Charles G.
Kissel, D.P.M.
Michael S. Schey, D.P.M.
Zeehan S. Husain, D.P.M.
Bunion Deformity
Bunion is a term used to describe a painful "bump" on the inside portion of the foot near the great toe. This deformity varies not only in size but also severity of symptoms. The symptoms do not always correlate to the size of the bunion and are often secondary to shoe irritation. Foot and ankle surgeons utilize the technical term; hallux abducto valgus to describe the deformity associated with a bunion. The prominence is not a growth of bone but rather a slow dislocation of the joint just behind the great toe. As the toe dislocates, the bony prominence increases in size and the great toe deviates toward the other toes.
As alluded to earlier, shoes do not cause bunions. Foot type is inherited and you may notice other people in your family that have similar deformities and/or symptoms. The type of foot that causes bunions tends to be a very mobile foot that may flatten out slightly when standing. In this type of foot, the joints loosen allowing bones to move into a different position. Controlling the flattening of the foot may help to prevent such deformities but will probably not improve a deformity that already exists. The symptoms caused by a bunion deformity are often related to inflammation caused by shoes or arthritic changes within the joint. Conservative treatments used for these conditions include oral anti-inflammatory medications, cortisone injections, padding and shoe modification. These methods of treatment are often helpful but usually temporary because they do not address the underlying deformity.
When conservative treatments have met with less than satisfactory results, the surgeon may recommend more definitive treatment in the form of surgery. One important issue to remember is that there are many different types of bunion deformities requiring different surgical approaches. Pre-operative assessment requires evaluation of weight-bearing x-rays of the foot. The surgeon will measure several angles, which are correlated to the physical examination, to determine where the deformity arises. The main goal of the surgical procedure is to realign the joint and straighten the great toe slightly. A mild to moderate bunion deformity may require a different surgical procedure than that for a severe bunion. The difference among the procedures lies within the post-operative course for the patient. A mild to moderate bunion will require a post-operative dressing for a few days and a post-operative shoe to be worn for 4-6 weeks while a severe bunion deformity may necessitate bone grafting and will require the patient to be non-weight-bearing in a cast for 4-6 weeks. Current procedures have improved drastically over the past ten years.
The surgery is performed in the hospital and is usually done on an out-patient basis. This means the patient goes to the hospital has the surgery and goes home the same day. The anesthesia consists of sedation with infiltration of local anesthesia in which you are taken to the operating room and the anesthesiologist gives you some medicine that puts you to sleep while we inject the local anesthesia into the portion of your foot that will be surgically corrected. The foot will be numb for several hours following the procedure and allows time for you to get home and elevate the extremity and apply ice. The post-operative dressing should be kept clean and dry until seen in the office approximately 3-5 days following the surgery. After the first post-operative visit, the surgeon may determine that no further dressings be applied and you may begin bathing as usual. The post-operative shoe must be worn at all times while bearing weight for approximately 4-6 weeks. If a casting is indicated, you will initially be placed in a compressive bandage and splint that will allow for swelling. At the first post-operative visit, a short-leg synthetic cast will be applied. As with any surgical procedure, there are no guarantees and complications do arise infrequently.
Choosing your foot & ankle surgeon is a very important part of reaching your desired outcome. Be sure your surgeon is competent in all aspects of foot and ankle surgery. They should be well versed in conservative and surgical treatment options for all foot and ankle problems. Your surgeon should have completed a surgical residency and also be Board certified or qualified by the American Board of Podiatric Surgery.
