If you’ve never experienced a bunion, you might just think it is a part of aging, achy feet or an enlarged bone. However, they are a bit more complex. A bunion is a bone that has shifted out of position causing a deformity in the foot, not to mention a lot of pain and discomfort.
Bunions develop slowly as frequent pressure on the joint causes the big toe to lean inwards to the second toe and over time changing the structure of the bone resulting in a bump. The deformity will gradually continue to increase and may make wearing shoes or walking difficult due to pain.
Anyone can get a bunion, though they are more common in women as women are more likely to wear tight, narrow shoes that squeeze their toes together making them prone to developing bunions.
What is a bunion?
As mentioned above, a bunion is a result of shifting bones within the toe, the big toe to be exact. The big toe is made up of two joints and a bunion is formed as the bones within your toe move out of alignment with the joints causing inflammation at the joints. A bump forms on the joint of the base of your big toe as the bone moves out of place.
A bunion can greatly alter the appearance of the foot. In advanced cases, the big toe can angle itself under or over the second toe and possibly cause other toes to fall out of alignment as well.
Several factors may increase the chance of developing a bunion including:
- Improper footwear–in particular wearing shoes with narrow, tight, or pointed toe boxes that squeeze your toes into an unnatural position.
- Those who suffer from conditions such as arthritis or other inflammatory conditions may be more susceptible to bunions due to joint inflammation
- Family history can also be a factor if bunions run in your family.
A bump on the outside of your toe may not bother you too much, but other symptoms might! Some common symptoms associated with bunions are:
- Swelling, redness, and soreness around your big toe
- Corns and callus developing where toes rub together
- Stiffness and restricted movement of the joint
- Difficulty moving or pain during activities/applied pressure on the foot
In most cases, patients find relief without surgery, and though this will not remove the bunion, it can help keep it from worsening as well as reduce pain and inflammation.
Non-surgical treatment options
Some methods of non-surgical treatment your doctor may recommend:
- Changes in footwear– Sometimes discomfort and pain can be managed by switching to shoes that fit properly and do not compress the toes together.
- Padding– Moleskin patches and other protective bunion shield pads can help cushion the painful area of a bunion.
- Orthotics– Your podiatrist may also recommend orthotics, shoe inserts, splints, or other orthotic treatment to help manage the pain.
Your doctor may recommend surgery if you still experience pain or difficulty walking despite changes with non-surgical treatment after a long time.
Are you a good candidate for surgery?
Good candidates for bunionectomy, or bunion correction surgery, are those who:
- Experience significant amounts of pain that limit day-to-day activities such as walking and standing for long periods of time
- Have chronic inflammation and swelling that does not improve with medication or rest
- Have deformity caused by the bunion pulling the big toe towards the other toes with possible crossover
Before deciding the right treatment option for you, your doctor will perform a medical evaluation to identify if any interference will occur with your surgery. Other factors such as the severity of the bunion, age, medication, medical history, and activity level will be taken into account.
The goal of a bunionectomy is to realign the joint at the base of the big toe, correct deformity, and eliminate the patient’s pain. As bunions vary in nature, various surgical procedures can be performed to correct them. In most bunion surgeries bone cutting is necessary as is the use of metal pins, screws, and plates to hold the bones in the right position. Below is a list of other forms of treatment.
- Osteotomy– Small cuts along the bone are made to realign the joint. The bone is held in place with pins, screws, or even plants to make the bone straight and balanced.
- Arthrodesis– This is an option for those who have severe arthritis, a severe bunion, or have previously had unsuccessful bunion correction surgeries before. In this surgery, arthritic joint surfaces are removed and held into place with wires, screws, and plates as the bone heals.
- Exostectomy– An exostectomy does not realign the joint or correct the bunion. Instead, the doctor shaves down the bone to minimize the appearance of the bunion. It is often performed as part of a larger corrective surgery combined with osteotomy and other soft tissue procedures.
- Resection arthroplasty– This surgery removes the damaged portion of the joint, shortening the overall length of the toe bone. However, due to the smaller size of the toe, walking and other activities can become more difficult.
A bunionectomy realigns the bones, ligaments, tendons, and nerves of the patient to correct the problem, so it should not be taken lightly. Though the procedure may be done on the same day without a hospital stay, the road to recovery is long.
Some common risks associated with a bunionectomy include scars, incomplete correction, nerve damage, restricted movement at the joint, failure to relieve pain, the return of a bunion, development of arthritis, painful permanent hardware, and difficulty healing.
Recovering from a bunionectomy can take anywhere from 6 months to a year as bones, nerves, tendons, and ligaments will take time to fully heal. It is strongly recommended that patients avoid putting any weight on the foot. Following your doctor’s instructions on whether and when you can put weight on your foot or begin to use it is crucial. Putting weight on or disturbing the foot too early without proper support will cause the bones to shift and correction will be lost.
Assistive footgear such as crutches, walkers, boots and other protective footwear, as well as scooters are often needed throughout the recovery process to prevent injury and complications. Physical therapy will also be recommended for a successful recovery.
Be realistic with your expectations of bunion treatment and be transparent with your podiatrist so he or she can inform you of what to expect with your desired treatment. Even with surgery, you may not be able to continue to wear smaller shoes or narrow ones that you may have worn before. There is always a possibility that a bunion may return. For more information on bunions and treatment, contact Resnikoff Podiatry and Foot Surgery Centers, Adam F. Resnikoff, DPM today.