Description

Painful bunions are one of the more common conditions treated by podiatric surgeons. Patients with this condition will usually complain of pain when wearing certain shoes, especially snug fitting dress shoes. Treatment may involve changing shoe gear, padding and orthotics. When this fails to provide adequate relief, surgery is often recommended. There are several surgical procedures to correct bunions. Selection of the most appropriate procedure for each patient requires knowledge of the level of deformity, review of the x-rays and an open discussion of the goals of the surgical procedure. Almost all surgical procedures require cutting and repositioning the first metatarsal.

Cause of Bunion Deformity

The classic bunion, medically known as hallux abductovalgus or HAV, is a bump on the side of the great toe joint. This bump represents an actual deviation of the first metatarsal and often an overgrowth of bone on the metatarsal head. In addition, there is also deviation of the great toe toward the second toe. Shoes are often blamed for creating these problems. This is inaccurate. It has been noted that primitive tribes, where going barefoot is the norm, will develop bunions. Bunions develop from abnormal foot structure and mechanics which place an undue load on the first metatarsal. This leads to stretching of supporting soft tissue structures such as joint capsules and ligaments with the end result being gradual deviation of the first metatarsal. As the deformity increases, there is an abnormal pull of certain tendons, which leads to the drifting of the great toe toward the second toe. At this stage, there are joint changes with possible damage to the cartilage.

Symptoms Related to Bunion Deformity

The most common symptoms associated with this condition are pain on the side of the foot. Shoes will typically aggravate bunions. Stiff leather shoes or shoes with a tapered toe box are the prime offenders. This is why bunion pain is most common in women whose shoes have a pointed toe box. The bunion site will often be slightly swollen and red from the constant rubbing and irritation of a shoe. Occasionally, corns can develop between the first and second toes from the pressure of the toes rubbing against each other. With severe bunions, the second toe can actually overlap or underlap the great toe. On rare occasions, the joint itself can be acutely inflamed from the development of a sac of fluid over the bunion called a bursa. This is designed to protect and cushion the bone. However, it can become acutely inflamed, a condition referred to as bursitis.

Treatment of Bunion Deformity

Early treatment of bunions is centered on providing symptomatic relief. The use of pads and cushions to reduce the pressure over the bone can be helpful for mild bunion deformities. Functional foot orthotics, by controlling abnormal pronation, reduce the deforming forces leading to bunions in the first place. These may help reduce pain in mild bunion deformities and slow the progression of the deformity. When these conservative measures fail to provided adequate relief, surgical correction is indicated. The choice of surgical procedures (bunionectomy) is based on a biomechanical and radiographic examination of the foot. Simply "shaving the bump" is often inadequate in providing long-term relief of symptoms. Because there is actual bone displacement and joint adaptation, most successful bunionectomies require cutting and realigning the first metatarsal (an osteotomy).

The information provided in this web site is not intended to be a substitute for medical examination, diagnosis or treatment. The material is provided for information purposes alone. Visitors should not exclusively rely on answers provided in this web site. Specific questions should be directed to your own health care provider. Dr. Tina Starkweather makes no claims, expressed or implied as to the accuracy and timeliness of any advice, services, or other information referenced in the web site. Additionally, Dr. Tina Starkweather is not obligated to follow-up or contact visitors to this site, nor is it liable in any manner for the decisions of visitors whose actions are based on information found in this web site.