Bunions

What is a Bunion?

A bunion is a bony enlargement on the inside of the foot near the big toe.  Bunions are an abnormal bony enlargement of the joint at the base of the big toe.  This joint is called the metatarsophalangeal joint.   As the bunion progresses the big toe may begin to lean toward the second toe. The “bump” maybe painful and become red and stiff.  An advanced bunion may crowd the other toes and cause hammertoes toe develop.  

Causes of Bunions?

Bunions can develop for many reasons. Poor foot mechanics are the most common cause of bunions, and people with family members who have them are more likely to develop bunions. Poor foot mechanics can affect the normal balance of forces to the joints and tendons of the foot.  This will cause instability in the foot which can lead to the development of a bunion deformity. 

 While shoes aren’t a direct cause of bunions, tight shoes may cause pain by putting pressure on the bony prominence.  In addition, pointed toe shoes can cause someone, already predisposed, to develop a bunion faster. To reduce your chances of developing a bunion, always purchase shoes that fit your feet. Never make your feet fit into the shoes. In addition, look for shoes with a wide toe box, good arch support, and soft soles. Avoid shoes that are tight, short or that have pointed toes. Also high heels, higher than 2 1/4 inches are not good for your feet. If you are already developing a bunion, wear shoes that are roomy enough to not put pressure on it. This should help relieve most of your pain.  Other causes of a bunion include; injury to the foot, gout, and neuromuscular disorders.

Signs/Symptoms of a Bunion

The most common symptom is a painful bulging bump on the inside of the base of the big toe. Surprisingly, the amount of pain is not always proportional to the size of the bunion. Some patients have a severe bunion deformity with very little pain while others have an almost normal appearing foot with severe pain.  X-rays will generally reveal a prominent bony bump at the base of the big toe with increased spacing between the first and second metatarsals.

 Metatarsals are the long bones in the forefoot that connect each toe with the rest of the foot. If the bunion has been present for many years, patients often experience arthritis at the big toe joint. Redness may occur on the bunion at the point of maximum tenderness. Occasionally a “painful condition called a bursa” may develop at the site. With severe bunions the big toe may crowd the second toe causing it to elevate and rub on the top of the shoe.

Treatment Options of a Bunion

Conservative treatment includes physical therapy, padding, taping, wearing comfortable shoes, and taking oral anti-inflammatory medication. Unfortunately these conservative treatments are not always effective and surgery is frequently needed.  

Click here if you would like to learn more about forms of bunion surgery. Please note that this page contains surgical photos and may not be suitable for all audiences.  No matter how long you have had a bunion, the pain and discomfort isn’t something you simply have to endure.                                                                                                                                                                                                           

Let the doctors at Gulf South Foot & Ankle evaluate your foot and help you explore a wide range of options for finding relief. Schedule and appointment at one of convenient locations: Metairie (504)-708-4810 or Covington (985) 809-1464.

What is involved in a Bunion Surgery?

When conservative treatments do not provide relief from a bunion, then surgery may be considered as an option. There are more than 60 different types of bunion surgeries, depending on the specifics of the condition.  In simple terms bunion surgery involves cutting off the “bump” and then performing an osteotomy to the first metatarsal to realign the big toe.  An osteotomy is the surgical cutting of a bone and then re-positioning the bone.  After the bone is re-positioned the bone is fixated with a screw, pin, or other devices.   With severe or long-standing bunions, the joint cartilage may become damaged or destroyed.  In these instances straightening the bunion deformity will not relieve the pain.  This is because the joint is arthritic and bone on bone contact is occurring. When there is a significant amount joint destruction present, an implant or joint fusion may be required. When deciding whether to use joint fusion or an implant, factors such as patient’s age, activity level, gender, and lifestyle are considered. Fusion can be performed with screws, staples, pins, or a plate. Fusing the bunion will limit the range of motion in the big toe, but the toe remains functional.  Following a bunion fusion, patients may have difficulty wearing high-heeled shoes, but otherwise there will be very little restrictions in footwear. Implants generally recover faster because there is no waiting period while the bones fuse.  However, joint implants can shift or wear our over time.  The decision between fusion or implant should be a decision that the patient and doctor make together.  

Bunion Surgery Rehabilitation

After surgery, it is important for the patient to avoid putting weight onto their foot for the next three to five days or longer depending on the procedure. Also during the recovery period, the patient should keep the foot elevated and iced.  Minimal weight bearing in the special boot is permitted around the house.  In addition the foot should remain dry and the bandages should only be removed by a doctor.  A follow-up appointment is usually scheduled about 4 to 7 days post operative.  During this appointment an x-ray will be performed to make sure that the bones are in good position and the screws are where they should be.  After this check up appointment, a general schedule is followed depending on the patient’s needs:

  • 2 weeks after appointment:  stitches will be removed.
  • 4 weeks after appointment: patient can return to a comfortable shoe such as a tennis shoe.

Depending on the patient, shoes such as high heels should not be worn for several weeks, even months. Re-occurrence of bunions after surgery is possible but very rare. Complications are few and patients are almost always very pleased with the results.

 

Before and After Bunion Surgery

If you are suffering from a bunion, please note that surgery may not always be necessary. The doctors at Gulf South Foot & Ankle can provide a complete evaluation of your foot and discuss a full range of treatment options with you.  Schedule an appointment at one of our convenient locations:  Metairie (504)-708-4810 or Covington (985) 809-1464.

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Additional appointment times available upon request

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