What Are Bunions?
A bunion (hallux valgus) is a deformity in the big toe joint. When the bones in the big toe joint become misaligned, a bony bump develops along the inside of the foot at the base of the big toe. The tip of the big toe gets pulled inward, toward the other toes.
Bunions are a permanent, progressive disorder and can damage other toes. They will not heal on their own and can not be corrected without surgery. It’s recommended that a person who notices the development of a bunion have it evaluated by an experienced podiatrist right away. The sooner this condition is treated, the easier it is to slow it’s progression and reduce potential damage to the big toe joint. A minor bunion will typically benefit from conservative measures like wider shoes, maintaining a healthy weight, foot exercises and better foot alignment.
Bunion are not always painful, but pain is a symptom that commonly occurs over time as the condition progresses.
A smaller bunion that occurs on the outside of the foot and involves misalignment of the little toe joint is called bunionette (tailor’s bunion). Bunionettes are not as common as bunions. The majority of bunionettes are treated without surgery.
Causes and Risk Factors
Women are more likely to develop bunions as the result of footwear that pushes the toes out of their natural alignment. Improper footwear doesn’t cause a bunion, but can make the deformity and associated symptoms worse. Some people may be predisposed to developing bunions due to the shape of their foot. A person with flat feet or a low arch has an increased risk of developing bunion. Arthritis may also contribute to the development of a bunion.
Symptoms Associated With Bunions
In addition to the development of a bony bump near the big toe joint, common symptoms associated with a bunion may include:
- Burning Sensation
- Big Toe Stiffness
Corns or calluses can develop if the toes rub against each other. Pressure from the big toe can also cause complications like hammertoe, metatarsalgia and bursitis. Bone spurs are another possible complication of a bunion. As the symptoms of a bunion progress, walking and standing for long periods of time can become difficult.
A podiatrist will review your medical history and discuss any symptoms your are experiencing. A physical examination is performed to assess the progression of the bunion and to check for any additional complications that may have developed. You may be asked you to walk a short distance so the prodiatrist can observe how your body weight is distributed.
X-rays are ordered to evaluate toe alignment and the MTP joint. X-rays are taken while a patient is standing (weight bearing). Additional imaging test may be ordered if the podiatrist feels that you may have additional issues or complications.
Some patients who think they have a bunion may actually have a different foot disorder. Pain, redness, and inflammation are also symptoms that are associated with bursitis, gout and other types of arthritis.
Non-Surgical Treatment For Bunions
While some patients may only need periodic evaluations of their condition, most people with a bunion will benefit from some combination of conservative treatments. Examples of conservative measures and treatments that may help reduce pain, pressure on the toe joint and other symptoms associated with a bunion can include:
Footwear Changes – comfortable footwear with wide toe box and a low heel.
Weight Loss – patients who are overweight may experience more inflammation and pain
Activity Modification – avoiding activities that cause or increase bunion pain.
Custom Orthotics – custom made orthotics can be prescribed by a doctor to keep the foot in a proper position and weight distributed correctly while standing and walking.
Bunion Pads – used to reduce pressure on the bunion while wearing shoes.
Splints / Taping – can be utilized if the big toe isn’t too stiff.
Arch Supports – supports for people with flat feet may help relieve to reduce foot stress.
Cold Packs – cold packs can be applied a few times a day to help reduce swelling.
Medication (NSAIDs) – over the counter medicines like Ibuprofen and Naproxen help reduce swelling and pain.
Physical Therapy / Exercises – Exercise and stretching the smaller muscles of foot.
In the majority of cases, non-surgical bunion treatments should be used first to slow the progression of a bunion and reduce or alleviate any symptoms. Measures that result in better foot mechanics and reduce stress on the big toe joint may be enough for some people to adequately slow down bunion progression, reduce pain and avoid a surgical procedure.
Bunion Correction Surgery (Bunionectomy)
Bunion surgery is recommended when conservative measures fail to provide adequate relief. Surgery is the only way to correct bone alignment and repair soft tissues (tendons and ligaments).
