See How a Bunion is Treated (Bunionectomy with Osteotomy)
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What is a Bunion?
A bunion is a bump at the base of the big toe on the medial (inside) side. Hallux valgus is another more descriptive term used for this condition. A bunion is usually a complex deformity of the big toe that involves separation of the metatarsals and angulation of the toe away from the midline of the body (toward the lesser toes). Bunions occur in all age groups, and are much more common in women. The cause of bunions is thought to be partially hereditary and partially influenced by footwear (such as women’s fashion shoes).
What are the Symptoms of Bunions?
Bunions usually do not cause pain unless pressure from shoe wear occurs, or pressure from the deformed toe is applied to the second toe. Most people with a bunion have no pain when barefoot; however, bunions may develop redness and swelling if inflamed. A callus can develop under the bunion or under the ball of the foot at the base of the second toe due to weight transfer.
Non-surgical Treatment
Wider and deeper toe-box shoes
Stretching of the shoe over the area of prominence (a shoe-repairman will usually perform this for a minimal fee)
Physical Therapy
Foot exercises and toe stretches for bunions can help keep the joint between your big toe and the rest of your foot mobile, maintaining flexibility and strengthening the muscles that control your big toe. Stretching the toes, flexing and contracting, resistance exercises, and walking on surfaces like sand can help improve strength and flexibility in the foot.
Over the counter medications: The pain and discomfort caused by bunions should be treated initially by medications such as Tylenol and anti-inflammatories (NSAIDS: non-steroidal anti-inflammatory drug), which include medications such as ibuprofen, naproxen, etc. You should consult your doctor in taking these for more than a few days.
Prescribed Products
Toe spacers, which can help in mild deformities
Nighttime bunion splints, which may help to prevent progression of deformity
Surgical Treatment
Surgical reconstruction if discomfort persists despite treatment attempts; many techniques exist for correction of bunions, and most produce good results; it is important that the surgeon understands the major elements of the deformity, as more severe deformities are usually treated differently than mild bunions.
An osteotomy involves cutting the joint to realign it. This may also be combined with repair of the tendons and ligaments that pull the joint incorrectly.
Recovery From Surgery
Studies have shown that less than 10% of patients who have bunion surgery experience complications.
You may be sent home in bandages or a walking cast to keep the toe in place following surgery. It is usually recommended to use crutches or a walker immediately following surgery for at least a few days. Gradual weight bearing can begin after that. Surgery is typically done one foot at a time if a bunion is present on both feet, to allow for mobility post-surgery.
Rest, ice, and elevation are generally recommended; you should follow your doctor’s advice regarding the length and frequency of routine.
Outcomes of Surgery
Most patients experience a significant improvement in the alignment of the big toe following surgery. If pain was present, it is usually resolved.
The main cause of bunions is ill-fitting footwear. Wearing shoes that are too tight can cause the bunion to reappear, even after surgery.
Prevention
- Wear shoes that are comfortable and that fit well – especially in the toe box area. There should be enough space that no pressure is applied to the bunion.
- Use a custom orthotic to avoid abnormal foot compensation and improve stability.
If left untreated, the bunion will continue to develop slowly. Uncomfortable footwear can accelerate and aggravate the bunion.
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