Do Bunions Require Surgery?


Overview
Bunions
The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents a misalignment of the big toe joint (metatarsal phalangeal joint) and, in some cases, additional bone formation. The misalignment causes the big toe to point outward (medically termed hallux valgus deformity) toward the smaller toes. This deformity is progressive and will increase with time. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A more deep joint pain may occur as localized arthritis develops in later stages of the deformity. A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor's bunion or bunionette.

Causes
Causes of bunions and risk factors for bunions include a family tendency to bunions may make them more likely to develop. Arthritis of the foot, if it affects walking, it can make bunions more likely to develop. Neuromuscular problems, such as cerebral palsy. Biomechanical factors, such as low arches, flat feet and hypermobile joints, can increase the risk. Wearing shoes that are too tight, too narrow and with pointed toes will exacerbate symptoms if bunions are present. Wearing high heels will also exacerbate existing bunions. Women are more prone to bunions than men.
SymptomsThe most common symptoms of foot bunions are toe Position, the toe points inwards towards the other toes in the foot into the hallux adbucto valgus position and may even cross over the next toe. Bony Lump, swelling on the outer side of the base of the toe which protrudes outwards. Redness, over the bony lump where it becomes inflamed. Hard Skin, over the bony lump known as a callus. Pain, it is often painful around the big toe, made worse by pressure on the toe and weight bearing activities. Change in Foot Shape, Your whole foot may gradually change shape for example getting wider. Stiffness, the big toe often becomes stiff and may develop arthritis. Foot bunions are more common with increasing age. They develop gradually overtime from repeated force through the big toe and left untreated, become more pronounced with worsening symptoms.

Diagnosis
Your family doctor or chiropodist /podiatrist can identify a bunion simply by examining your foot. During the exam, your big toe will be moved up and down to determine if your range of motion is limited. You will be examined for signs of redness or swelling and be questioned about your history of pain. A foot x-ray can show an abnormal angle between the big toe and the foot. In some cases, arthritis may also be seen. A X-ray of your foot may help identify the cause of the bunion and rate its severity.

Non Surgical Treatment
When the deformity is mild, treatment is usually not necessary. However, changing shoes to ones that have little or no heel, and are wider in the toe area (toe box) will be more comfortable and may help to prevent worsening of the bunion deformity. If the bunion starts to become painful, other measures may help. Bunions can cause pain in several different areas. The medial eminence may be painful, the entire first toe joint may hurt, or there may be pain underneath some or all of the forefoot (the ball of the foot). Pain over the medial eminence is the most common problem that affects bunion patients. A ?toe spacer? can be placed between the first and second toes and can provide some pain relief as it straightens out the bunion slightly. Pads placed over the medial eminence itself are hard to keep in place and rarely help to relieve pain. Pain underneath the first toe or lesser toes can be relieved by pads placed in the shoes in precise areas. The pads help to take pressure off the prominent areas on the bottom of the foot. Generalized measures to relieve bunion pain, such as physical therapy or foot stretching exercises, have not been shown to be helpful. Orthotics are often prescribed, but are also rarely helpful in relieving pain over the bunion, but may help with pain felt under the ball of the foot.
Bunion Pain

Surgical Treatment
There are dozens and dozens of types of surgery designed to address bunion deformities, and each have different indications. But in short, some procedures simply address an enlarged bump. Some simply address a crooked big toe. But in order to slow the return of the bunion deformity, most procedures aim to realign the big toe with the bone behind it, the "first metatarsal." This would also realign the joint surfaces between those two bones. But even if the surgery is designed to realign the big toe, there are still many choices to consider. Some procedures are meant for a short first metatarsal and others for a long first metatarsal. Some are best when the foot is very unstable, others are based on the severity of the arthritis present. In fact, there are many, many factors to consider when designing a procedure to address a particular patient's foot, to the extent that what's involved in a bunion surgery not only varies from patient to patient--the procedures often vary even from a patient's right foot to the left foot.
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