One of the more common conditions treated by podiatric surgeons is the painful bunion. Patients with this condition will usually complain of pain when wearing certain shoes, especially snug fitting dress shoes, or with physical activity, such as walking or running. Conservative treatment of bunions include shoe gear modification, padding and orthoses. When this fails to provide adequate relief, surgery is often recommended. There are multiple surgical procedures to correct bunions. No two patients and no two bunions are alike. The key to getting a good long term correction of bunion deformities is the selection of the most appropriate procedure for each individual patient. This requires a physical exam and evaluation of the bunion deformity, evaluation of the x-rays, evaluation of the patient’s medical history and work and social activities and an open discussion of the goals of the surgical procedure.
Our Certified Bunion Experts are here to help you
Do you often feel pain or soreness in your feet? Maybe Inflammation, redness, or numbness? Be aware; you can be experiencing Bunion formation in your toes.
Bunions can seriously limit your activities and lifestyle, but you can rest assured that Dr. Korfin and his staff will be able to fully understand your pain, as well as communicate your options for treatment and recovery.
The classic bunion, medically known as hallux abductovalgus or HAV deformity, is a bump on the side of the great toe joint. This bump represents an actual deviation of the 1st metatarsal and often an overgrowth of bone on the metatarsal head. In addition, there is also deviation of the great toe toward the second toe. In severe cases, the great toe can either lie above or below the second toe. Shoes are often blamed for creating these problems. This, however, is inaccurate. It has been noted that primitive tribes where going barefoot is the norm will also develop bunions. Bunions are a hereditary condition that develop from abnormal foot structure and mechanics which place an undue load on the 1st metatarsal. This leads to stretching of supporting soft tissue structures such as joint capsules and ligaments with the end result being gradual deviation of the 1st metatarsal. As the deformity increases, there is an abnormal pull of certain tendons, which leads to the drifting of the great toe toward the 2nd toe. At this stage, there is also adaptation of the joint itself that occurs.
Symptoms Related to Bunion Deformity
The most common symptoms associated with this condition are pain on the side of the foot. Shoes will typically aggravate bunions. Stiff leather shoes or shoes with a tapered toe box are the prime offenders. This is why bunion pain is very common in women whose shoes have a pointed toe box. The bunion site will often be slightly swollen and red from the constant rubbing and irritation of a shoe. Occasionally, corns can develop between the 1st and 2nd toe from the pressure the toes rubbing against each other. On rare occasions, the joint itself can be acutely inflamed from the development of a sac of fluid over the bunion called a bursa. This is designed to protect and cushion the bone. However, it can become acutely inflamed, a condition referred to as bursitis.
Treatment of Bunion Deformity
Early treatment of bunions is centered on providing symptomatic relief. Switching to a shoe with a rounder, deeper toe box and made of a softer more pliable leather will often provide some relief. The use of pads and cushions to reduce the pressure over the bone can also be helpful for mild bunion deformities. Functional foot orthotics, by controlling abnormal pronation, reduces the deforming forces leading to bunions in the first place. These may help reduce pain in mild bunion deformities and slow the progression of the deformity. When these conservative measures fail to provide adequate relief, surgical correction is indicated.
The choice of surgical procedures (bunionectomy) is based on a biomechanical and radiographic examination of the foot. Because there is actual bone displacement and joint adaptation, most successful bunionectomies require cutting and realigning the 1st metatarsal (an osteotomy) or possibly lapiplasty type of fusion at the first metatarsal cuneiform joint. Simply “shaving the bump” is often inadequate in providing long-term relief of symptoms and in some cases can actually cause the bunion to progress faster. The most common procedure performed for the correction of bunions is the 1st metatarsal neck osteotomy near the level of the joint. This refers to the anatomical site on the 1st metatarsal where the actual bone cut is made. Other procedures are performed in the shaft of the metatarsal bone and still other procedures are selected by the surgeon that are performed in the base of the metatarsal bone or at the first metatarsal cuneiform joint.
Glossary of Terms
- Bunion Bump on the side of the foot at the base of the great toe
- Bursitis An inflammation of a fluid sac often found overlying a bunion
- Fixation Act of holding bones together, commonly require external devices such as pins, screws or plates
- Hallux abductovalgus (HAV) Medical term describing the deviation of the great toe toward the 2nd toe; common component of bunions
- Metatarsal A long bone of the foot that forms the ball of the foot
- Orthoses Devices made from a mold of the foot used to control abnormal motion of the foot; may be prescribed to prevent progression of bunion deformity
- Osteotomy Surgical procedure that creates a cut in a bone to achieve realignment; a “surgical fracture”
- Pronation Motion of the foot which when excessive results in flattening of the arch; one possible cause of bunion formation
- Toe box Part of the shoe that covers the toes
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