A bunion is a deformity of the front of the foot and the great toe joint. It is often described as a bump on the side of the big toe. Several different things may cause bunions, such as:
Congenital deformities present at birth
Inherited structural or biomechanical factors
Mechanical factors such as high heeled or ill-fitting shoes
Inflammatory conditions or arthritis
General laxity (looseness) of ligaments
When the biomechanics of the foot are imbalanced it can worsen over time. They start when the big toe rotates sideways towards the second toe. The bones of the first metatarsal shifts in the opposite direction and gradually changes the angle of the bones. This produces the characteristic bump, which increases prominently over the years.
Causes of bunions
Bunions can occur for several reasons, and it is important to remember there isn’t one specific cause. In general, bunions are a result of:
Genetics and a family history of bunions
Arthritis (inflammation) in the foot
Certain neuromuscular conditions that affect movement and coordination like cerebral palsy
Connective tissue disorders
Signs and symptoms of bunions
Signs and symptoms include
Pain and swelling around the big toe
Calloused skin and swelling near the base of the big toe
The big toe is pushing the second toe out of place because it is turning inward
The base of the big toe includes a large bump
Soreness near a big bump
Any difficulty or discomfort while walking
Diagnosis of bunions include physical exam as well as weightbearing xrays. From there, we will be able to assess the extent of the bunion and the best treatment options moving forward.
Bunion treatment options
Treatment options for bunions fall into 2 camps. Surgical and Nonsurgical
Nonsurgical treatment options include:
Shoe gear modification: Using wider shoes with larger toe boxes
Splinting, strapping, cushioning, and padding of the bunion
Custom orthoses to stabilize and slow progression of the deformity
Avoidance of activities that aggravate symptoms
Anti-inflammatory medication for periodic relief
Physical therapy to calm the inflammatory process
Bunion surgery is performed as an outpatient procedure, under monitored IV anesthesia. The primary goal of bunion surgery is to relieve the pain associated with the deformity. Bunion surgery consists of removing the pronounced bone, making a cut in the bone to realign the big toe and balancing the foot so the bunion does not return. Screws and staples may be used to hold the bones in place while it heals. The foot surgeons at CMD take pride in performing a more cosmetically pleasing incision performed on the inside of the foot rather than the typical bunion incision placed on top. The advantage of this technique is that you cannot see the incision when looking straight down onto the top of your foot. It also helps to avoid casting or crutches and instead allows you to walk out of the operation in a post-operative boot or shoe.
In cases of more severe bunions a joint fusion also known as “lapidus procedure” is sometimes necessary. This procedure is able to realign even the worst bunions however requires a period of non weight bearing 2-4 weeks depending on a patients bone quality and overall health. After this period patients can progress to protected weight bearing and expect to be back in sneakers at about 6-8 weeks.