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Bunions
What to Do about a Bunion?
In the front of the foot, the joint at the base of the great toe is the most
complex. Here the bones, tendons and ligaments work together to transmit and
distribute the body's weight, especially during movement. Should this joint
become abnormally stressed over an extended period of time, a bunion deformity
may result.
A bunion (from the Latin "bunio," meaning enlargement) is a protuberance of bone
or tissue around the joint. The enlargement occurs either at the base of the
great toe or on the outside of the foot, at the base of the little toe where it
is called a "bunionette" or "tailor's bunion."
Bunions at the base of the great toe usually begin when the big toe starts
moving toward the smaller toes when tight, pointed shoes are worn. This crowding
puts pressure on the joint, pushing it outward. The movement of the joint in
this outward direction starts the formation of a bunion.
A common deformity of the big toe joint, a bunion occurs mostly among people who
wear shoes. Women are more frequently affected with bunions because of tight,
pointed, confining or high-heeled shoes. Wearing high heels is especially
stressful on the joints of the foot because all of the body's weight rests
there. The foot is then forced into a narrow, pointed "toe box", compounding the
problem. Older people are also vulnerable to bunions because of the higher
incidence of arthritis affecting the big toe joint.
What Causes a Bunion?
A bunion is most often a symptom of faulty mechanics of the foot. The deformity
runs in families, but it is the foot type that is hereditary, not the bunion.
People with flat feet or low arches are more prone to develop the problem than
those with higher arches. Bunions also may be associated with various forms of
arthritis. Arthritis can cause the joint's protective covering of cartilage to
deteriorate, leaving the joint damaged and with a decreased range of motion.
Parents who have bunions should know that there is a strong hereditary
predisposition to bunion development, and should have children evaluated if
early signs of deformity and/or discomfort are evident. If the child has the
same foot type, there is a possibility that a bunion will eventually develop.
Symptoms
Pain from a bunion can be mild, moderate or severe, making it difficult to walk
in normal shoes, especially high-heeled shoes. The skin and deeper tissues
around the bunion also may be swollen or inflamed.
The other toes can be affected by a bunion, as a result of pressure from the
great toe pushing inward toward the lesser toes. Toenails may begin to grow into
the sides of the nail bed; the smaller toes can develop corns and become bent
(hammertoes); or calluses may form on the bottom of the foot.
Treatments
Treatments vary depending on the severity of pain and deformity. Left untreated,
bunions tend to get larger and usually more painful. Evaluation by a podiatric
surgeon should be sought at the first sign of pain or discomfort, so that severe
deformity can be avoided.
Early Treatment
The main goal of early treatment is to relieve pressure on the bunion and
smaller toes, and to diminish the progression of joint deformities.
Padding the bunion is an important first step, as is wearing shoes that are
large enough to comfortably accommodate the bunion (such as sandals, athletic
shoes or shoes made from soft leather). Stiff leather shoes may be stretched
slightly for greater comfort. Tight, confining or high-heeled shoes should be
avoided.
Medications, such as nonsteroidal anti-inflammatory drugs or cortisone
injections, may be prescribed to ease pain and inflammation caused by joint
deformities.
Physical therapy, ultrasound treatment, whirlpool baths or other techniques can
also provide temporary relief.
Orthoses (shoe inserts) may be useful in controlling abnormal foot movement, and
may reduce symptoms for those with a painful bunion that has not yet caused a
significant bony abnormality at the joint. If a systemic disease like rheumatoid
arthritis or gouty arthritis is related to the bunion, appropriate medical
treatment may be recommended. Surgical Treatment
When conservative treatment does not provide satisfactory relief from
symptoms, or when the condition interferes with your activities, surgery may
be necessary.
Pain and deformity are significantly reduced in the great majority of
patients who undergo bunion surgery. In addition to easing pain, the purpose
of bunion surgery is to remove the enlargement and realign the joint to
restore normal function. This means that after surgery, the foot can carry
the body's weight properly, and that special shoes are no longer needed.
Postoperative orthoses or supportive devices may be recommended to improve
foot function.
Surgery may be performed at a hospital, surgical center or properly equipped
office operating room. Depending on the procedure, the facility at which it
is performed and the patient's medical status, the surgeon may choose a
local, spinal or general anesthetic. In many cases, the procedure can be
performed under local anesthesia.
Types of Surgery
Many surgical procedures are used to correct bunions. The decision to employ a
prodedure is based on the severity of the deformity, the patient's age, the
general health of the patient, their activity level, and the general health of
the bones and connective tissue. Other factors may influence the choice of a
procedure used.
The general guidelines for types of surgery are: Mild Bunion , Moderate Bunion,
Severe Bunion, and Arthritic Bunion or big toe joint.
For a mild bunion, the podiatric surgeon may remove the enlarged portion of bone
and realign the muscles, tendons and ligaments surrounding the joint.
For a moderate bunion, the podiatric surgeon may cut the bone and shift it to
its proper position. Whether or not the bone is cut depends on the severity and
location of the deformity. In addition, the surrounding tendons and ligaments
may need to be repositioned.
For a severe bunion, a combination of the following procedures may be necessary:
removal of the enlarged portion of the bone; cutting and realignment of the
bone; and correction of the tendons and ligaments. If the joint is destroyed
beyond repair (commonly seen in arthritis), it may need to be reconstructed or
replaced with an artificial joint. Joint replacement implants may be used in the
reconstruction of the big toe joint.
Simple Bunion
Before
After
Moderate Bunion
Before
After
Severe Bunion
Before
After
Postoperative
Care
Following surgery to correct a mild or moderate
bunion, the foot is bandaged and a postoperative shoe is usually worn for three
to four weeks. The amount of activity allowed will vary, and the podiatric
surgeon may suggest that flexible footwear be worn for several weeks either
directly after surgery or after wearing a postoperative shoe.
If the bone was cut, as in surgery for a moderate to severe bunion, it may be
held in place with an internal pin, screw or absorbable rod. In many cases, a
slipper or short leg cast is worn for four to six weeks, and walking is assisted
by crutches.
Movement of the toe joint is important after any type of bunion surgery.
Specific instructions for exercising the joint will be provided by the podiatric
surgeon.
After the foot has healed, and if the bunion was the result of improper foot
function or foot type, the cause of the problem should be addressed. Orthoses
may be prescribed to protect the foot and improve its function. Guidelines may
also be provided by the podiatric surgeon on the types of shoes that should be
worn. These instructions should be followed carefully to avoid recurrence of the
bunion.
What Should I Expect After Surgery?
After surgery, the foot may become narrower. Also, for a period of time, the
joint may remain slightly stiff and not be as flexible as before the surgery.
Gradual return to normal activity will be recommended by the podiatric surgeon
as healing progresses Risks
Some risks when considering bunion surgery
include joint stiffness, malalignment, joint pain and recurrence. The
ultimate goal is to relieve pain and prevent the bunion from recurring.
While these are some of the most commonly prescribed treatments for bunion,
others may be used.
Schedule an appointment to visit with Aloha
Foot and Ankle Associates, Inc. to determine which treatment is likely to be
the most successful in your case.
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Aloha Foot and Ankle Associates, Inc.
26732 Crown Valley Parkway, Suite
317 • Mission Viejo, California 92691
• (949) 364-2525 • www.AlohaFootAndAnkle.com |