Candidates for corrective bunion surgery may have one or more of the following symptoms:
- Chronic Inflammation And Swelling
- Severe Foot Pain
- Stiff Big Toe (Hallux Rigidus)
- A Severe Deformity
The goal of bunion surgery is to relieve pain and other symptoms by correcting as much of the deformity as possible.
The type of surgical procedures used to correct a bunion vary based on a patient’s:
- Activity Level
- Bunion Severity
Surgical procedures used during a bunionectomy can include:
Osteotomy – cuts are made in the bone. Pins, plates or screws are used to repair the bone, helping to realign the big toe joint into a more normal position. There are different types of osteotomies. The location and type of cuts made vary based on a patient’s condition. Osteotomy is the most commonly used surgical technique for a bunion.
Exostectomy – used in combination with other corrective measures. During an exostectomy, the surgeon removes (shaves) part of the bump on the big toe joint. This technique alone doesn’t help realignment. It is usually done in conjunction with an osteotomy and soft tissue repair.
Arthrodesis – Fusion of the big toe joint. Arthritic surfaces are removed. Plates, wires or screws are used to hold bones together until they heal. It may be done on patients with severe arthritis, a severe bunion or a failed bunion surgery.
Arthroplasty – the damaged portion of the big toe joint is removed. Scar tissue will develop in the newly created space between the reshaped bones, preventing them from rubbing directly against each. An arthroplasty may be done on patients who are elderly and have severe arthritis or have a failed bunionectomy.
Minimally Invasive Bunion Surgery
Minimally invasive bunion surgery is an alternative to traditional open surgery. The benefits of a minimally-invasive procedure versus an open procedure include:
- Smaller Incision (Less Scarring)
- Less Pain and Swelling
- Shorter Recovery Period
- Lower Risk of Infection or Complications
A person with a severe bunion or significant arthritis may not be a candidate for a minimally-invasive procedure. A foot doctor will discuss whether or not a minimally-invasive procedure is the best surgical option with their patient.
Minimally invasive techniques and hardware used to correct bunions have advanced significantly in recent years. Our board-certified foot and ankle surgeons have been experiencing a lot of success using the minimally-invasive Minibunion® procedure.
The miniBunion® procedure, developed by CrossRoads Extremity Systems is a minimally-invasive surgical technique.
The benefits of the miniBunion® 3D procedure include a walking recovery (in a post-operative boot), less pain, less swelling and minimal scarring.
During the mini bunion procedure, a small incision (approximately 20mm) is made on the side of foot. The misaligned metatarsal bone is cut, rotated and properly aligned in all 3 dimension using surgical instrumentation. A specially designed low profile micro-titanium implant is then placed into the long part of the metatarsal. The implant is then secured to both bone segments with flat-headed screws. The hardware provides structural reinforcement to maintain correct bone alignment and does not need to be removed at a later date. The incision is then closed.
The mini bunion procedure is appealing for a number of reasons. The procedure preserves the surrounding soft tissue and does not invade the toe joint. The implanted hardware provides immediate stability to the patient’s foot. These factors allow the majority of patients a walking recovery. Full recovery from a miniBunion® procedure take approximately four to 6 weeks in the post-operative boot.
Not every patient with a bunion is a candidate. The condition of the bunion and other factors will determine which type of corrective surgery will offer the greatest benefit to the patient. After a thorough examination and imaging test, a foot surgeon will be able to advise you and discuss the best available treatment options.
Foot Doctors in NYC and NJ
Our board-certified podiatrist help patients suffering from the symptoms associated with bunions. While most patients will benefit from conservative measures, our podiatrist also provide surgical care when conservative measures fail to bring adequate relief.
If you have developed a bunion, your should purse an evaluation as soon as possible. A bunion will only get worse over time, and it’s much easier to treat earlier than later. Schedule an appointment with a podiatrist today at one our conveniently located facilities.