Bunions

The main thing to know about bunions is that they’re not a bump. A bunion is an angular deformity between the first metatarsal and the proximal phalanx. These two ideally line up to make a straight line, but in a bunion, the toe deviates away from midline, causing the metatarsal to angle inwards. Therefore, correction of a bunion is not removal of a bump. It’s a complex reconstructive surgery in which we change the shape of the foot

Many surgeons do not understand the cause of bunions and therefore do not understand how to treat them appropriately. For this reason, the term “bunionectomy” or “bunion removal” has become colloquial language. In addition, many patients are dissatisfied with the cosmetic appearance and lack of pain relief from their improper surgeries. No bone should be removed in the treatment of a bunion. The shape of the bones has to be changed, and the soft tissue has to be tightened.

Causes

There are two main causes of bunions: genetics and shoewear. Almost all shoes can cause the toe to be squeezed in a way that can cause a bunion, but the more narrow or pointed the shoe, the worse the risk. Some people have an inherited tendency towards persistence of the deformity even with shoes off. Women have this problem more commonly than men, but it can be a painful problem for men as well.

Diagnosis

A set of high-quality weight-bearing (standing) x-rays are required for diagnosis, as well as a thorough physical examination. Specific x-rays will be taken in my office to ensure the highest quality of x-rays.

Treatment

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Shoewear modification to avoid high heels and narrow, pointed toes that predispose to bunion formation and pain. Shoes with a soft upper are preferred. Shoes can be taken to a cobbler to be stretched around the bunion.

Orthotics and braces do not help with bunions. There are no devices that will reverse the deformity. However, toe spacers may be used to temporarily alleviate pain.

Surgery is necessary when the pain is not able to be treated via shoewear modification. This requires reshaping the metatarsal and sometimes the phalanx in addition to tightening up the stretched capsule. Because bunions will recur with shoes that recreate the deformity, the rehabilitation from this surgery is prolonged open-toe shoewear followed by allowance of tennis shoes no sooner than four months postoperatively.

What not to expect

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Bunion surgery is a complex reconstructive surgery. Beware of promises of pain-free return to normal activity in the short term. There is no way to make soft tissue and bone heal faster. As is often the case, the best things take a bit of effort and time, and are generally worth the investment.

Bunion surgery will not change your shoe size. It will make you more comfortable in your actual shoe size

Bunion surgery is not meant fore purely cosmetic purposes. It is possible to
convert a pain-free bunion to a painful but beautiful foot. For this reason, it is only medically indicated to operate on bunions that cause discomfort.

For best results

See a Board Certified Orthopaedic Surgeon with accredited fellowship training in Foot and Ankle surgery about your bunion.

Be prepared for a new set of x-rays in office. Not all x-rays are the same.

Be prepared for a postoperative protocol that allows for downtime as well as time in a medical shoe. Normal shoewear is not immediate and can lead to recurrence.