Robert J. Snyder, MD
Bunions are one of the most common foot problems and thousands of people seek treatment annually for this mostly inherited condition. Bunions occur when a person’s big toe is pushed towards the remaining toes, causing the joint of the big toe to swell and protrude outward at the base of the big toe, forming a bony knot. A bunion can also be caused due to a structural defect, or from other medical conditions such as rheumatoid arthritis or a foot related injury. They can be aggravated by wearing ill-fitting shoes. Bunions can also form on the joint of a person’s little toe. These are known as bunionettes and are smaller in size than bunions that form on the big toe. Women are more likely than men to develop bunions and bunionettes.
The symptoms of the onset of a bunion include a visible bulge or thickening of the skin at the base of the big toe joint, swelling, redness or soreness around the joint, pain, as well as a decrease in the ability to move the big toe. Besides causing pain and making it difficult to find foot wear that fits properly, bunions can also cause other complications such as bursitis, hammertoe, and metatarsalgia, each of which cause pain and inflammation of the affected toe or part of the foot. If a patient experiences any of these signs, an orthopedic specialist should be seen.
The physician will conduct a physical exam of the foot, looking for redness and swelling, and ask the patient to move his or her big toe up and down repeatedly. This will help determine the range of motion in the joint of the big toe. An X-ray of the toe may be required to determine the cause and severity of the bunion.
Once formed, bunions are permanent unless surgically corrected. There are nonsurgical treatments to help reduce the amount of pain experienced, as well as reducing the possibility of further joint damage. Such treatments include wearing shoes with large tow boxes, padded shoe inserts, and taping or splinting the toe into a normal position. Over-the-counter pain relievers, cortisone injections, as well as icing the bunion can reduce both pain and inflammation of the joint.
If pain caused by a bunion limits a person’s ability to complete daily activities, or cannot be relieved by any other treatment, a surgical procedure may be required. Surgical options include the removal of tissue from the swollen big toe joint, the removal of bone in order to straighten the big toe, the straightening out of the toe by realigning the bones in the affected foot, and the permanent fusion of the joint. Screws, pins, rods, wires and plates may be required to hold the bones in place if the foot is deformed. An artificial joint may be implanted. The surgery is usually performed on an outpatient basis.
Depending on the procedure, recovery from a bunion related surgery can take months or up to a year. You will be given a surgical boot or cast to wear for the first few weeks to provide support to your foot as it heals. You will probably have to use crutches until your physician allows you to walk on your foot. You will need to keep your foot dry and clean until your surgical sutures are removed, anywhere from 10-21 days.
Swelling and pain tend to be the biggest issue post-operatively and it is important to keep the foot elevated as much as possible. Ice helps to reduce the inflammation and swelling. Physical Therapy may be prescribed to help regain range of motion and strength. If used, external pins and wires will be removed when your physician feels that your foot has healed appropriately, as early as 3 weeks or as late as 6 weeks.
Return to work is allowed in a few weeks if the patient has a sedentary job and can elevate their foot for most of the day. Otherwise, they may have to wait weeks longer before returning to their normal activities and work.
Risks from surgery include infection, unresolved pain or additional pain, nerve damage, restricted movement of the big toe or foot, bunion recurrence or having a shortened big toe.
As most bunions are hereditary, there is not a lot one can do to prevent them. However, you can take steps to see that they are not worsened. A properly fitted shoe should not squeeze or push any part of the foot and should provide space between the end of the longest toe and the edge of shoe. Correctly fitting shoes can go a long way to decrease pain and improve function during daily activities and exercise.
Robert J. Snyder, MD