What is a bunion?
A bunion (also referred to as hallux valgus) is a condition described as a bump on the side of the big toe. The bunion occurs when the big toe starts to push against the 2nd toe. The bump that is seen on the side of the big toe is a mixture of an enlarged bone and dislocation of the big toe joint which is caused by the deviation of the metatarsal that changes the bony framework of the front of the foot.
What causes a bunion?
The most probable cause of bunions is inheritance of certain mechanics of the foot, which predispose a patient to develop the deformity. Although shoe gear is not a direct cause of a bunion, a narrow, pointy shoe(such as a high heel) may progress the deformity and cause pain and discomfort around the bump on the side of the big toe.
Bunions come in a variety of shapes and sizes, from mild to severe, which is determined by their clinical appearance, physical examination and radiographic measurements. Depending on the severity of the bunion, the appropriate non-surgical or surgical approach can be determined.
The most common symptom is pain around the bump. In addition to pain, most patients also complain of swelling, redness, and callus formation over the bump as well as pain within the big toe joint. All these symptoms are aggravated by tight fitting shoes.
Surgical Management is based on the severity of the bunion.
There is a wide array of procedures for correcting bunions. Each patient is treated on a case by case basis and the bunion procedures are chosen based on radiographic evaluation as well as a biomechanical examination and structure of the foot.
Conservative treatment includes wearing wider shoes, custom orthotics, anti inflammatory medications and injections, but most of the time conservative treatment fails and surgical management is necessary.
Typically the procedures involve creating a surgical “break” (osteotomy) in the misaligned metatarsal bone to realign only a portion of the bone. A variety of shaped cuts can be performed to treat varying sizes of bunions. These procedures are reserved for mild to moderate procedures.
On average it takes anywhere from 6 to 10 weeks for the bones to heal, depending on health of each individual. Patients often return to normal activities and shoe gear by 6 weeks to 3 months. Smoking, obesity, age and certain systemic diseases increase the length of healing.
Due to advances in metal implants, patients are able to walk on the day of surgery, while wearing a protective surgical shoe or CAM walker. Most of the time the implanted metal screws and plates become incorporated within the bones and it is not necessary to remove the materials. There are instances when the implants become painful or the patient doesn’t want any metal in their foot and at those times it is acceptable to remove the implants, as long as the bone has healed.
Joint freezing(fusion) procedures realign the entire deviated bone at the root of the problem, where the deviation originates. The name of this procedure is called the Lapidus Bunionectomy. This procedure is reserved for a severe bunionectomy or for moderate bunions that have increased instability at the 1st tarsometatarsal joint.
All procedures need to stabilized with either metal screws or metal plates to hold the bones in proper position until the bones heel.