bunions

Bunions are known in medical terms as Hallux Abducto Valgus, which in English is a crooked big toe joint with a bump on the side. This is actually a progressive misalignment of the big toe joint (the joint is dislocating) which starts with a slight leaning of the big toe toward the second and then gradually produces the characteristic bump and joint symptoms. In the late stages of progression, the big toe actually can overlap or underlap the second and cause reactive hammertoes (contracted) of the other toes. Even though they are extremely common, most people wait until they have significant symptoms and deformity before they seek medical attention. Often they have had pain in shoes and with activity for years when they finally come into the office. This is due to the misconception that they always require surgery for treatment. Don't wait until your bunions are painful! There are many treatment options that are not surgery, to help prevent the deformities from worsening. If you wait until it is painful, usually you have bone-on-bone, the joint is damaged, and it is too late to prevent surgery.

What causes bunions? No, it’s not always the shoes! (But, they don’t help). Bunions are caused by the faulty biomechanics of your foot structure that you inherited. Couple that with high heeled shoes or even just shoes that crowd your toes (Listen up guys who wear cowboy boots!) and you are prone to the formation of bunions.

What if my bunions are not painful? Can’t I just ignore them? NO!!! You want to have your feet fully evaluated and determine the extent of the deformities and what treatment options exist so you can make an informed decision on what treatment you want to choose for your bunions.

Symptoms of bunions are the prominent bump with redness from rubbing in shoes, grinding of the joint, pain, swelling, burning and occasionally even numbness.

Diagnosis of a bunion is done by x-ray findings coupled with physical exam. A bump is not necessarily always a bunion, so a complete podiatric exam including x-rays should be done to evaluate your condition. Many people actually have arthritis of the big toe joint or even just a cyst overlying the joint and think they have bunions. Sometimes gouty tophi are on the medial side of the foot, simulating a bunion deformity.

Treatment includes shoe gear modification, custom orthotics to control the abnormal biomechanics (prevent the arch from going down, therefore the orthotics take pressure off the great toe joint), padding, anti-inflammatories or MLS laser therapy to decrease inflammation, and at the later stages, surgery. We can help prevent the bunion from getting worse. It is imperative that you have the bunion evaluated early, before pain sets in. Once the bunion is painful, the joint is damaged. We want to prevent damage to the joint and keep you on your feet.

When is surgery needed for bunions? If you have pain every day, in every pair of shoes you own (including your athletic shoes), with custom orthotics, and you have treated your condition with conservative therapy without any relief, it’s time to discuss bunion surgery. There are many advances in bunion surgery and varied procedures depending on your foot type, the stage of your deformity, your activity level, your medical history, and your age. Make an appointment to discuss surgery with us if you have progressing symptoms.

The American College of Foot and Ankle Surgeons cites a study that showed 96% satisfaction after bunion surgery with a board-certified foot and ankle surgeon. Fear of surgery should not keep you out of the office because 80% of patients who come in asking for bunion surgery should leave with a conservative treatment plan. Call or contact us on the website for an appointment today to get your questions answers. Don’t live with the pain of bunions for one more day.

In our office, the doctor examines your foot, reviews x-rays with you, and discussed the conservative and surgical treatment options. Many times surgery can be avoided if you know what to do. We offer custom orthotics to help prevent worsening of the bunion.

Bunion Surgery

Bunions are progressive bone deformities of the foot that often cause recurring or chronic inflammation, irritation, and pain that require surgical correction. Surgical removal of a bunion is called abunionectomy. However, there are multiple types of bunionectomies, each designed to resolve different structural changes caused by the deformity.

Bunion surgeries fall into two major categories:

  • Head proceduresthat treat the big toe joint. In a head procedure bunionectomy, the bone is cut just behind the joint, moved into its proper position, and fixed in place with a screw or pin. Head procedures are often used for patients who cannot be immobilized for long periods of time.
  • Base proceduresconcentrate on the bone near or behind the big toe joint. Different types of base procedures are conducted depending on the nature of the deformity. These range from cutting a wedge out of the bone and splitting it so that it can be moved into its proper position; making a semi-circular cut and rotating the bone into its correct position; or fusing the joint. Ligaments inside and outside the toe may also be treated during a base procedure.

Our favorite bunion surgery is the Lapiplasty, which does correct the deformity completely and the bunion will not return!

 

There are three important factors that impact the success of bunion surgery:

  1. Choose a surgeon with extensive experience with bunionectomies. Because a deep understanding of the biomechanics of each patient's foot as well as the intricacies of each surgical option is needed, surgeons with more experience at doing bunionectomies are better able to help each patient achieve the best outcome.
  2. Be realistic in your expectation about what a bunionectomy can accomplish. No physician can guarantee that a bunion won't recur or that a patient will be absolutely pain free. Additionally, because of the complexity of the foot structures impacted by a bunion, patients may never be able to wear normal or slender shoes. Bunion surgery can reduce or eliminate the bone deformity, improve foot alignment and function, and prevent damage to other toes, but it does have its limitations. Be sure you understand all the possibilities before opting for this surgery.
  3. Bunion surgery is not a magic bullet. Surgery alone may not be all that is needed to achieve your best outcome. After surgery, many patients experience long healing and recovery times and often have to spend time in physical therapy. Additionally, you may need custom orthotics on an ongoing basis.

What To Expect

Most bunions surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.

Prior to the surgery, patients will need to make some preparatory arrangements. These include:

  • Seeing your Primary Care Physician (PCP) to make sure any other health conditions are stabilized prior to surgery and to document your complete medical history, which can then be given to our doctors.
  • Arranging your schedule to make sure you don't need to take any long trips for at least six weeks following the surgery.
  • Lining up another person to drive you home and stay with you for the first 24 hours after the surgery.
  • Stopping the use of any anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen, for seven days before the surgery.

The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.

Bunion surgery is usually performed under MAC anesthesia ("twilight"), administered by an anesthesiologist. You will not see or hear anything during the surgery. After the surgery, patients are often given a long-acting anesthetic and pain medication, which is why someone else must drive the patient home.

The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Some patients, particularly those having base procedures, may have to use crutches; others may be sent home wearing a surgical shoe. The foot will be covered in a dressing, which you will need to keep dry for up to two weeks or until the sutures are removed.

During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to the ankle to reduce swelling. Limited ambulation or walking is required over the first two weeks to promote healing. Most patients also are instructed on some basic exercises that need to be performed daily.

Sutures are generally removed about two weeks after the surgery in our office. Once the sutures are removed, you can bathe and shower normally, but will still need to wear a dressing over the wound to keep it clean and prevent infection.

By the sixth week after surgery, swelling generally subsides enough for the patient to begin wearing a wide athletic shoe. It is important to continue daily exercises. If recommended, physical therapy may be initiated at this time. Once the wound has completely closed, you can use lotions to soften the skin in the surgical area.

 

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