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A patient decided to see a podiatrist after feeling upset about not being to wear heels due to her bunion. She said it’s hard to go out on date nights with her husband because she debates about whether to wear something comfortable or sexy. At her 4th follow-up appointment, she made sure to wear these beautiful shiny red heels. Her shoes were not the only things bright that day.
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.
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.
The most common symptoms that patients will often complain about include pain, irritation with activity, difficulty with walking, redness, fatigue, and problems with different types of shoe gear. Given the nature of how bunions develop, and the secondary effects that can result, patients may also complain about arch pain, heel pain, muscle soreness, and development of hammertoe contractures etc.
In short, no. Bunions by nature are typically a progressive deformity that are unlikely to resolve without surgical intervention. With that said, for many patients, a bunion may develop to a certain degree and plateau, but it is unlikely that it will spontaneously improve. In most instances, a bunion deformity will continue to worsen over a course of months to years.
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.
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 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.
Once conservative treatments fail, the majority of severe bunions will require a surgical procedure. Currently, there are at least 100 different types of bunion correction surgical procedures. After a patient makes an appointment, your physician will perform a comprehensive physical exam and obtain a series of X-rays. Depending on where the patient is experiencing foot pain, which bones are involved, and the severity of their deformity, your podiatrist will work with you to develop a personalized treatment plan that will be tailored to your specific needs and lifestyle.
Surgical options can vary greatly in terms of post-operative weight bearing, number and length of incisions used, joints corrected, and anticipated discomfort or swelling. More recently, minimally invasive surgery (MIS), has become a popular bunion treatment. With MIS, the surgeon will utilize intraoperative X-ray, and a series of stab incisions to create cuts and realignment of the bones. Once the bones have shifted into the correct anatomical position, the surgeon will permanently fixate the bones with percutaneous screws. Studies have demonstrated quicker returns to full activity, earlier weight bearing, and reduced postoperative pain, swelling, and infection rates.
The majority of bunions treated surgically are performed in the outpatient setting. In addition to reducing the overall cost of the bunion surgery, patients will typically prefer resuming their postoperative care in the comfort of their own home. During the day of surgery, the patient will receive multiple types of anesthesia that will allow for the patient to have no memory of the procedure, and to reduce their postoperative pain. Depending on what type of local anesthetic is used, and where, the foot is typically numb for approximately 8 to 12 hours after surgery. In addition to your block, your surgeon will potentially provide you with oral pain medication to help reduce any potential breakthrough pain. Depending on what type of procedure you and your physician agree upon, the surgeon will make a series of incisions, realign the necessary bones, and fixate them into the appropriate anatomical position to allow for the greatest level of correction. After the surgery, the patient will wake up with a bulky bandage, or even a fiberglass cast. Surgical stitches will stay in for 2-3 weeks depending on soft tissue quality. Over the course of the next few weeks, weight bearing is increased as serial X-rays continue to demonstrate interval healing. Once the healing process is completed, minor swelling can be anticipated for up to one year postoperatively. Depending on what type of surgical techniques are used, a full return to normal activity is achieved by 4 months.
Are you concerned about your bunions? Are you interested in reconstructive foot surgery? Do you want to learn more about how to fix your foot problems? Treat your feet to the very best and contact our practice to schedule your appointment today!
