Bunions "…To fix, or not to fix…?"

As your doctors, we usually come back with a couple of simple questions:

• Is your bunion painful and does it limit your activity and ability to wear reasonable shoes?
• Have you noticed your bunion getting progressively worse over the past year?
• What have you done conservatively to treat your bunion?

If your bunion is not painful, then we usually do not need to go any further. We continue to watch the progression of the deformity and recommend continuing to wear sensible shoes. Bunion surgery is usually reserved for the painful condition.

What is a Bunion?

A bunion is considered an enlargement or "lump" at the base and side of the big toe (or the first metatarsal phalangeal joint). It is a condition that gets worse over time and can be aggravated by the shoes that we wear. As the big toe bends over towards the others, the "bump" gets larger and more painful, often leading to arthritis and stiffness. "Pain" with a bunion is commonly due to 2 things: 1. Pressure from shoe gear over the prominent medial bump, and, 2. Pain or stiffness from within the joint.

A bunion can cause other painful conditions like hammertoes (usually of the 2nd digit), corns and callouses, pain under the lesser metatarsals, and ingrown toenails.

Bunions are considered to be due to a combination of faulty foot mechanics (the way we walk), the foot we inherit, and the use of inappropriate footwear. Those with flatfeet or pronated feet are more likely to develop bunions because of the instability about the joint.

What to Expect on Your Office Exam

In the office, you can expect a full clinical exam by one of our board certified doctors. We assess the appearance of the bunion, the motion available of the great toe joint, and the way that you walk. Digital X-rays are taken in the office, which also helps to determine the severity of the bunion, and if needed, what surgery would be appropriate for your particular foot.

Nonsurgical approaches or conservative care is always the first line of treatment. Simply, by wearing more sensible, wider toe box shoes can eliminate bunion pain. Other simple treatments include:

• Padding with various materials such as felt or foam. This can be placed over the painful medial bump.
• Injection therapy (to reduce the swelling, pain and redness over the bunion)
• Nonsteroidal anti-inflammatory medication
• Physical therapy (to help with the symptoms and improve range of motion of the great toe joint). Manipulation will NEVER correct the alignment of the big toe; only surgery can achieve this.
• Foot orthosis (inserts for the shoes which can limit the instability of the joint and progression of the deformity). No insert of over-the-counter braces will correct the bunion we already have.

The only way to correct the bunion, alignment of the joint, and appearance of the foot is SURGERY.

Surgery is indicated when conservative care has failed to relieve the pain.

The goal of surgery is to relieve as much pain and correct as much deformity as realistically possible. The goal of the "perfect" foot usually leads to an unhappy patient.

The "type" of procedure chosen depends on the symptoms, and severity of the deformity as assessed from your clinical and radiographic exam. Some procedures include:

• A simple bunionectomy (literally cutting off the enlarged bone). This is the easiest procedure, but does not address realignment of the joint.
• A distal osteotomy (a cut and shift in the head of the bone which realigns the joint and requires fixation-screws, plates, or wires). This is the most common bunion procedure performed and allows for immediate walking in a protective boot or shoe. Our goal is to have you back in sneakers by 3-4 weeks.
• A proximal osteotomy or fusion (a cut further back on the metatarsal bone, also requiring fixation). This is reserved for the more severe or unstable cases and usually requires casting and several weeks of nonweightbearing status. This requires longer healing time, but is necessary if your deformity is severe.

SUMMARY

The most common cause of dissatisfaction of patients following bunion surgery is UNREALISTIC EXPECTATIONS. Several studies have shown that 85-90% of those who have bunion surgery are satisfied with the results. The goal of bunion surgery should be relief of pain and improvement of the alignment of the great toe. Returning to tight shoes puts you at risk for the bunion returning.

There are also risks involved, which holds true for any type of surgery. Less than 10% of surgical patients experience complications associated with bunion surgery. These include, but are not limited to:

• Infection
• Recurrence of bunion
• Nerve damage
• Chronic swelling
• Long-term pain

Bunion surgery is the most common surgery performed in our practice. All of our doctors are board certified in foot surgery and have performed several hundreds of these procedures. With a thorough evaluation, proper communication between you and your doctor, and realistic expectations, you can expect excellent results.

Our goal at Main Street Foot and Ankle is to help you walk comfortably-if you find your bunion getting worse and pain more consistent, it is time to talk to your doctor about fixing this problem!