Bunions

A bunion is a bony bump, located at the base of the big toe joint. The big toe may turn toward the second toe, and the tissues surrounding the joint may become swollen and tender. Bunions are caused by faulty foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal range. In some cases joint damage caused by arthritis or an injury produces a bunion. Some people are born with an increased risk of developing a bunion. If you are at risk for developing a bunion, wearing high heeled or poorly fitted shoes makes the problem worse.

Types of Bunions

Positional Bunions

As new bone grows, the joint enlarges. This stretches the joints outer ligaments. Force created by the stretching pushes the big toe toward the smaller ones. Eventually inside tendons tighten, pulling the big toe farther out of alignment.

Structural Bunions

When the angle between the bones of the first and second toes is greater than normal, the big toe slants toward the smaller ones.

Risks of Bunions

A bunion can cause discomfort and pain and may make it difficult to walk. Shoes may rub on the bunion, causing pain, blisters, calluses, or sores. At the bunion location, a bacterial infection of the skin ( cellulitis) or bone infection may occur, especially if you have diabetes or peripheral arterial disease. If you have one of these conditions and sores develop, contact your doctor. In addition , bunions may be cosmetically unappealing and cause disfigurement of shoes.

Treatments

To determine the best treatment for your problem, your doctor may ask if and when your bunion causes pain and may perform an evaluation of your walking pattern, to see if your feet flatten as you walk. X-rays may be taken of your feet to show the position of the big toe joint. Non painful bunions may be treated by changes in shoe gear or custom made inserts or orthotics may be prescribed, to correct faulty foot mechanics. If the bunion is severe or painful, surgery may be recommended. Surgery may involve removal of excess bone and/or realignment of the big toe joint. Depending on the type of surgery performed, healing time may take a few weeks to several months. Bunion surgery can reduce pain associated with bunions and improve appearance of your feet. For best results, see your doctor as scheduled and follow all recovery instructions.

Types of Bunion Surgery

The general types of bunion surgery are:

Removal of part of the metatarsal head (the part of the foot that is bulging out). This procedure is called exostectomy or bunionectomy.

Realignment of the soft tissues ( ligaments) around the big toe joint.

Removal of a small wedge of bone from the foot ( metatarsal osteotomy) or from the toe ( phalangeal osteotomy).

Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe ( metatarsophalangeal joint). At the metatarsophalangeal joint, both the big toe and metatarsal bones are reshaped ( resection arthroplasty).

Fusion ( arthrodesis) of the big toe joint.

Fusion of the joint where the metatarsal bone joins the mid-foot ( Lapidus) procedure).

Implant insertion of all or part of an artificial joint.


What are the possible complications of Bunion Surgery?

Complications of surgery may include:

• Infection in the soft tissue or bone of the foot.
• Side effects from anesthetic medications.
• Recurrence of the bunion.
• Decreased sensation, numbness or tingling. Generally this is temporary.
• Pain and swelling, which may be temporary.
• Scarring
• Degenerative joint disease (arthritis) or avascular necrosis (disruption to the blood supply to the bone after surgery.
• Stiffness

Is bunion surgery effective?

In 80 percent of cases patients experience relief of pain and reduction of the bunion deformity. In 20 percent of cases, patients may experience recurrence of the problem.

Reasons To Have Foot Surgery

You have tried non surgical treatments, and they have not been effective.

You have severe pain or a deformed foot that interferes with daily activities.

Surgery may allow you to walk and wear properly fitted shoes more easily and comfortably.

For some bunions, surgery is effective in relieving pain and restoring the bone alignment.