypermobility. Most theories do believe that there is in fact a genetic component, and that your likelihood of developing a bunion deformity increases substantially if a primary family member has also been affected.

Prevention for Bunions

In an effort to prevent bunion formation, it is important to understand the etiology of why the bunion has initially developed. For example, if a patient’s bunion has formed secondary to excessively flat feet and hypermobility, conservative therapy should be focused on creating arch stability and establishing a rigid structure for the foot. This process can be completed by utilizing a high quality over the counter orthotic vs. a custom molded orthotic, and by use of a supportive, firm soled shoe. Shoe brands that are commonly recommended by our office include, but are not limited to, Brooks, New Balance, and Hoka. To reduce overall pain, it is important to avoid shoes that will aggravate the affected area, such as high heeled shoes, or flat, non-supportive, flexible shoes.

What are Hammertoes?

A hammertoe contracture is a very common physical finding that will often develop in patients with bunions. A hammertoe is a contracture of the lesser digits of the foot, and the name stems from the shape a toe develops when it occurs. Depending on which joints are involved, and the severity of the contracture, hammertoes can also be referred to as “mallet toes,” or “claw toes.” Over time, as hammertoes worsen, the flexibility of the joints affected will decrease and the deformity will become rigid, or non-reducible. When the deformity is still in the earlier stages, patients may be able to utilize conservative therapies such as digital splints to allow the toe to straighten. Once the digit becomes severely contracted and rigid, surgical intervention is typically required. Bunion corrective surgery is often completed in conjunction with hammertoe correction, although this can be completed as an isolated procedure.

Treatment for Bunions

Non-surgical Treatment Options

Treatment options for your bunion do not always require surgical intervention. Instead, your doctor may suggest simple lifestyle changes, such as wearing shoes that are more comfortable and supportive, adding inserts to your shoes, or incorporating padding to your shoes. Simple adjustments such as utilizing a silicone gel bunion sleeve can significantly reduce pain, irritation, and rubbing in shoes. Further treatments are focused on reducing inflammation. Inflammatory control can be achieved through routine icing, compression sleeves/limb elevation for edema control, and taking scheduled over-the-counter anti-inflammatories. Patients often find that by simple adjustments to their shoes, or incorporating a shoe with a wider toe box to reduce aggravation, that they are able to obtain tremendous relief.

A bunion (also referred to as hallux abductovalgus) is often described as a bump on the side of the big toe. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment—producing the bunion’s bump.

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.

Bunions can be treated conservatively including changing shoe gear, padding, custom orthotics, icing, injections but surgery is warranted when all conservative measures are attempted and bunion pain is preventing you to perform daily activities or unable to wear shoes without pain.

Xrays will need to be performed to assess the severity and extent of deformity. The surgeon will perform appropriate surgical procedure, based on xray findings, your age and activity level or any other factors.

Surgical procedures include:

1. Austin bunionectomy- The first step of this procedure is to remove the “bump” or excessive bone from the side of the first metatarsal head. The next step is to perform a “V-shaped” cut, called an osteotomy, through the metatarsal head to re position the bone. The head of the metatarsal is shifted toward the second toe, and stabilized with a screw thereby reducing the bunion deformity and straightening the big toe.

2. Lapidus bunionectomy- The Lapidus procedure is a fusion of the first TMT joint intended to eliminate joint movement and correct deformity around the first metatarsal.

3. Lapiplasty 3D Bunion Correction procedure uses instruments that have been specifically designed to rotate the bone back to its normal position. This naturally straightens your toe and removes the bump as well as alleviates the pain it has been causing. Using titanium plating technology5.6, the foundation that was once unstable is secured. After the procedure, most patients are able to walk within a few days.
• No casting
• Weight-bearing within days*
o Walking in a surgical boot for 6 weeks
• At 6 – 8 weeks, patients can go back to tennis shoes
• Walking 6 – 8 weeks ahead of the traditional surgery

CE Foot & Ankle Clinic, Nashville
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